Allergy and Respiratory Research Group, University of Edinburgh, Edinburgh, UK.
Br J Gen Pract. 2011 Jul;61(588):e443-51. doi: 10.3399/bjgp11X583407.
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.
2004 年引入按绩效付费合同后，通过针对高血压等慢性病患者提供高质量护理，全科医生的收入中能够与绩效挂钩的部分比例有所增加。
调查苏格兰初级保健中按绩效付费对高血压患者管理的影响。
苏格兰初级保健实践中基于人群的重复横断面研究（n=315），为初级保健临床信息学单位数据库提供资料。
提取了 2001 年至 2006 年期间年龄≥40 岁的 826973 例患者的数据集，包括年龄、性别、社会经济剥夺状况、高血压诊断、记录的血压测量值、目标血压水平的达标情况以及高血压相关处方的开具情况。
整个研究期间，高血压治疗（绝对差值[AD]9.2%；95%置信区间[CI]9.0 至 9.5）有所增加。血压测量（AD 46.8%；95%CI 46.5 至 47.1）和记录的高血压（AD 5.9%；95%CI 5.7 至 6.0）的大部分增加发生在 2004 年之前。整个研究期间血压控制均有所改善（绝对增加≤140/90mmHg；18.9%；95%CI 18.5 至 19.4）。2004 年后，最年长的女性以及社会经济地位最不利的男性和女性患者，与最年轻（<40 岁）和最富裕的患者相比，记录血压测量值的可能性较小（P<0.05）。未开处方的患者年龄较小，血压水平较高（P<0.001）。
一般实践为改善高血压诊断、监测和治疗所做的持续努力，可能会降低高血压患者未来的心血管事件和死亡率。然而，一旦诊断出患者年龄较大且社会经济地位较低，就需要对其进行随访，同时还需要对年龄较小、可能受益于早期干预的患者开具抗高血压治疗药物。
