While the use of pay for performance as a quality improvement tool in health care is increasing, little is known about the impact of these programs on the quality of care delivered to patients with multiple conditions. Pay for performance schemes, such as the Quality and Outcomes Framework in the UK, could impact the quality of care delivered to patients with complex medical problems in several ways. A study published by myself and colleagues in the Journal of the Royal Society of Medicine suggested that introduction of pay-for-performance in primary care in the UK has not had a negative impact on the quality of care delivered to patients with multiple medical conditions. Rather, patients with co-morbid medical conditions seem to have benefited more than those without co-morbidity. This is reassuring given that previous studies have found that patients with multiple medical conditions are more likely to be excluded from performance reporting in pay for performance programs. Our findings provide no support for setting lower treatment targets for patients with multiple conditions within quality improvement programs and pay-for-performance schemes. This is important given that the longer-term benefits of good diabetes control are now firmly established and that associated health gain may be greatest in high-risk groups with existing co-morbid conditions such as coronary heart disease and hypertension.
Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have
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