Linnane Sarah, Mullarkey Sarah, Kyne Eoin, Healy Maeve, Fallon John, Sharma Santosh, Hannigan Ailish, O'Regan Andrew, O'Connor Ray
Irish College of General Practitioners Mid-West GP Training Scheme, School of Medicine Building, University of Limerick, Plassey, Limerick V94T9PX, Ireland.
School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Plassey, Limerick V94T9PX, Ireland.
Fam Pract. 2025 Apr 12;42(3). doi: 10.1093/fampra/cmaf025.
In Ireland, a mixed public-private system exists, whereby some patients receive state-funded general practice (GP) care under the General Medical Services (GMS), while private patients (PPs) pay fees. In 2020, the chronic disease management programme was introduced at the practice level to enhance the management of eight conditions. This pay for performance (P4P) programme incentivises GPs to review GMS patients regularly using a structured protocol. It is hypothesized that ineligible PPs receiving 'routine care', receive a poorer standard of care.
To investigate the effect of P4P on the standard of care between PPs and GMS patients.
Retrospective cross-sectional study involving 11 GP practices in the Midwest of Ireland. Clinical parameters recorded for the previous 12 months on 25 GMS patients and 25 PPs, matched by age group, sex, and one clinical condition, were collected from each practice. Parameters included vaccination status, and recording of: blood pressure, smoking status, renal function, glycosylated haemoglobin, and lipids.
Data from 550 patients showed that GMS patients were more likely than PPs to have received/been offered vaccinations (influenza (66% vs 26%), COVID-19 (69% vs 23%), pneumococcal (59% vs 15%)). GMS patients were more likely than PPs to have other parameters measured: blood pressure (92% vs 54%); smoking status (84% vs 24%); renal function (90% vs 59%); glycated haemoglobin (87% vs 56%); lipids (89% vs 57%) (P < .001 for all parameters).
Significant disparities exist in the management of chronic disease in Ireland between GMS patients and PPs. Limiting P4P programmes to GMS patients promotes inequality.
在爱尔兰，存在一种公私混合的医疗体系，一些患者在一般医疗服务（GMS）下接受国家资助的全科医疗服务，而私人患者（PPs）则需支付费用。2020年，在实践层面引入了慢性病管理计划，以加强对八种疾病的管理。这个按绩效付费（P4P）计划激励全科医生使用结构化协议定期对GMS患者进行评估。据推测，接受“常规护理”的不合格私人患者获得的护理标准较低。
研究按绩效付费对私人患者和GMS患者护理标准的影响。
对爱尔兰中西部11家全科医生诊所进行回顾性横断面研究。从每家诊所收集前12个月记录的25名GMS患者和25名私人患者的临床参数，这些患者按年龄组、性别和一种临床疾病进行匹配。参数包括疫苗接种状况，以及血压、吸烟状况、肾功能、糖化血红蛋白和血脂的记录。
550名患者的数据显示，GMS患者比私人患者更有可能接受/被提供疫苗接种（流感疫苗（66%对26%）、新冠疫苗（69%对23%）、肺炎球菌疫苗（59%对15%））。GMS患者比私人患者更有可能进行其他参数的测量：血压（92%对54%）；吸烟状况（84%对24%）；肾功能（90%对59%）；糖化血红蛋白（87%对56%）；血脂（89%对57%）（所有参数P < 0.001）。
爱尔兰GMS患者和私人患者在慢性病管理方面存在显著差异。将按绩效付费计划仅限于GMS患者会加剧不平等。
