Skip to main content

Ethnic Differences in Diabetes Management in Patients With and Without Comorbid Medical Conditions

The Introduction of the Quality and Outcome Framework (QOF) in 2004 was a major change in how family practitioners are paid in the United Kingdom. The scheme rewards family practitioners for the achievement of predetermined targets. Diabetes is one of the most important components of QOF and accounts for approximately 15 percent of the QOF clinical domain points (650 points are available in the clinical domain out of he total 1,000 points). Currently half of the points available for diabetes care are directed towards the achievement of intermediate outcome targets such as the control of blood pressure, cholesterol and HbA1c.

Although financial incentives have gained momentum in recent years and are seen as a way to improve quality of care, many commentators raised their concerns regarding the potential negative consequences of using pay for performance to improve the quality of care, such as its impact on care delivered to patients from ethnic minority groups and how this may contribute to ethnic inequalities.

In a paper published recently in the journal Diabetes Care, Riyadh Alshamsan and colleagues examined ethnic disparities in diabetes management among patients with and without comorbid medical conditions after a period of sustained investment in quality improvement in the UK. They found that the presence of ≥2 cardiovascular comorbidities was associated with similar blood pressure control among white and South Asian patients when compared with whites without comorbidity but with worse blood pressure control among black patients. They concluded that despite major reforms to improve quality, disparities in blood pressure management have persisted in the UK, particularly among patients with cardiovascular comorbidities. Consequently, policy makers and clinicians should consider the potential impacts of quality initiatives on groups at high risk of clinical complications and adverse outcomes.

Comments

Popular posts from this blog

Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements …

Can GPs issue private prescriptions to NHS patients?

The NHS prescription charge in England is currently £8.40 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association's General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Fur…

What impact will Brexit have on the UK's life sciences sector?

On Thursday 3 November 2016, I spoke at a seminar at the Imperial College Business School on the topic of the impact of Brexit on the UK's life sciences sector (the NHS, universities, and pharmaceutical and biomedical companies). I emphasised the important role played in the life sciences sector by EU-trained professionals and the need to ensure that the UK continued to attract highly-qualified professionals to work, for example, in our National Health Service. I also discussed the need to increase spending on research and development to ensure that the UK remained a world leader in the biomedical industry. The other speakers at the seminar were Andrew Lansley (former Secretary of State for Health) and Richard Phillips (Director of Healthcare Policy at the Association of British Healthcare industries). The event was chaired by Andrew Brown. A copy of my talk can be viewed on Slideshare.