Has pay for performance improved the management of diabetes in the United Kingdom?

SummaryObjective To determine whether ethnic group differences in glycated haemoglobin (HbA1c) changed over a 5-year period in people on medication for type 2 diabetes. Design Open cohort in 2004 -9.Setting Electronic records of 100 of the 101 general practices in two inner London boroughs.Participants People aged 35 to 74 years on medication for type 2 diabetes.Main outcome measures Mean HbA1c and proportion with HbA1c controlled to ≤7.5%.Results In this cohort of 24,111 people, 22% were White, 58% South Asian and 17% Black African/Caribbean. From 2004 to 2009 mean HbA1c improved from 8.2% to 7.8% for White, from 8.5% to 8.0% for Black African/Caribbean and from 8.5% to 8.0% for South Asian people. The proportion with HbA1c controlled to 7.5% or less, increased from 44% to 56% in White, 38% to 53% in Black African/ Caribbean and 34% to 48% in South Asian people. Ethnic group and social deprivation were independently associated with HbA1c. South Asian and Black African/Caribbean people were treated more intensively than White people.Conclusion HbA1c control improved for all ethnic groups between 2004-9. However, South Asian and Black African/Caribbean people had persistently worse control despite more intensive treatment and significantly more improvement than White people. Higher social deprivation was independently associated with worse control.

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“…Our findings support previous reports of social deprivation associated with poor HbA1c control. 14,24,25 …”

Section: Discussionmentioning

confidence: 99%

Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004–9

et al. 2012

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“…For example, women and ethnic minority groups are less likely to have targets for diabetes met compared with their counterparts. 51 The findings suggest that people with dementia are also disadvantaged.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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“…These programs aim at improving quality and promoting increased access to health services. The Portuguese experiences of 2008 [4][5][6][7][8] and British experience of 2004 and 2010 [9][10][11][12][13][14] have suggested positive conclusions and indicated some precautions in the application of this strategy, and improvement of the initial results of the contractualized goals was noted. These authors alert to the need to change the agreed indicators every two or three years, to avoid ethical biases with what is called "gaming", that is, the focus of the health teams in achieving contractualized goals and paying less attention to other non-contractual aspects.…”

Section: In Item (Iv)mentioning

confidence: 99%

Análise dos atributos dos cuidados primários em saúde utilizando os prontuários eletrônicos na cidade do Rio de Janeiro

Soranz

Pinto

Camacho

2017

Ciênc. saúde coletiva

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Has pay for performance improved the management of diabetes in the United Kingdom?

Cited by 31 publications

References 23 publications

Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004–9

Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004–9

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Análise dos atributos dos cuidados primários em saúde utilizando os prontuários eletrônicos na cidade do Rio de Janeiro

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