School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK.
BMC Health Serv Res. 2011 Nov 2;11:297. doi: 10.1186/1472-6963-11-297.
Hypertension is a common major risk factor for stroke and coronary heart disease. Little is known about how achievement of financially incentivised and non-incentivised indicators of quality of care varies with deprivation, or about the effect of financial incentives on health inequalities in hypertension. General practices in the UK have received financial incentives for high quality care since 2004. This study set out to assess the variations in achievement of incentivised and non-incentivised quality indicators for hypertension by patient area deprivation, before and after the introduction of financial incentives.
Achievement of 14 quality indicators for hypertension in 304 patient participants in 18 general practices in Norfolk, England was assessed one year before (2003) and one year after (2005) the introduction of financial incentives. Four indicators were incentivised and 10 were non-incentivised. Each participant's postcode was linked to an index of multiple deprivation score.
The range of achievement of incentivised quality indicators was 65-94% in the least deprived third of participants, and 77-94% in the most deprived third in 2003 and 2005 combined. For non-incentivised indicators, the range was 7-85% in the least deprived and 24-93% in the most deprived third.Achievement of incentivised quality indicators in 2003 and 2005 combined did not vary significantly by area deprivation. Achievement of three of 10 non-incentivised indicators was higher in participants from more deprived postcode areas: providing lifestyle advice (odds ratio 1.34, 95% confidence interval 1.00-1.79), assessment of peripheral vascular disease (1.54, 1.02-2.35) and electrocardiography (1.38, 1.04-1.82).
Participants from more deprived areas received at least the same, and sometimes better, quality of care than those from less deprived areas. Quality of care for hypertension in general practice may not follow the inequitable distribution seen with some other conditions.
高血压是中风和冠心病的常见主要危险因素。人们对经济激励和非激励的护理质量指标的实现情况随贫困程度的变化知之甚少，也不知道经济激励对高血压健康不平等的影响。自 2004 年以来，英国的全科医生因高质量的护理而获得经济奖励。本研究旨在评估在引入经济激励措施之前和之后，根据患者区域贫困程度，高血压激励和非激励质量指标的实现情况的变化。
在英格兰诺福克的 18 家全科医生中，对 304 名患者参与者的 14 项高血压质量指标进行了评估，一年前（2003 年）和一年后（2005 年）引入经济激励措施。其中有 4 个指标是激励性的，10 个是非激励性的。每个参与者的邮政编码与多因素剥夺评分指数相关联。
在最不贫困的三分之一参与者中，激励性质量指标的实现范围为 65-94%，而在最贫困的三分之一参与者中，2003 年和 2005 年的综合实现范围为 77-94%。对于非激励性指标，实现范围为最不贫困的 7-85%和最贫困的三分之一的 24-93%。2003 年和 2005 年综合的激励性质量指标的实现情况与区域贫困程度没有显著差异。在来自贫困程度较高的邮政编码区域的参与者中，有 10 个非激励性指标中的三个指标的实现情况更高：提供生活方式建议（优势比 1.34，95%置信区间 1.00-1.79）、评估外周血管疾病（1.54，1.02-2.35）和心电图（1.38，1.04-1.82）。
来自较贫困地区的参与者获得的护理质量至少与来自较富裕地区的参与者相同，有时甚至更好。全科医生治疗高血压的护理质量可能不会遵循与其他一些疾病相同的不公平分布。
