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38 We found a high level of exception reporting for MH9.
A study on outcomes in CVD found no significant association between sex, age, deprivation and the level of exception reporting [ 38].
Level of exception reporting was monitored for each individual practice and if it would be unusually high or low the data would need to be verified.
Although strict criteria for exception reporting have been defined and practices can expect close scrutiny if their exception reporting level appears high [ 27], we found wide variation in levels of exception reporting but our final regression model was only modestly influenced by the level of exception reporting.
Second, we stratified practices into tercile groups by their level of exception reporting and interacted the respective achievement rate with the population exception rate: 3 This sensitivity analysis was restricted to indicators MH6 and MH9 as there was insufficient variation in exception rates for the bipolar indicators to classify them into terciles.
It is not possible to identify an appropriate level of exception reporting, but some people with SMI may be harder to reach due to the nature of their mental health problems; thus, practices may face difficulties in establishing and maintaining contact, and some degree of exception reporting is, therefore, expected.
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There has been concern that high levels of exception reporting in practices serving deprived populations may be disguising unmet need.
Practices with lower levels of exception reporting tended to have larger proportions of elderly patients (p < 0.01) and patients without any formal educational qualifications (p < 0.05).
These studies have used publicly available national datasets such as QMAS to identify the characteristics of practices with high levels of exception reporting [ 2, 6- 8].
The mean exception reporting rate for the selected indicators was 9.0% (SD 5.2); higher levels of exception reporting were associated with higher QOF scores (Spearman's rho = 0.13; P < 0.001).
All demographic characteristics such as age, marital status, level of education, with exception of distance to the nearest health facility had no statistically significant association with satisfaction at both univariate and multivariate analysis.
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