Does general practice reduce health inequalities? Analysis of quality and outcomes framework data
Does general practice reduce health inequalities? Analysis of quality and outcomes framework data
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DOI：
10.1093/eurpub/ckq177
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发表时间：
2012-02-01
影响因子：
4.4
通讯作者：
Gilmour, Stuart
中科院分区：
文献类型：
--
作者：
Dixon, Anna;Khachatryan, Artak;Gilmour, Stuart
背景：政府制定了一系列目标，旨在到 2010 年减少英格兰的健康不平等。初级保健在减少健康不平等方面发挥着重要作用。该研究的目的是评估一般做法对减少地区健康不平等的影响。方法：使用 2004/05 和 2005/06 质量和结果框架 (QOF) 的数据、PCT 的实践特征和 Spearhead 状态，分析 Spearhead 和非 Spearhead 初级保健信托 (PCT) 实践中临床指标成就的差异。该研究使用了英格兰 8339 项初级保健实践的数据。计算了 26 项临床指标子集的未加权平均报告成绩。该研究分析了这两年中先锋地位和剥夺程度的成就差异以及年份之间的变化。还对先锋地位、收入剥夺、报告成就和其他因素之间的关系进行了多元回归分析。结果：这两年，先锋 PCT 的实践表现均低于非先锋 PCT 的实践，但显示出更大的改进。在最贫困的实践中，先锋和非先锋 PCT 之间的 QOF 成就没有差异。上一年的成就是最有力的业绩预测指标。结论：先锋和非先锋 PCT 实践之间绩效的缩小可能间接有助于减少基于地区的健康不平等，但差异很小。先锋 PCT 和非先锋 PCT 中最贫困实践之间缺乏差异，这表明解决不平等问题的基于地区的举措尚未对贫困实践产生明显影响。未观察到的因素可以解释大部分成就差异。
Background: The government set a series of targets to reduce health inequalities in England by 2010. Primary care has an important role in reducing health inequalities. The aim of the study was to assess the impact of general practice on reducing area-based health inequalities. Methods: Analysis of differences in achievement on clinical indicators between practices in Spearhead and non-Spearhead Primary Care Trusts (PCTs) using data from the Quality and Outcomes Framework (QOF) for 2004/05 and 2005/06, practice characteristics and Spearhead status of PCTs. The study used data on 8339 primary care practices in England. Unweighted mean reported achievement on subset of 26 clinical indicators was calculated. The study analysed differences in achievement by Spearhead status and deprivation in both years and the change between years. Multiple regression analysis of relationship between Spearhead status, income deprivation, reported achievement and other factors also were carried out. Results: Practices in Spearhead PCTs performed worse than practices in non-Spearhead PCTs in both years but showed greater improvement. Among the most deprived practices, there were no differences in QOF achievement between Spearhead and non-Spearhead PCTs. Previous year's achievement was the strongest predictor of performance. Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement.