Skip to main content

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 different baseline performance respond differently to this programme?

The findings of this study suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period.

The authors concluded that the QOF should set more challenging but achievable targets for general practitioners. Specific targets aimed at reducing ethnic disparities in health care may also be needed.

Figure: Trends in mean total cholesterol in patients with CHD and stroke.

Comments

Post a Comment

Popular posts from this blog

Protecting Against the "Quad-demic": Influenza, Covid-19, Norovirus and RSV

As the NHS braces for a challenging winter season, it is grappling with a "quad-demic" of health emergencies caused by influenza, Covid-19, norovirus, and respiratory syncytial virus (RSV). This confluence of viral threats poses a significant risk to public health in the UK as well as putting strain on healthcare resources, emphasising the importance of preventive measures to safeguard public health. Public health measures such a vaccination and good personal hygiene are pivotal in reducing the impact of these illnesses, particularly for vulnerable groups. The Four Viruses: What Are They? Influenza: A highly contagious respiratory infection that causes significant illness each winter. It can lead to severe complications, particularly in the elderly, young children, pregnant women, and those with chronic health conditions. Covid-19: Though its most acute phase has passed, Covid-19 remains a concern, especially as new variants of SA...
Post a Comment
Read more

MPH Student Presentations on the NHS Care.Data Programme

As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments: Arguments fo...
6 comments
Read more

How can we work successfully across the health and care system to make a success of Pharmacy First?

Pharmacies in England to begin treating patients for seven common conditions. How can we work successfully across the health and care system to make a success of Pharmacy First? 1. The Pharmacy First scheme aims to provide convenient access to healthcare through community pharmacies. Patients with minor ailments or common conditions can seek advice and treatment directly from their local pharmacy instead of visiting a general practice, urgent care centre or emergency department. The conditions covered by the scheme may vary depending on local funding arrangements and participation of pharmacies.  2, A potential problem with Pharmacy First is pharmacists misdiagnosing a patient's condition. It may also lead to delays in patients seeing doctors when medical assessment is needed. To mitigate these risks, appropriate safeguards and referral pathways should be established, ensuring timely medical assessment when necessary. The scheme will also increase the workload of pharmacies, thereb...
Post a Comment
Read more