Chronic disease detection and access: does access improve detection, or does detection make access more difficult?

Abstract

BackgroundThe recorded detection of chronic disease by practices is generally lower than the prevalence predicted by population surveys. AimTo determine whether patient-reported access to general practice predicts the recorded detection rates of chronic diseases in that setting. Design and settingA cross-sectional study involving 146 general practices in Leicestershire and Rutland, England. MethodThe numbers of patients recorded as having chronic disease (coronary heart disease, chronic obstructive pulmonary disease, hypertension, diabetes) were obtained from Quality and Outcomes Framework (QOF) practice disease registers for [2008][2009]. Characteristics of practice populations (deprivation, age, sex, ethnicity, proportion reporting poor health, practice turnover, list size) and practice performance (achievement of QOF disease indicators, patient experience of being able to consult a doctor within 2 working days and book an appointment >2 days in advance) were included in regression models. ResultsPatient characteristics (deprivation, age, poor health) and practice characteristics (list size, turnover, QOF achievement) were associated with recorded detection of more than one of the chronic diseases. Practices in which patients were more likely to report being able to book appointments had reduced recording rates of chronic disease. Being able to consult a doctor within 2 days was not associated with levels of recorded chronic disease. ConclusionPractices with high levels of deprivation and older patients have increased rates of recorded chronic disease. As the number of patients recorded with chronic disease increased, the capacity of practices to meet patients' requests for appointments in advance declined. The capacity of some practices to detect and manage chronic disease may need improving.Keywords chronic disease; early diagnosis; health services accessibility; primary health care.

Impact of pay for performance on behavior of primary care physicians and patient outcomes

“…After the implementation of the P4P, results particularly on unfairness are reported in five studies about genders , nine about ages , two about patients’ socioeconomic status , six about ethnics , one about the duration of the illness , four about the severity or comobility of the disease , and five about the size of the practices . In contrast, positive results of solving the inequity problems, to some extent, were demonstrated in one research about genders of patients , three about ages of patients , six about patients’ socioeconomic status , two about ethnics , two about the duration of the illness , four about severity or comobility of diseases , and three about sizes of practices . Notably, results of no effect were illustrated in three studies on socioeconomic status , two on ethnics , one on severity or comobility of diseases , and one on practice size .…”

“…Thirteen focused on the preventive care , 10 of which reported the positive results in vaccine injection or screening of diseases such as cervical cancer screen. Twelve focused on the hypertension , 11 of which presented improvement on controlling the management of blood pressure. Fourteen related to coronary heart disease , and all got positive results.…”

“…Factors which influenced the equity of the health care included genders of patients or physicians , ages of patients and physicians , socioeconomic status of patients , ethnics of patients , comobility or severity , duration of the illness , and size of the practice . After the implementation of the P4P, results particularly on unfairness are reported in five studies about genders , nine about ages , two about patients’ socioeconomic status , six about ethnics , one about the duration of the illness , four about the severity or comobility of the disease , and five about the size of the practices . In contrast, positive results of solving the inequity problems, to some extent, were demonstrated in one research about genders of patients , three about ages of patients , six about patients’ socioeconomic status , two about ethnics , two about the duration of the illness , four about severity or comobility of diseases , and three about sizes of practices .…”

Disenrollment from general practitioners among chronic patients: a register-based longitudinal study of Norwegian claims data

“…Longer patient lists are also associated with better illness detection [15], which may suggest that practices detecting a higher number of chronic conditions have greater demand from patients due to their systematic chronic disease management [15–18]. …”

Are there enough GPs in England to detect hypertension and maintain access? A cross-sectional study

“…8 Moreover, as the numbers of patients recorded with hypertension increased, the ability of patients to get an appointment at their practice declined, indicating a relationship between levels of detected disease and the capacity of practices to meet demand for care, and suggesting that to improve hypertension detection, the capacity of practices to manage large numbers of patients with chronic conditions needs to be increased. 9 Two approaches may be used to increase capacity, the first being increased resourcing or supply of…”