title: Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study.
abstract: BACKGROUND
  The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension.
  
  
  OBJECTIVE
  To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care.
  
  
  METHODS
  A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database.
  
  
  METHODS
  A dataset was extracted on 826 973 patients aged ≥40 years including, age, sex, socioeconomic deprivation status, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels, and provision of hypertension-related prescribing for each year from 2001 until 2006.
  
  
  RESULTS
  Increasing treatment for hypertension (absolute difference [AD] 9.2%; 95% confidence interval [CI] = 9.0 to 9.5) occurred throughout the study period. The majority of increases found 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 mmHg; 18.9%; 95% CI = 18.5 to 19.4). After 2004, the oldest female, as well as the male and female patients with the greatest socioeconomic deprivation status, 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 mortality in those with hypertension. However, there is a need to follow up patients who are older and more socioeconomically deprived once they are diagnosed, as well as prescribing antihypertensive therapy to younger patients, who are likely to benefit from early intervention.
authors: Allergy and Respiratory Research Group, University of Edinburgh, Edinburgh, UK. c.simpson@ed.ac.uk
authors: Colin R
authors: CR
authors: Simpson
authors: Philip C
authors: PC
authors: Hannaford
authors: Lewis D
authors: LD
authors: Ritchie
authors: Aziz
authors: A
authors: Sheikh
authors: David
authors: D
authors: Williams
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000191:economics* / Q000592:standards; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012052:Reimbursement, Incentive / Q000191:economics*; D012606:Scotland; D017678:Sex Distribution; D012959:Socioeconomic Factors
chemical_list: D000959:Antihypertensive Agents