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

C. Simpson, Philip Christopher Hannaford, Lewis Duthie Ritchie, Aziz Sheikh, David Williams

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background

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.

Aim

To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care.

Design and setting

A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database.

Method

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.

Results

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).

Conclusion

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.
Original languageEnglish
Pages (from-to)443-451
Number of pages9
JournalThe British Journal of General Practice
Volume61
Issue number588
DOIs
Publication statusPublished - 2011

Fingerprint

Incentive Reimbursement
Contracts
Primary Health Care
Cross-Sectional Studies
Hypertension
Population
Blood Pressure
Confidence Intervals
Social Class
Medical Informatics
Quality of Health Care
Therapeutics
General Practice
Antihypertensive Agents
Chronic Disease
Databases

Keywords

  • disease management
  • epidemiology
  • hypertension
  • pay for performance
  • prescriptions
  • primary care

Cite this

@article{de32d45e6d7748a09e3c8f9d0539e228,
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",
abstract = "Background 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. Aim To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care. Design and setting A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database. Method 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. Results 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). Conclusion 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.",
keywords = "disease management, epidemiology , hypertension , pay for performance , prescriptions , primary care",
author = "C. Simpson and Hannaford, {Philip Christopher} and Ritchie, {Lewis Duthie} and Aziz Sheikh and David Williams",
year = "2011",
doi = "10.3399/bjgp11X583407",
language = "English",
volume = "61",
pages = "443--451",
journal = "The British Journal of General Practice",
issn = "0960-1643",
publisher = "Royal College of General Practitioners",
number = "588",

}

TY - JOUR

T1 - Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care

T2 - a 6-year population-based repeated cross-sectional study

AU - Simpson, C.

AU - Hannaford, Philip Christopher

AU - Ritchie, Lewis Duthie

AU - Sheikh, Aziz

AU - Williams, David

PY - 2011

Y1 - 2011

N2 - Background 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. Aim To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care. Design and setting A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database. Method 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. Results 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). Conclusion 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.

AB - Background 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. Aim To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care. Design and setting A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database. Method 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. Results 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). Conclusion 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.

KW - disease management

KW - epidemiology

KW - hypertension

KW - pay for performance

KW - prescriptions

KW - primary care

U2 - 10.3399/bjgp11X583407

DO - 10.3399/bjgp11X583407

M3 - Article

VL - 61

SP - 443

EP - 451

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

IS - 588

ER -