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Rheumatoid arthritis (RA) QOF tips

Dr Gavin Jamie offers advice on meeting targets in this QOF area, plus details of the indicators for 2013/14.

The domain is aimed at preventing further complications (Picture: SPL)
The domain is aimed at preventing further complications (Picture: SPL)

Tips for meeting targets in this domain

GP Dr Gavin Jamie writes:

Rheumatoid arthritis is a new domain for the QOF in 2013/14. Despite the name there is relatively little about joint pains in this area. The general thrust of the area is about the prevention of further complications. Details of all the indicators and achievement thresholds can be found in the table below.

The first indicator is for a register of patients with rheumatoid arthritis. Quite a few Read codes will count and, in general, any code that contains the words Rheumatoid Arthritis will put the patient on the register.

It is this register that will set the prevalence payment for the area and the practice will get one point for having any patients on the register.

There are five points for an annual review of the patients (the timescale for all of these indicators is 15 months in Wales, but 12 months in the other countries).

Much of the care of these patients, especially if they are taking immunosuppressant drugs, will be under the care of a specialist. The review is expected to concentrate on the current state of the disease and may require a further referral to secondary care.

The final two indicators are for risk calculations. Firstly the risk of cardiovascular disease should be calculated using a formula which takes into account the increased risk from rheumatoid arthritis. The only formula that currently qualifies is the QRisk formula available at www.qrisk.org or directly on many GP computer systems.

The second risk assessment is for osteoporotic fracture. There is no need for bone density measurement although this may be appropriate in patients who have been shown to be at high risk.

There are two formulae that can be use QFracture and FRAX. If it is not integrated into your practice system then FRAX is rather easier to use and can also use the result of bone density measurement to refine the result.

The cardiovascular risk assessment carries seven points and the fracture risk earns five.

Current indicators

Indicator

Points

Achievement thresholds (in all countries)

RA001: The contractor establishes and maintains a register of patients aged 16 or over with rheumatoid arthritis.

1

 

RA002: The percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face annual review in the preceding 12 months (15 months in Wales and N Ireland).

5

40-90%

RA003: The percentage of patients with rheumatoid arthritis aged 30 or over who have not attained the age of 85 who have had a cardiovascular risk assessment using a CVD risk assessment tool adjusted for RA in the preceding 12 months (15 months in Wales and N Ireland).

7

40-90%

RA004: The percentage of patients afed 50 or over who have not attained the age of 91 with rheumatoid arthritis who have had an assessment of fracture risk using a rish assessment adjusted tool for RA in the preceding 24 months (27 months in Wales and N Ireland).

5

40-90%

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