The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework.
BACKGROUND
The existence of health inequalities between least and most socially deprived areas is now well established.


OBJECTIVE
To use Quality and Outcomes Framework (QOF) indicators to explore the characteristics of primary care in deprived communities.


METHODS
Two-year study.


METHODS
Primary care in England.


METHODS
QOF data were obtained for each practice in England in 2004-2005 and 2005-2006 and linked with census derived social deprivation data (Index of Multiple Deprivation scores 2004), national urbanicity scores and a database of practice characteristics. Data were available for 8480 practices in 2004-2005 and 8264 practices in 2005-2006. Comparisons were made between practices in the least and most deprived quintiles.


RESULTS
The difference in mean total QOF score between practices in least and most deprived quintiles was 64.5 points in 2004-2005 (mean score, all practices, 959.9) and 30.4 in 2005-2006 (mean, 1012.6). In 2005-2006, the QOF indicators displaying the largest differences between least and most deprived quintiles were: recall of patients not attending appointments for injectable neuroleptics (79 versus 58%, respectively), practices opening > or =45 hours/week (90 versus 74%), practices conducting > or = 12 significant event audits in previous 3 years (93 versus 81%), proportion of epileptics who were seizure free > or = 12 months (77 versus 65%) and proportion of patients taking lithium with serum lithium within therapeutic range (90 versus 78%). Geographical differences were less in group and training practices.


CONCLUSIONS
Overall differences between primary care quality indicators in deprived and prosperous communities were small. However, shortfalls in specific indicators, both clinical and non-clinical, suggest that focused interventions could be applied to improve the quality of primary care in deprived areas.
Ashworth
Mark
M
Honorary senior lecturer, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London. mark.ashworth@gp-G85053.nhs.uk
Seed
Paul
P
Armstrong
David
D
Durbaba
Stevo
S
Jones
Roger
R
D004739:England; D005194:Family Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000592:standards*; D011610:Psychosocial Deprivation; D019984:Quality Indicators, Health Care; D012959:Socioeconomic Factors