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years before being withdrawn (registration of fragility fracture and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