Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework

Strong, Mark; Maheswaran, Ravi; Radford, John

doi:10.1093/pubmed/fdi065

Cited by 42 publications

(33 citation statements)

References 8 publications

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“…[22][23][24][25] This is not to deny that deprived populations may face particular disadvantages in gaining access to high quality primary care. Several studies suggest that general practices located in areas of socioeconomic deprivation provide a lower quality of care as judged by QOF scores [26][27][28][29][30] (although it should be acknowledged that other studies find little evidence of socioeconomic inequality 31,32 ). There may also be plausible reasons why, relative to underlying morbidity, deprived groups need greater access to primary care.…”

Section: Original Papers Discussion Papermentioning

confidence: 99%

“…For example, there appears to be a greater readiness on the part of disadvantaged people to consult GPs, perhaps due to a lack of confidence in self-management. [31][32][33][34][35] This, together with higher levels of psychological distress would be expected to place higher demands on primary care practitioners working in deprived areas. 36,37 The point, then, is not to dismiss the legitimate healthcare needs that arise from deprivation but to recognise that evidence on inequalities in the provision of GPs is more complex and equivocal than implied by the Darzi interim report.…”

Section: Original Papers Discussion Papermentioning

confidence: 99%

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Deprivation, demography, and the distribution of general practice:

Asthana¹,

Gibson²

2008

Br J Gen Pract

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Section: Original Papers Discussion Papermentioning

confidence: 99%

Section: Original Papers Discussion Papermentioning

confidence: 99%

Deprivation, demography, and the distribution of general practice:

Asthana¹,

Gibson²

2008

Br J Gen Pract

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“…This information is then brought together into one overall IMD score, which was initially done in 2000. The indices are used widely to analyze patterns of socioeconomic deprivation and relationships with several health outcomes to identify areas that would benefit from special initiatives or programs of action for health and development (15)(16)(17)(18)(19)(20).…”

Section: Measures Of Sesmentioning

confidence: 99%

Socioeconomic Status and Chronic Kidney Disease at Presentation to a Renal Service in the United Kingdom

Bello

Peters

Rigby

et al. 2008

Clinical Journal of the American Society of Nephrology

109

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Background and objectives: Low socioeconomic status (SES) is associated with both development and progression of chronic kidney disease (CKD). The impact of SES on severity of CKD at presentation to a renal service is less well known. This study investigated the relationship between SES and severity of CKD in a retrospective, cross-sectional analysis involving 1657 patients at the Sheffield Kidney Institute (Sheffield, UK).Design, setting, participants, & measurements: SES was assigned to each patient according to electoral ward of residence by postcode and ranked according to the corresponding British Index of Multiple Deprivation score, which comprises five deprivation quintiles (Q1, least deprived; Q5, most deprived). National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of CKD was used for stratification and analysis. Binary logistic regression analysis was applied for the association of variables/risk factors with CKD (lower GFR) at presentation.Results: The age-adjusted prevalence of diagnosed CKD at presentation by area of residence, across the five deprivation quintiles, per million population was Q1 ‫؍‬ 1495, Q2 ‫؍‬ 3530, Q3 ‫؍‬ 3398, Q4 ‫؍‬ 3989, and Q5 ‫؍‬ 19,599. Logistic regression models showed that living in the lowest SES quintile area (Q5) as compared with the highest SES (Q1) was associated with a greater risk for presenting with a lower estimated GFR, after adjustment for sociodemographic, lifestyle, and clinical variables.Conclusions: Low SES is related to severity of CKD at presentation. Further studies are needed to examine this issue across the various SES categories in the United Kingdom.

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“…By using proxy measures, it is also likely that the role of ethnicity and social deprivation in determining health inequalities has been underestimated. 10 The study analysis was confined to mortality reduction. Arguably, the impact of primary care is likely to be greater in terms of improving quality-adjusted life years or reducing disability-adjusted life years, but this study, like others, found few data to conduct such an analysis.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The Public Health Impact score: a new measure of public health effectiveness for general practices in England

Ashworth¹,

Schofield²,

Doran³

et al. 2013

Br J Gen Pract

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BackgroundHealth policy in the UK is increasingly focused on the measurement of outcomes rather than structures and processes of health care. AimTo develop a measure of the effectiveness of primary care in terms of population health outcomes. Design and settingA cross-sectional study of general practices in England. MethodTwenty clinical quality of care indicators for which there was evidence of mortality reduction were identified from the national Quality and Outcomes Framework (QOF) payfor-performance scheme. The number of lives saved by 8136 English practices (97.97% of all practices) in 2009/2010 was estimated, based on their performance on these measures, and a public health impact measure, the PHI score, was constructed. Multilevel regression models were used to identify practice and population predictors of PHI scores. ResultsThe mean estimated PHI score was 258.9 (standard deviation [SD] = 73.3) lives saved per 100 000 registered patients, per annum. This represents 75.7% of the maximum potential PHI score of 340.9 (SD = 91.8). PHI and QOF scores were weakly correlated (Pearson r = 0.28). The most powerful predictors of PHI score were the prevalence of the relevant clinical conditions (β = 0.77) and the proportion of patients aged ≥65 years (β = 0.22). General practices that were less successful at achieving their maximum potential PHI score were those with a lower prevalence of relevant conditions (β = 0.29), larger list sizes (β = -0.16), greater area deprivation (β = -0.15), and a larger proportion of patients aged ≥65 years (β = -0.13). ConclusionThe PHI score is a potential alternative metric of practice performance, measuring the estimated mortality reduction in the registered population. Rewards under the QOF pay-forperformance scheme are not closely aligned to the public health impact of practices.

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Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework

Abstract: Practice-level CHD prevalence is associated with deprivation, but we found no evidence of socioeconomic inequality in CHD care. This finding is in contrast to that from previous studies and the widely reported inverse care law.

Cited by 42 publications

References 8 publications

Deprivation, demography, and the distribution of general practice:

Deprivation, demography, and the distribution of general practice:

Socioeconomic Status and Chronic Kidney Disease at Presentation to a Renal Service in the United Kingdom

The Public Health Impact score: a new measure of public health effectiveness for general practices in England

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