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.