QOF

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  • Exception Codes - go to this
  • Rationale for this indicator - go to this
  • Depression review codes (To be added not earlier than 10 days after and not later than 56 days after the date of diagnosis)

    9H91. Depression medication review
    9H92. Depression interim review

    Codes For Depression (Added between the preceeding 1st April and 31st March) Episode type must be 'First ever' or 'New Event' to count for this indicator. Applies to adults aged 18 years and over.

    E0013 Presenile dementia with depression
    E0021 Senile dementia with depression
    E112. Single major depressive episode
    E1120 Single major depressive episode, unspecified
      E1121 Single major depressive episode, mild
    E1122 Single major depressive episode, moderate
      E1123 Single major depressive episode, severe, without mention of psychosis
      E1124 Single major depressive episode, severe, with psychosis
    E1125 Single major depressive episode, in partial or unspecified remission
      E1126 Single major depressive episode, in full remission
    E112z Single major depressive episode NOS
    E113. Recurrent major depressive episode
    E1130 Recurrent major depressive episodes, unspecified
    E1131 Recurrent major depressive episodes, mild
    E1132 Recurrent major depressive episodes, moderate
    E1133 Recurrent major depressive episodes, severe, without mention of psychosis
    E1134 Recurrent major depressive episodes, severe, with psychosis
    E1135 Recurrent major depressive episodes, in partial or unspecified remission
    E1136 Recurrent major depressive episodes, in full remission
    E1137 Recurrent depression
    E113z Recurrent major depressive episode NOS
    E118. Seasonal affective disorder
    E11y2 Atypical depressive disorder
    E11z2 Masked depression
    E130. Reactive depressive psychosis
    E135. Agitated depression
    E2003 Anxiety with depression
    E291. Prolonged depressive reaction
    E2B.. Depressive disorder NEC
    E2B1. Chronic depression
    Eu204 [X]Post-schizophrenic depression
    Eu251 [X] Schizoaffective disorder, depressive type
     
    Eu32. [X]Depressive episode
    Eu320 [X]Mild depressive episode
    Eu321 [X]Moderate depressive episode
    Eu322 [X]Severe depressive episode without psychotic symptoms
    Eu323 [X]Severe depressive episode with psychotic symptomS
    Eu324 [X]Mild depression
    Eu325 [X]Major depression, mild (v16)
    Eu326 [X]Major depression, moderately severe (v16)
    Eu327 [X]Major depression, severe without psychotic symptoms (v16)
    Eu328 [X]Major depression, severe with psychotic symptoms (v16)

    Eu32y [X]Other depressive episodes
    Eu32z [X]Depressive episode, unspecified
    Eu33. [X]Recurrent depressive disorder
    Eu330 [X]Recurrent depressive disorder, current episode mild
    Eu331 [X]Recurrent depressive disorder, current episode moderate
    Eu332 [X]Recurrent depressive disorder, current episode severe without psychotic symptoms
    Eu333 [X]Recurrent depressive disorder, current episode severe with psychotic symptoms
    Eu334 [X]Recurrent depressive disorder, currently in remission
    Eu33y [X]Other recurrent depressive disorders
    Eu33z [X]Recurrent depressive disorder, unspecified
    Eu341 [X]Dysthymia
    Eu412. [X]Mixed anxiety and depressive disorder
     
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    Exceptions

    212S. Depression resolved (After date of diagnosis)
    9hC0. Excepted from depression quality indicators: Patient unsuitable (In Last 15 months)
    9hC1. Excepted from depression quality indicators: Informed dissent (In Last 15 months)

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    Depression 003.1 Rationale

    The NICE clinical guideline on depression in adults states that patients with mild depression or sub-threshold symptoms be reviewed and re-assessed after initial presentation, normally within two weeks.

    CG90 recommends that patients with mild or moderate depression who start antidepressants are reviewed after one week if they are considered to present an increased risk of suicide or after two weeks if they are not considered at increased risk of suicide.Patients are then re-assessed at regular intervals determined by their response to treatment and whether or not they are considered to be at an increased risk of suicide.

    This indicator promotes a single depression review between ten and 56 days inclusive after the date of diagnosis. For some patients this may not be their first review as they will have been reviewed initially within a week of the diagnosis. Unless a patientís symptoms have resolved, further reviews may be required.

    Practitioners are reminded of the importance of regular follow-up in this group of patients to monitor response to treatment, identify any adherence issues and provide on-going support. This review could address the following:

    Additionally, clinicians may wish to use formal assessment questionnaires such as PHQ9, HADS and BDI-II to monitor response to treatment.

    In most clinical circumstances, the review would be performed during a face-to-face consultation so that body language and non-verbal cues may be observed. However, there is some evidence that telephone review may be appropriate for patients starting antidepressants or for patients with mild depression who are not considered at increased risk of suicide and:

    Only face-to-face or telephone contact with a GP or nurse practitioner is acceptable to meet the requirements for this indicator.

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    Depression 003.2 Reporting and verification

    See indicator wording for requirement criteria.

    Those patients exception reported from DEP001 using a domain level exception code because the BPA and the diagnosis of depression were made by specialist mental health services will be exception reported from DEP002.

    Those patients whose ongoing case is being provided by specialist mental health services should be exception reported.

    It is recommended that where the diagnosis is made by specialist mental health services and the patient has been discharged for follow-up by the primary care team, the contractor should - find out the diagnosis date in order to record this and invite the patient for a review within the timeframe specified.

    Suspected depression seen in secondary care may not always be referred to specialist mental health services for further assessment and management. It may be in the form of a discharge letter from an acute medical or surgical ward, A&E or from an outpatient appointment. It may be reasonable in these circumstances for a contractor to contact the patient to ask them to attend for an assessment to assess if they have a clinical diagnosis of depression. In such cases, the BPA can be carried out at that time.

    The disease register for the depression indicators for the purpose of calculating the APDF is defined as all patients aged 18 or over, diagnosed on or after 1 April 2006, who have an unresolved record of depression in their patient record.

    Verification - NHS England may wish to ask contractors about the percentage of telephone reviews conducted and who they were delivered by.

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    Prepared By Jean Keenan