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Showing posts from December, 2011

Primary care organisation size and quality of commissioning

There is uncertainty about the best size for the primary care organisations responsible for commissioning health services in England. This includes the concern that small commissioning units are more exposed to financial risk, due to their smaller populations. Smaller commissioning units may also not have sufficient expertise or the required ‘market power’ to be able to negotiate effectively with health care providers to achieve good-value contracts. Alternatively, smaller organisations may have better local engagement and responsiveness for clinicians and patients.

In a study publishedin the British Journal of General Practice, Felix Greaves and colleagues from the Department of Primary Care & Public Health at Imperial College London investigated whether there is a relationship between the size of commissioning organisations and how well they perform on a range of performance measures. This included a comparison of primary care trust (PCT) size against 36 indicators of commissio…

Impact of Pay for Performance on Disparities in Stroke, Hypertension, and Coronary Heart Disease Management

The Quality and Outcomes Framework (QOF), a pay for performance programme, was introduced into United Kingdom (UK) primary care as part of a new General Practitioner (GP) contract in April 2004. Before the introduction of QOF, most British family doctors were earning a large proportion of their income from capitation payments. This system rewarded family doctors for having a large list of registered patients rather than for the quality of care that they provided.

There is limited definitive information about the impact of the QOF on level disparities in health care. In a study published in the journal PLoS One, John Lee and colleagues from Imperial College London investigated the following research questions: has QOF resulted in a step change in the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has QOF reduced disparities in the quality of care for these conditions between these ethnic groups? Did general practices with …

Does higher quality primary health care reduce stroke admissions?

Hospital admission rates for stroke are strongly associated with population factors. The supply and quality of primary care services may also affect admission rates, but there is little previous research on this association. In a paper published recently in the British Journal of General Practice, Michael Soljak and colleagues from the Department of Primary Care & Public Health at Imperial College London investigated whether the hospital admission rate for stroke is reduced by effective primary and secondary prevention in primary care.

This was a national cross-sectional study in an English population (52 763 586 patients registered with 7969 general practices in 152 primary care trusts). They found that mean annual stroke admission rates per 100 000 population varied from zero to 476.5 at practice level. In a practice-level multivariable Poisson regression, observed stroke prevalence, deprivation, and smoking prevalence were all risk factors for hospital admission. Protective he…

Smoking cessation activities: How effective are financial incentives for healthcare professionals?

Financial incentives are seen as one approach to encourage more systematic use of smoking cessation interventions by healthcare professionals. In a study published in the journal Tobacco Control, Dr Fiona Hamilton and colleagues from the Department of Primary Care & Public Health at Imperial College London carried out a systematic review to examine the evidence to support financial incentives for health professionals as a method for improving smoking cessation activities.They found 8 studies examined smoking cessation activities alone and 10 that studies that examined the UK's Quality and Outcomes Framework, which contains quality measures for chronic disease management including smoking recording and smoking cessation activities. Five non-Quality and Outcomes Framework studies examined the effects of financial incentives on individual doctors and three examined effects on groups of healthcare professionals based in clinics and general practices. Most studies showed improveme…