NIHR School for Primary Care Research,Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK.
Research Fellow in Health Economics,Centre for Health Economics,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK.
Br J Psychiatry. 2018 Oct;213(4):600-608. doi: 10.1192/bjp.2018.143. Epub 2018 Jul 30.
Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014.
Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables.
No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092).
Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
按绩效付费政策旨在通过激励改善医疗质量来改善人群健康。目的：评估在国家激励计划下，普通实践在严重精神疾病（SMI）和抑郁指标方面的表现与英格兰自杀风险之间的关系，时间范围为 2006-2014 年。
使用人口结构调整后的自杀人数作为因变量，对 32844 个小区域地理单位（较低的超级输出区域，LSOA）进行纵向空间分析。采用负二项式模型，在 LSOA 水平上调查空间估计记录的护理质量与自杀风险之间的关系。调整剥夺程度、社会碎片化、抑郁和 SMI 的流行率以及其他 2011 年人口普查变量后，计算发病率比（IRR）。
在实践所在地，实践在精神卫生指标上的表现与自杀发生率之间没有关联（IRR=1.000，95%CI 0.998-1.002）。IRR 表明，与地区层面的社会碎片化（1.030；95%CI 1.027-1.034）、剥夺（1.013，95%CI 1.012-1.014）和农村化（1.059，95%CI 1.027-1.092）相关的自杀风险升高。
初级保健在预防自杀方面发挥着重要作用，但我们没有观察到实践中报告的激励性心理健康活动更高的护理质量与当地人群更低的自杀率之间存在联系。有效的自杀预防可能需要更协调、多机构的方法。为全科医生提供更好的预防自杀培训也至关重要。这些发现适用于英国，但对其他考虑类似计划的国家也具有相关性。
无。
