Background The introduction of pay-for-performance (in 2004) has increased the proportion of income general practitioners are able to earn from targeted quality care to patients with chronic diseases such as hypertension. We wished to investigate the impact of pay-for-performance on the management of patients with hypertension in Scottish primary care.
Method A population-based repeated cross-sectional study using data from 826 973 patients registered with 315 Scottish primary care practices. Information was extracted on age, sex, socioeconomic deprivation, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels and provision of hypertension-related prescribing for each year for the period 2001–2006.
Results Increasing treatment for hypertension (Absolute Difference (AD): 9.2%; 95% CI 9.0 to 9.5) was found. The majority of increases in blood pressure measurement (AD: 46.8%; 95% CI 46.5 to 47.1) and recorded hypertension (AD: 5.9%; 95% CI 5.7 to 6.0) occurred prior to 2004. Blood pressure control increased throughout the study period (absolute increase ≤140/90 mm Hg: 18.9%; 95% CI 18.5 to 19.4). After 2004, the oldest female and most socioeconomically deprived male and female patients became less likely than their youngest (<40 years) and most affluent counterparts to have a blood pressure measurement recorded (p<0.05). Patients not prescribed therapy were younger and had higher blood pressure levels (p<0.001)
Conclusions It is likely that the continued efforts of general practice to improve hypertension diagnosis, monitoring and treatment will reduce future cardiovascular events and deaths in this population. However, there is a need to follow-up older and more socio-economically deprived patients once they are diagnosed and prescribe anti-hypertensive therapy to younger patients who are likely to benefit from early intervention.
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