Assessing the uptake of incentivised physical health checks for people with serious mental illness.

BACKGROUND:People with serious mental illness (SMI) are more likely to suffer from physical illnesses. The onset of many of these illnesses can be prevented if detected early. Physical health screening for people with SMI is incentivised in primary care in England through the Quality and Outcomes Framework (QOF). General Practitioners are paid to conduct annual physical health checks (PHCs) on their SMI patients, including checks on body mass index (BMI), cholesterol, and alcohol consumption. AIM:To assess the impact of removing and reintroducing QOF financial incentives on uptake of three PHCs (BMI, cholesterol, and alcohol consumption) for patients with SMI. DESIGN AND SETTING:Cohort study using UK primary care data from the Clinical Practice Research Datalink between April 2011 and March 2020. METHOD:We employed a difference-in-difference analysis to compare differences in the uptake before and after the intervention accounting for relevant observed and unobserved confounders. RESULTS:We found an immediate change in uptake after PHCs were removed from, and after they were added back to the QOF list. For BMI, cholesterol, and alcohol checks the overall impact of removal was a reduction in uptake of 14.3, 6.8, and 11.9 percentage points, respectively. The reintroduction of BMI screening in the QOF increased the uptake by 10.2 percentage points. CONCLUSION:Our analysis supports the hypothesis that QOF incentives lead to better uptake of PHCs.