Introduction of a new incentive and target‐based contract for family physicians in the UK: good for older patients with diabetes but less good for women?

McGovern, Matthew; Williams, David; Hannaford, Philip Christopher; Taylor, Michael W.; Lefevre, Karen Elaine; Boroujerdi, M; Simpson, Colin R

doi:10.1111/j.1464-5491.2008.02544.x

Cited by 34 publications

(40 citation statements)

References 12 publications

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“…An IMPACT modelling study to examine the relationship between socioeconomic status and the factors that explain the declining rates of CHD mortality in the UK between 2000 and 2007 found no evidence of inequity in the delivery of a wide range of interventions [13]. Our findings therefore broadly concur with those of these studies and a number of other individual-level studies [ 20–22] although they conflict with those of several ecological studies [ 14–18 ] and studies of UK populations during the 1990’s [47–49] that reported evidence of inequity in primary care elements of CHD healthcare.…”

Section: Discussionsupporting

confidence: 87%

“…A large individual-level UK study of secondary prevention of CHD found no evidence of inequity, and some findings suggested that more deprived groups were more likely to receive treatment [ 19 ]. UK-based individual-level studies of the management of diabetes found no evidence of inequity in the prescribing of antihypertensive medication and lipid-lowering therapy [ 20–22 ]. Other studies have reported clear evidence of inequity in the use of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the UK [ 23–29 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Equity in healthcare for coronary heart disease, Wales (UK) 2004–2010: A population-based electronic cohort study

et al. 2017

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BackgroundDespite substantial falls in coronary heart disease (CHD) mortality in the United Kingdom (UK), marked socioeconomic inequalities in CHD risk factors and CHD mortality persist. We investigated whether inequity in CHD healthcare in Wales (UK) could contribute to the observed social gradient in CHD mortality.Methods and findingsLinking data from primary and secondary care we constructed an electronic cohort of individuals (n = 1199342) with six year follow-up, 2004–2010. We identified indications for recommended CHD interventions, measured time to their delivery, and estimated risk of receiving the interventions for each of five ordered deprivation groups using a time-to-event approach with Cox regression frailty models. Interventions in primary and secondary prevention included risk-factor measurement, smoking management, statins and antihypertensive therapy, and in established CHD included medication and revascularization. For primary prevention, five of the 11 models favoured the more deprived and one favoured the less deprived. For medication in secondary prevention and established CHD, one of the 15 models favoured the more deprived and one the less deprived. In relation to revascularization, six of the 12 models favoured the less deprived and none favoured the more deprived–this evidence of inequity exemplified by a hazard ratio for revascularization in stable angina of 0.79 (95% confidence interval 0.68, 0.92). The main study limitation is the possibility of under-ascertainment or misclassification of clinical indications and treatment from variability in coding.ConclusionsPrimary care components of CHD healthcare were equitably delivered. Evidence of inequity was found for revascularization procedures, although this inequity is likely to have only a modest effect on social gradients in CHD mortality. Policymakers should focus on reducing inequalities in CHD risk factors, particularly smoking, as these, rather than inequity in healthcare, are likely to be key drivers of inequalities in CHD mortality.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Equity in healthcare for coronary heart disease, Wales (UK) 2004–2010: A population-based electronic cohort study

et al. 2017

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“…[18][19][20] It is also reassuring to note that the reported decrease in the rate of smoking (6%) was similar to that reported in the General Household Survey. 1 The mean rate of smoking in 2002 was also considerably lower than the mean rate of smoking reported in Europe (33%), 22 but more than found in a national survey in the US (21%; 2005).…”

Section: Comparison With Existing Literaturementioning

confidence: 51%

Trends in the epidemiology of smoking recorded in UK general practice

Simpson¹,

Hippisley‐Cox²,

Sheikh³

2010

Br J Gen Pract

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Smoking represents the most important cause of avoidable morbidity and mortality in the economically developed world. The UK has recently introduced a range of initiatives aiming to reduce smoking prevalence and smoking-related health inequalities. AimTo investigate the epidemiology of smoking in UK general practice. Design of studyCross-sectional study. SettingA total of 525 general practices contributing to the QRESEARCH database. MethodA dataset was extracted on 2.7 million patients around each financial year for the period 2001-2007, including, age, sex, deprivation, and smoking status. For patients newly recorded as smoking, data were extracted on receipt of smoking cessation advice and referral to stop-smoking services.

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“…In fact, throughout these studies a closing gap has been identified for performance differences. A small difference implicating less P4P achievement for female as compared to male patients was found[46,49,60,61]. One should take into account that no randomized intervention studies have reported equity of care results.…”

Section: Resultsmentioning

confidence: 99%

Systematic review: Effects, design choices, and context of pay-for-performance in health care

Herck

Smedt

Annemans

et al. 2010

BMC Health Serv Res

432

417

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BackgroundPay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices and contextual mediators on these effects. Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness.MethodsThe systematic review made use of electronic database searching, reference screening, forward citation tracking and expert consultation. The following databases were searched: Cochrane Library, EconLit, Embase, Medline, PsychINFO, and Web of Science. Studies that evaluate P4P effects in primary care or acute hospital care medicine were included. Papers concerning other target groups or settings, having no empirical evaluation design or not complying with the P4P definition were excluded. According to study design nine validated quality appraisal tools and reporting statements were applied. Data were extracted and summarized into evidence tables independently by two reviewers.ResultsOne hundred twenty-eight evaluation studies provide a large body of evidence -to be interpreted with caution- concerning the effects of P4P on clinical effectiveness and equity of care. However, less evidence on the impact on coordination, continuity, patient-centeredness and cost-effectiveness was found. P4P effects can be judged to be encouraging or disappointing, depending on the primary mission of the P4P program: supporting minimal quality standards and/or boosting quality improvement. Moreover, the effects of P4P interventions varied according to design choices and characteristics of the context in which it was introduced.Future P4P programs should (1) select and define P4P targets on the basis of baseline room for improvement, (2) make use of process and (intermediary) outcome indicators as target measures, (3) involve stakeholders and communicate information about the programs thoroughly and directly, (4) implement a uniform P4P design across payers, (5) focus on both quality improvement and achievement, and (6) distribute incentives to the individual and/or team level.ConclusionsP4P programs result in the full spectrum of possible effects for specific targets, from absent or negligible to strongly beneficial. Based on the evidence the review has provided further indications on how effect findings are likely to relate to P4P design choices and context. The provided best practice hypotheses should be tested in future research.

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Introduction of a new incentive and target‐based contract for family physicians in the UK: good for older patients with diabetes but less good for women?

Cited by 34 publications

References 12 publications

Equity in healthcare for coronary heart disease, Wales (UK) 2004–2010: A population-based electronic cohort study

Equity in healthcare for coronary heart disease, Wales (UK) 2004–2010: A population-based electronic cohort study

Trends in the epidemiology of smoking recorded in UK general practice

Systematic review: Effects, design choices, and context of pay-for-performance in health care

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