GP incentives to design hypertension and atrial fibrillation local quality-improvement schemes: a controlled before–after study in UK primary care

Abstract

BackgroundFinancial incentives in the UK such as the Quality and Outcomes Framework (QOF) reward GP surgeries for achievement of nationally defined targets. These have shown mixed results, with weak evidence for some measures, but also possible unintended negative effects.AimTo look at the effects of a local intervention for atrial fibrillation (AF) and hypertension, with surgeries rewarded financially for work, including appointing designated practice leads, attendance at peer review workshops, and producing their own protocols.Design and settingA controlled before–after study comparing surgery performance measures in UK primary care.MethodThis study used published QOF data to analyse changes from baseline in mean scores per surgery relating to AF and hypertension prevalence and management at T1 (12 months) and T2 (24 months) for the intervention group, which consisted of all 58 surgeries in East Lancashire Clinical Commissioning Group (CCG), compared to the control group, which consisted of all other surgeries in north-west England.ResultsThere was a small acceleration between T0 (baseline) and T2 in recorded prevalence of hypertension in the intervention group compared to the controls, difference 0.29% (95% confidence interval [CI] = 0.05 to 0.53), P = 0.017, but AF prevalence did not increase more in the intervention group. Improvement in quality of management of AF was significantly better in the intervention group, difference 3.24% (95% CI = 1.37 to 5.12), P = 0.001.ConclusionThis intervention improved diagnosis rates of hypertension but not AF, though it did improve quality of AF management. It indicates that funded time to develop quality-improvement measures targeted at a local population and involving peer support can engage staff and have the potential to improve quality.

Angiotensin‐converting enzyme inhibitors and risk of age‐related macular degeneration in individuals with hypertension

“…Due to the comprehensive availability of data on diagnoses (coded using the Read code classification system), prescriptions (coded according to the British National Formulary), laboratory test results, referrals and patient demographics, the database is suitable for performing high‐quality real world evidence studies. The Quality and Outcomes Framework 32 is a payment incentive scheme that rewards general practices for achieving set targets on maintaining records and appropriate management of patients with specific chronic illnesses, including hypertension; this leads to a high level of data quality for these conditions.…”

Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care

“…In the UK, clinicians are recommended to assess patients’ pulse rhythm as part of National Health Service (NHS) health checks,19 driven by an explicit aim of NHS programmes and policy to increase identification and diagnosis of previously undetected AF 20 21. NHS England has distributed digital ECG devices to increase AF detection,22 and some clinical commissioning groups have encouraged opportunistic AF case-finding in primary care 23 24…”