2023-09-28 14:46:10 +00:00
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abstract: 'Background: Socioeconomic deprivation is associated with inequalities in
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health care and outcomes. Despite concerns that the Quality and Outcomes
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Framework pay-for-performance scheme in the UK would exacerbate
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inequalities in primary care delivery, gaps closed over time. Local
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schemes were promoted as a means of improving clinical engagement by
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addressing local health priorities. We evaluated equity in achievement
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of target indicators and practice income for one local scheme.
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Methods: We undertook a longitudinal survey over four years of routinely
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recorded clinical data for all 83 primary care practices. Sixteen
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indicators were developed that covered five local clinical and public
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health priorities: weight management; alcohol consumption; learning
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disabilities; osteoporosis; and chlamydia screening. Clinical indicators
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were logit transformed from a percentage achievement scale and modelled
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allowing for clustering of repeated measures within practices. This
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enabled our study of target achievements over time with respect to
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deprivation. Practice income was also explored.
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Results: Higher practice deprivation was associated with poorer
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performance for five indicators: alcohol use registration (OR 0.97; 95
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\% confidence interval 0.96,0.99); recorded chlamydia test result (OR
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0.97; 0.94,0.99); osteoporosis registration (OR 0.98; 0.97,0.99);
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registration of repeat prednisolone prescription (OR 0.98; 0.96,0.99);
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and prednisolone registration with record of dual energy X-ray
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absorptiometry (DEXA) scan/referral (OR 0.92; 0.86,0.97); practices in
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deprived areas performed better for one indicator (registration of
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osteoporotic fragility fracture (OR 1.26; 1.04,1.51). The
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deprivation-achievement gap widened for one indicator (registered
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females aged 65-74 with a fracture referred for a DEXA scan; OR 0.97;
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0.95,0.99). Two other indicators indicated a similar trend over two
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years before being withdrawn (registration of fragility fracture and
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over-75 s with a fragility fracture assessed and treated for
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osteoporosis risk). For one indicator the deprivation-achievement gap
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reduced over time (repeat prednisolone prescription (OR 1.01;
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1.01,1.01). Larger practices and those serving more affluent areas
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earned more income per patient than smaller practices and those serving
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more deprived areas (t = -3.99; p = 0.0001).
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Conclusions: Any gaps in achievement between practices were modest but
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mostly sustained or widened over the duration of the scheme. Given that
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financial rewards may not reflect the amount of work undertaken by
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practices serving more deprived patients, future pay-for-performance
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schemes also need to address fairness of rewards in relation to
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workload.'
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affiliation: 'Hackett, JEC (Corresponding Author), Univ Leeds, Leeds Inst Hlth Sci,
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Charles Thackrah Bldg,101 Clarendon Rd, Leeds, W Yorkshire, England.
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Glidewell, Liz; West, Robert; Hackett, Julia E. C.; Foy, Robbie, Univ Leeds, Leeds
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Inst Hlth Sci, Leeds, W Yorkshire, England.
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Carder, Paul, Yorkshire \& Humber Commissioning Support Unit, Bradford, W Yorkshire,
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England.
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Doran, Tim, Univ York, Dept Hlth Sci, York YO10 5DD, N Yorkshire, England.'
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article-number: '61'
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author: Glidewell, Liz and West, Robert and Hackett, Julia E. C. and Carder, Paul
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and Doran, Tim and Foy, Robbie
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author-email: j.e.hackett@leeds.ac.uk
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author_list:
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- family: Glidewell
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given: Liz
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- family: West
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given: Robert
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- family: Hackett
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given: Julia E. C.
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- family: Carder
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given: Paul
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- family: Doran
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given: Tim
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- family: Foy
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given: Robbie
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da: '2023-09-28'
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doi: 10.1186/s12875-015-0279-9
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eissn: 1471-2296
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files: []
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journal: BMC FAMILY PRACTICE
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keywords: Primary health care; Social deprivation; Pay-for-performance
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keywords-plus: 'GENERAL-PRACTICE; OUTCOMES FRAMEWORK; QUALITY; PERFORMANCE; PAY; UK;
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INDICATORS; IMPACT'
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language: English
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month: MAY 14
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number-of-cited-references: '31'
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orcid-numbers: 'Glidewell, Liz/0000-0003-2519-2654
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Glidewell, Liz/0000-0003-2519-2654
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Foy, Robbie/0000-0003-0605-7713
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carder, paul/0000-0002-7940-6016'
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papis_id: 774ff2e0c72b936f0c70b9eb700f99fc
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ref: Glidewell2015doeslocal
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researcherid-numbers: 'Glidewell, Liz/N-8832-2019
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Glidewell, Liz/G-7338-2011
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'
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times-cited: '5'
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title: Does a local financial incentive scheme reduce inequalities in the delivery
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of clinical care in a socially deprived community? A longitudinal data analysis
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000354834500002
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usage-count-last-180-days: '0'
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usage-count-since-2013: '10'
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volume: '16'
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web-of-science-categories: Primary Health Care; Medicine, General \& Internal
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year: '2015'
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