Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

Title: Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study
Authors: Saxena, S
Car, J
Eldred, D
Soljak, M
Majeed, A
Item Type: Journal Article
Abstract: BACKGROUND: Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP) Contract. METHODS: We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke) Quality and Outcomes Framework (QOF) indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. RESULTS: Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively). Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P < 0.0001) for referral for exercise testing and specialist assessment of patients with newly diagnosed angina. CONCLUSION: The volume-outcome relationship found in hospital settings is not seen between practices in the UK in management of cardiovascular disorders in primary care. Further work is warranted to explain apparently poorer quality achievement in some aspects of cardiovascular management relating to initial diagnosis and management among practices in deprived areas, smaller practices and those with a smaller caseload
Issue Date: 27-Jun-2007
URI: http://hdl.handle.net/10044/1/52793
DOI: http://www.biomedcentral.com/1472-6963/7/96
Start Page: 96
Volume: 7
Copyright Statement: © 2007 Saxena et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Department of Health
Department of Health
Funder's Grant Number: PDA/02/06/076
SDO/209/2007
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
HEALTH CARE SCIENCES & SERVICES
ACUTE MYOCARDIAL-INFARCTION
UNITED-KINGDOM
HEALTH-CARE
VOLUME
ASSOCIATION
HOSPITALS
PAY
Censuses
Coronary Disease
Cross-Sectional Studies
England
Family Practice
Humans
Hypertension
Outcome Assessment (Health Care)
Practice Patterns, Physicians'
Prevalence
Primary Health Care
Quality Indicators, Health Care
Referral and Consultation
Registries
Scotland
Socioeconomic Factors
Stroke
Ventricular Dysfunction, Left
Vulnerable Populations
Workload
Censuses Coronary Disease Cross-Sectional Studies economics England epidemiology Family Practice Humans Hypertension Outcome Assessment (Health Care) Physician's Practice Patterns Prevalence Primary Health Care Quality Indicators,Health Care Referral and Consultation Registries Scotland Socioeconomic Factors standards statistics & numerical data Stroke therapy utilization Ventricular Dysfunction,Left Vulnerable Populations Workload
1117 Public Health And Health Services
0807 Library And Information Studies
Health Policy & Services
Notes: DA - 20070716 BACKGROUND: Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP) Contract. METHODS: We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke) Quality and Outcomes Framework (QOF) indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. RESULTS: Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively). Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P < 0.0001) for referral for exercise testing and specialist assessment of patients with newly diagnosed angina. CONCLUSION: The volume-outcome relationship found in hospital settings is not seen between practices in the UK in management of cardiovascular disorders in primary care. Further work is warranted to explain apparently poorer quality achievement in some aspects of cardiovascular management relating to initial diagnosis and management among practices in deprived areas, smaller practices and those with a smaller caseload
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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