Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework.
BACKGROUND
The provision of coronary heart disease (CHD) health care has been shown to be inequitous, with those most in need having the least access to high-quality care. The new UK general practitioner (GP) Quality and Outcomes Framework (QOF) contract offers substantial financial rewards to general practices that combine maximal CHD case finding with high-quality CHD care.


OBJECTIVE
To examine whether GP practice-level CHD prevalence and the measures of quality of care derived from the new QOF data are associated with area-level socioeconomic deprivation.


METHODS
An ecological study of 38 GP practices contracting with Rotherham Primary Care Trust, United Kingdom, was carried out. We calculated Spearman rank correlation coefficients for practice-level age-sex-standardized QOF CHD prevalence against area deprivation score and for 11 QOF CHD indicator achievements against area deprivation score.


RESULTS
Practice-level CHD prevalence showed a positive correlation with deprivation (r=0.64, p<0.001), as did one of the 11 quality-of-care indicators (recording of smoking status, r=0.34, p=0.04). The remaining 10 quality-of-care indicators showed no significant correlation with deprivation.


CONCLUSIONS
Practice-level CHD prevalence is associated with deprivation, but we found no evidence of socioeconomic inequality in CHD care. This finding is in contrast to that from previous studies and the widely reported inverse care law.
Strong
Mark
M
Rotherham Primary Care Trust, Oak House, Moorhead Way, Bramley, Rotherham S66 1YY, UK. mark.strong@rotherhampct.nhs.uk
Maheswaran
Ravi
R
Radford
John
J
D003284:Contract Services; D003327:Coronary Disease / Q000453:epidemiology* / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010816:Physician Incentive Plans; D011204:Poverty Areas; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D019984:Quality Indicators, Health Care; D012959:Socioeconomic Factors; D035862:Vulnerable Populations