Ethnic Disparities in Coronary Heart Disease Management and Pay for Performance in the UK
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Few pay for performance schemes have been subject to rigorous evaluation, and their impact on disparities in chronic disease management is uncertain.
To examine disparities in coronary heart disease management and intermediate clinical outcomes within a multiethnic population before and after the introduction of a major pay for performance initiative in April 2004.
Comparison of two cross-sectional surveys using electronic general practice records.
Thirty-two family practices in south London, United Kingdom (UK).
Two thousand eight hundred and ninety-one individuals with coronary heart disease registered with participating practices in 2003 and 3,101 in 2005.
Percentage achievement by ethnic group of quality indicators in the management of coronary heart disease
The proportion of patients reaching national treatment targets increased significantly for blood pressure (51.2% to 58.9%) and total cholesterol (65.7% to 73.8%) after the implementation of a major pay for performance initiative in April 2004. Improvements in blood pressure control were greater in the black group compared to whites, with disparities evident at baseline being attenuated (black 54.8% vs. white 58.3% reaching target in 2005). Lower recording of blood pressure in the south Asian group evident in 2003 was attenuated in 2005. Statin prescribing remained significantly lower (p < 0.001) in the black group compared with the south Asian and white groups after the implementation of pay for performance (black 74.8%, south Asian 83.8%, white 80.2% in 2005).
The introduction of pay for performance incentives in UK primary care has been associated with better and more equitable management of coronary heart disease across ethnic groups.
KEY WORDSpay for performance coronary heart disease primary care ethnicity
We wish to thank practices who participated in the study. Christopher Millett is supported by a grant from the National Institute for Health Research Service Delivery and Organisation Programme. The Wandsworth Primary Care Research Centre has received funding from the Department of Health and also received support from the Medical Research Council through the VOTES (Virtual Organisation of Trials and Epidemiological Studies) project. The Department of Primary Care & Social Medicine at Imperial College is grateful for support from the National Institute for Health Research Biomedical Research Centre Scheme and the National Institutes of Health Collaboration for Leadership in Applied Health Research and Care program.
JG, CM and AM conceived the study. MW performed the statistical analyses. All authors contributed to the data interpretation. CM wrote the first draft of the manuscript and all authors contributed to the revision and approved the final version. CM is the guarantor for the study.
Conflict of Interest
- 4.Department of Health. (June 2004) NHS Improvement plan: Putting people at the heart of public services. London. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084476 Accessed 01 October 2008.
- 5.British Medical Association (June 2005) Improving health - general practice. Available at: http://www.bma.org.uk/ap.nsf/content/ManifestoGPs. Accessed 01 October 2008
- 8.Peterson L, Woodard L, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006;145:265–72.Google Scholar
- 9.Health and Social Care Information Centre. National quality and outcomes framework statistics for England 2004/05. Statistical Bulletin , 23. 2005. Available at: http://www.ic.nhs.uk Accessed 01 October 2008
- 12.Forouhi N, Sattar N, Tillin T, McKeigue P, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. 2006;49(11):2580–8. Nov.PubMedCrossRefGoogle Scholar
- 19.British Medical Association. General medical services contract. Available at: http://www.bma.org.uk/ap.nsf/Content/Hubthenewgmscontract Accessed 01 October 2008
- 21.UK 2001 Census Available at: http://www.ons.gov.uk/census/index.html Accessed 01 October 2008
- 22.Department of Communities and Local Government. Index of Multiple Deprivation 2004. Available at: http://www.communities.gov.uk/archived/general-content/communities/indicesofdeprivation/216309/ Accessed 01 October 2008
- 24.Gill P, Quirke T, Mant J, Allan T. The use of lipid-lowering drugs across ethnic groups in the secondary prevention of ischaemic heart disease: analysis of cross-sectional surveys in England. BJGP. 2004;54:442–3.Google Scholar
- 32.Nazroo J. The health of Britain’s ethnic minorities. London: Policy Studies Institute; 1997.Google Scholar
- 37.Hippisley-Cox J, Pringle M, Cater R, Coupland C, Meal A. Coronary heart disease prevention and age inequalities: the first year of the National Service Framework for CHD. BJGP. 2005;55:369–75.Google Scholar
- 38.Department of Health. Tackling health inequalities. A programme for action. London: Department of Health; 2003 Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008268 Accessed 01 October 2008.Google Scholar