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Keywords:

  • deprivation;
  • diabetes mellitus;
  • financial incentives;
  • primary care;
  • quality of care

Abstract

Objective  To analyse achievement of metabolic targets by English general practices following the introduction of a new system of incentives.

Methods  Clinical data were abstracted from the records of 2099 patients at 26 general practices in South London. Cross-sectional data for 2005 were obtained for all general practices in England, including characteristics of registered populations, practice organizational characteristics and ‘Quality and Outcomes Framework’ (QOF) metabolic targets.

Results  Among 26 practices in South London, the median practice-specific proportion of patients achieving HbA1c ≤ 7.4% each year increased: 2000, 22%; 2001, 32%; 2002, 37%; 2003, 38% and in 2005 from QOF, 57%. In 8484 general practices in England in 2005, the median proportion of diabetic patients with HbA1c ≤ 7.4% was 59.0%; the highest and lowest centiles ranged from 27.7 to 89.8% among general practices, from 46.9 to 71.0% among 303 primary care trusts and from 49.9 to 67.1.% among 28 health authorities. Comparing the highest and lowest tertiles of deprivation, the per cent achieving HbA1c ≤ 7.4% was 2.96% (95% confidence interval 2.23–3.69%) lower in the most deprived areas. In areas with the highest proportion of ethnic minorities, the per cent achieving HbA1c ≤ 7.4% was 2.73% (1.85–3.61%) lower than where there were few ethnic minorities. Practices with the highest total QOF organization scores had more patients achieving the HbA1c target (difference 5.03%, 4.43–5.64%).

Conclusions  Intermediate outcomes are improving but deprived areas with less organized services achieve worse glycaemic control. Financial incentives may contribute to improved services and better clinical outcomes.