GP Incentives Don't Necessarily Spell Healthier Lifestyles Or Better Quality Of Life For Patients

Main Category: Primary Care / General Practice
Also Included In: Heart Disease
Article Date: 12 Aug 2008 - 0:00 PDT

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Incentivising primary care family doctors improves clinical care, but does not promote healthier lifestyles or improve patients' quality of life, when it comes to coronary heart disease, indicates research published ahead of print in Heart.

Research has shown that the better a country's primary care system is, the lower are its rates of premature death from various causes.

The current findings are based on 903 patients from 48 general practices. Sixteen of these were in Northern Ireland, which is part of the UK NHS, with a strong primary care infrastructure, including computerisation, disease records, and a reward scheme for GP performance.

The other 32 practices were in the Republic of Ireland, where the healthcare economy is mixed, with much less infrastructure and no performance related pay.

Analysis showed that blood pressure and cholesterol levels were better controlled among patients in the Northern Ireland practices. And more of these patients had had these levels checked in the previous year.

Similar proportions were prescribed medicines for secondary prevention for coronary heart disease, including statins and ACE inhibitors, although fewer patients in the Republic of Ireland practices had been prescribed beta blockers.

Republic of Ireland patients also made more outpatient visits, and had more hospital admissions than their Northern Ireland counterparts.

But patients in Northern Ireland ate a less healthy diet and took significantly less exercise than patients in the Republic, who scored higher on validated measures of physical and emotional wellbeing.

The authors point out that healthcare systems are complex, as are the results of strategies designed to improve health.

And they say that the evidence suggests that the quality of care was already improving in primary care before the new GP contract, with its inclusion of incentives, was introduced.

Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay for performance
Online First Heart 2008; doi 10.1136/hrt.2008.145912
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Heart

Heart (formerly British Heart Journal) is an international peer review journal that keeps cardiologists up to date with advances in the diagnosis and treatment of cardiovascular disease. Topics covered include coronary disease, electrophysiology, valve disease, imaging techniques, congenital heart disease (fetal, paediatric and adult), heart failure, surgery, and basic science. Each issue contains an extensive continuing professional education section (Education in Heart) and JournalScan highlighting important papers from outside the cardiology literature.

British Heart Journal