Background: A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay for performance seen in any health care system. The contract provides an important opportunity to address inequalities in chronic disease management. This thesis examines the impact of this pay for performance incentive on inequalities in the management of diabetes between ethnic groups. Methods: (1) Population based longitudinal survey using electronic general practice records carried out in Wandsworth, south London before and after the introduction of pay for performance (2) Secondary analysis of data from the Health Survey for England (1998-2004). Results: The proportion of patients achieving treatment targets for diabetes increased significantly after the implementation of pay for performance. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean group, which had significantly lower improvement in HbA1c and blood pressure control relative to the white British group. Variations in prescribing and achievement of treatment targets between ethnic groups evident in 2003 were not attenuated in 2005. Processes of care for diabetes were generally equitable before the introduction of pay for performance. Conclusions: Pay for performance has not addressed inequalities in the management of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued inequalities in morbidity and mortality from the major complications of diabetes.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:497930 |
| Date | January 2008 |
| Creators | Millett, Christopher Joseph |
| Publisher | Imperial College London |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/10044/1/8892 |
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