Ethnic Disparities in Coronary Heart Disease Management and Pay for Performance in the UK

  • Christopher Millett
  • Jeremy Gray
  • Martin Wall
  • Azeem Majeed
Original Article

Abstract

Background

Few pay for performance schemes have been subject to rigorous evaluation, and their impact on disparities in chronic disease management is uncertain.

Objective

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.

Design

Comparison of two cross-sectional surveys using electronic general practice records.

Setting

Thirty-two family practices in south London, United Kingdom (UK).

Patients

Two thousand eight hundred and ninety-one individuals with coronary heart disease registered with participating practices in 2003 and 3,101 in 2005.

Measurements

Percentage achievement by ethnic group of quality indicators in the management of coronary heart disease

Results

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).

Conclusions

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 WORDS

pay for performance coronary heart disease primary care ethnicity 

Notes

Acknowledgments

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.

Contributors

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

None disclosed.

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Christopher Millett
    • 1
    • 2
  • Jeremy Gray
    • 2
  • Martin Wall
    • 3
  • Azeem Majeed
    • 1
  1. 1.Department of Primary Care & Social MedicineImperial College Faculty of MedicineLondonEngland
  2. 2.Wandsworth Primary Care Research CentreWandsworth PCTLondonEngland
  3. 3.Institute of Health & Human DevelopmentUniversity of East LondonLondonEngland

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