title: Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis.
abstract: BACKGROUND
  Influenza immunisation is recommended for all people aged ≥65 years and younger people with particular chronic diseases. The Quality and Outcomes Framework (QOF) has provided new financial incentives for influenza immunisation since 2004.
  
  
  OBJECTIVE
  To determine the impact of the 2004 UK General Medical Services contract on the overall uptake of, and socioeconomic inequalities associated with, influenza immunisation.
  
  
  METHODS
  Retrospective general-practice population database analysis in 15 general practices in Scotland, UK.
  
  
  METHODS
  Changes in influenza-immunisation uptake for those in at-risk groups between 2003-2004 and 2006-2007 were measured, and variation in uptake examined using multilevel modelling.
  
  
  RESULTS
  Uptake rose from 67.9% in 2003-2004 to 71.4% in 2006-2007. The largest increases were seen in those aged <65 years with chronic disease, with uptake rising from 49.6% to 58.4%, but rates remained considerably lower than in those aged ≥65 years. Differences between practices narrowed (median odds ratio [OR] for two patients randomly selected from different practices: 2.13 (95% confidence interval [CI] = 2.00 to 2.26) in 2003-2004 versus 1.44 (95% CI = 1.40 to 1.49) in 2006-2007. However, inequalities in uptake by patient socioeconomic status did not change: adjusted OR for most deprived versus most affluent was 0.75 (95% CI = 0.70 to 0.80) in 2003-2004 versus 0.72 (95% CI = 0.68 to 0.76) in 2006-2007.
  
  
  CONCLUSIONS
  Overall uptake rose significantly and differences between practices narrowed considerably. However, socioeconomic and age inequalities in influenza immunisation persisted in the first 3 years of the QOF. This contrasts with other ecological analyses, which have concluded that the QOF has reduced inequalities. The impact of financial incentives on inequalities is likely to vary, and some kinds of care may require more targeted improvement activity and support.
authors: Ninewells Hospital and Medical School, University of Dundee, Dundee, UK. m.norbury@cpse.dundee.ac.uk
authors: Michael
authors: M
authors: Norbury
authors: Neil
authors: N
authors: Fawkes
authors: Bruce
authors: B
authors: Guthrie
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D032982:Contracts / Q000706:statistics & numerical data*; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D012959:Socioeconomic Factors
chemical_list: D007252:Influenza Vaccines