Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study
The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension. To investigate the impact of pay for performance on the management of patients with hypertensio...
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| Veröffentlicht in: | British journal of general practice 2011-07, Vol.61 (588), p.e443-e451 |
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| creator | Simpson, Colin R Hannaford, Philip C Ritchie, Lewis D Sheikh, Aziz Williams, David |
| description | The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension.
To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care.
A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database.
A dataset was extracted on 826 973 patients aged ≥40 years including, age, sex, socioeconomic deprivation status, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels, and provision of hypertension-related prescribing for each year from 2001 until 2006.
Increasing treatment for hypertension (absolute difference [AD] 9.2%; 95% confidence interval [CI] = 9.0 to 9.5) occurred throughout the study period. The majority of increases found in blood pressure measurement (AD 46.8%; 95% CI = 46.5 to 47.1) and recorded hypertension (AD 5.9%; 95% CI = 5.7 to 6.0) occurred prior to 2004. Blood pressure control increased throughout the study period (absolute increase ≤140/90 mmHg; 18.9%; 95% CI = 18.5 to 19.4). After 2004, the oldest female, as well as the male and female patients with the greatest socioeconomic deprivation status, became less likely than their youngest ( |
| doi_str_mv | 10.3399/bjgp11X583407 |
| format | Article |
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To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care.
A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database.
A dataset was extracted on 826 973 patients aged ≥40 years including, age, sex, socioeconomic deprivation status, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels, and provision of hypertension-related prescribing for each year from 2001 until 2006.
Increasing treatment for hypertension (absolute difference [AD] 9.2%; 95% confidence interval [CI] = 9.0 to 9.5) occurred throughout the study period. The majority of increases found in blood pressure measurement (AD 46.8%; 95% CI = 46.5 to 47.1) and recorded hypertension (AD 5.9%; 95% CI = 5.7 to 6.0) occurred prior to 2004. Blood pressure control increased throughout the study period (absolute increase ≤140/90 mmHg; 18.9%; 95% CI = 18.5 to 19.4). After 2004, the oldest female, as well as the male and female patients with the greatest socioeconomic deprivation status, became less likely than their youngest (<40 years) and most affluent counterparts to have a blood pressure measurement recorded (P<0.05). Patients not prescribed therapy were younger and had higher blood pressure levels (P<0.001).
It is likely that the continued efforts of general practice to improve hypertension diagnosis, monitoring, and treatment will reduce future cardiovascular events and mortality in those with hypertension. However, there is a need to follow up patients who are older and more socioeconomically deprived once they are diagnosed, as well as prescribing antihypertensive therapy to younger patients, who are likely to benefit from early intervention.</description><identifier>ISSN: 0960-1643</identifier><identifier>EISSN: 1478-5242</identifier><identifier>DOI: 10.3399/bjgp11X583407</identifier><identifier>PMID: 21722469</identifier><language>eng</language><publisher>England: Royal College of General Practitioners</publisher><subject>Adult ; Age Distribution ; Aged ; Antihypertensive Agents - economics ; Antihypertensive Agents - therapeutic use ; Blood Pressure - drug effects ; Cross-Sectional Studies ; Family Practice - economics ; Family Practice - standards ; Female ; Humans ; Hypertension - drug therapy ; Hypertension - physiopathology ; Male ; Middle Aged ; Quality of Health Care ; Reimbursement, Incentive - economics ; Scotland ; Sex Distribution ; Socioeconomic Factors</subject><ispartof>British journal of general practice, 2011-07, Vol.61 (588), p.e443-e451</ispartof><rights>British Journal of General Practice, January 2011 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c316t-5adb3db0f0624980c310f2ea2868f99d12ddff82aa7bdd1964a9e98a2db5e3083</citedby><cites>FETCH-LOGICAL-c316t-5adb3db0f0624980c310f2ea2868f99d12ddff82aa7bdd1964a9e98a2db5e3083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123508/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123508/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21722469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Simpson, Colin R</creatorcontrib><creatorcontrib>Hannaford, Philip C</creatorcontrib><creatorcontrib>Ritchie, Lewis D</creatorcontrib><creatorcontrib>Sheikh, Aziz</creatorcontrib><creatorcontrib>Williams, David</creatorcontrib><title>Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study</title><title>British journal of general practice</title><addtitle>Br J Gen Pract</addtitle><description>The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension.
To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care.
A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database.
A dataset was extracted on 826 973 patients aged ≥40 years including, age, sex, socioeconomic deprivation status, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels, and provision of hypertension-related prescribing for each year from 2001 until 2006.
Increasing treatment for hypertension (absolute difference [AD] 9.2%; 95% confidence interval [CI] = 9.0 to 9.5) occurred throughout the study period. The majority of increases found in blood pressure measurement (AD 46.8%; 95% CI = 46.5 to 47.1) and recorded hypertension (AD 5.9%; 95% CI = 5.7 to 6.0) occurred prior to 2004. Blood pressure control increased throughout the study period (absolute increase ≤140/90 mmHg; 18.9%; 95% CI = 18.5 to 19.4). After 2004, the oldest female, as well as the male and female patients with the greatest socioeconomic deprivation status, became less likely than their youngest (<40 years) and most affluent counterparts to have a blood pressure measurement recorded (P<0.05). Patients not prescribed therapy were younger and had higher blood pressure levels (P<0.001).
It is likely that the continued efforts of general practice to improve hypertension diagnosis, monitoring, and treatment will reduce future cardiovascular events and mortality in those with hypertension. However, there is a need to follow up patients who are older and more socioeconomically deprived once they are diagnosed, as well as prescribing antihypertensive therapy to younger patients, who are likely to benefit from early intervention.</description><subject>Adult</subject><subject>Age Distribution</subject><subject>Aged</subject><subject>Antihypertensive Agents - economics</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Blood Pressure - drug effects</subject><subject>Cross-Sectional Studies</subject><subject>Family Practice - economics</subject><subject>Family Practice - standards</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Quality of Health Care</subject><subject>Reimbursement, Incentive - economics</subject><subject>Scotland</subject><subject>Sex Distribution</subject><subject>Socioeconomic Factors</subject><issn>0960-1643</issn><issn>1478-5242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1v1DAQhi0EokvhyBX5xsngj8SxOSChio9KlTgAEjdrYk92UyVxsB2k_Bt-KtntUtHTjGaeee1XLyEvBX-jlLVv29v9LMTP2qiKN4_ITlSNYbWs5GOy41ZzJnSlLsiznG85l1IL_pRcSNFIWWm7I3-uxxl8obGj5YB0hpV1MbEZ01ZGmDxSH6eSjgxM4QRtY9jjiNPp7LBucMEp93Gi_US_-VhKnw90Tv0IaaUeEr6jQDVbERKd47wMUDaatZAx0IQzQtkan2LOLKM_LmGguSxhfU6edDBkfHGul-THp4_fr76wm6-fr68-3DCvhC6shtCq0PKOa1lZw7cp7ySCNNp01gYhQ-g6IwGaNgRhdQUWrQEZ2hoVN-qSvL_TnZd2xODxaHpwZxMuQu8ebqb-4Pbxt1NCqvok8PoskOKvBXNxY589DgNMGJfsTFMZ22hTbyS7I0-GE3b3rwjujqG6B6Fu_Kv_v3ZP_0tR_QW-JaOD</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>Simpson, Colin R</creator><creator>Hannaford, Philip C</creator><creator>Ritchie, Lewis D</creator><creator>Sheikh, Aziz</creator><creator>Williams, David</creator><general>Royal College of General Practitioners</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110701</creationdate><title>Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study</title><author>Simpson, Colin R ; Hannaford, Philip C ; Ritchie, Lewis D ; Sheikh, Aziz ; Williams, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c316t-5adb3db0f0624980c310f2ea2868f99d12ddff82aa7bdd1964a9e98a2db5e3083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Age Distribution</topic><topic>Aged</topic><topic>Antihypertensive Agents - economics</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Blood Pressure - drug effects</topic><topic>Cross-Sectional Studies</topic><topic>Family Practice - economics</topic><topic>Family Practice - standards</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Quality of Health Care</topic><topic>Reimbursement, Incentive - economics</topic><topic>Scotland</topic><topic>Sex Distribution</topic><topic>Socioeconomic Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Simpson, Colin R</creatorcontrib><creatorcontrib>Hannaford, Philip C</creatorcontrib><creatorcontrib>Ritchie, Lewis D</creatorcontrib><creatorcontrib>Sheikh, Aziz</creatorcontrib><creatorcontrib>Williams, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of general practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Simpson, Colin R</au><au>Hannaford, Philip C</au><au>Ritchie, Lewis D</au><au>Sheikh, Aziz</au><au>Williams, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study</atitle><jtitle>British journal of general practice</jtitle><addtitle>Br J Gen Pract</addtitle><date>2011-07-01</date><risdate>2011</risdate><volume>61</volume><issue>588</issue><spage>e443</spage><epage>e451</epage><pages>e443-e451</pages><issn>0960-1643</issn><eissn>1478-5242</eissn><abstract>The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension.
To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care.
A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database.
A dataset was extracted on 826 973 patients aged ≥40 years including, age, sex, socioeconomic deprivation status, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels, and provision of hypertension-related prescribing for each year from 2001 until 2006.
Increasing treatment for hypertension (absolute difference [AD] 9.2%; 95% confidence interval [CI] = 9.0 to 9.5) occurred throughout the study period. The majority of increases found in blood pressure measurement (AD 46.8%; 95% CI = 46.5 to 47.1) and recorded hypertension (AD 5.9%; 95% CI = 5.7 to 6.0) occurred prior to 2004. Blood pressure control increased throughout the study period (absolute increase ≤140/90 mmHg; 18.9%; 95% CI = 18.5 to 19.4). After 2004, the oldest female, as well as the male and female patients with the greatest socioeconomic deprivation status, became less likely than their youngest (<40 years) and most affluent counterparts to have a blood pressure measurement recorded (P<0.05). Patients not prescribed therapy were younger and had higher blood pressure levels (P<0.001).
It is likely that the continued efforts of general practice to improve hypertension diagnosis, monitoring, and treatment will reduce future cardiovascular events and mortality in those with hypertension. However, there is a need to follow up patients who are older and more socioeconomically deprived once they are diagnosed, as well as prescribing antihypertensive therapy to younger patients, who are likely to benefit from early intervention.</abstract><cop>England</cop><pub>Royal College of General Practitioners</pub><pmid>21722469</pmid><doi>10.3399/bjgp11X583407</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult Age Distribution Aged Antihypertensive Agents - economics Antihypertensive Agents - therapeutic use Blood Pressure - drug effects Cross-Sectional Studies Family Practice - economics Family Practice - standards Female Humans Hypertension - drug therapy Hypertension - physiopathology Male Middle Aged Quality of Health Care Reimbursement, Incentive - economics Scotland Sex Distribution Socioeconomic Factors |
| title | Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study |
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