title: Increase in the pharmacological management of Type 2 diabetes with pay-for-performance in primary care in the UK.
abstract: OBJECTIVE
  To determine whether the financial incentives for tight glycaemic control, introduced in the UK as part of a pay-for-performance scheme in 2004, increased the rate at which people with newly diagnosed Type 2 diabetes were started on anti-diabetic medication.
  
  
  METHODS
  A secondary analysis of data from the General Practice Research Database for the years 1999-2008 was performed using an interrupted time series analysis of the treatment patterns for people newly diagnosed with Type 2 diabetes (n = 21 197).
  
  
  RESULTS
  Overall, the proportion of people with newly diagnosed diabetes managed without medication 12 months after diagnosis was 47% and after 24 months it was 40%. The annual rate of initiation of pharmacological treatment within 12 months of diagnosis was decreasing before the introduction of the pay-for-performance scheme by 1.2% per year (95% CI -2.0, -0.5%) and increased after the introduction of the scheme by 1.9% per year (95% CI 1.1, 2.7%). The equivalent figures for treatment within 24 months of diagnosis were -1.4% (95% CI -2.1, -0.8%) before the scheme was introduced and 1.6% (95% CI 0.8, 2.3%) after the scheme was introduced.
  
  
  CONCLUSIONS
  The present study suggests that the introduction of financial incentives in 2004 has effected a change in the management of people newly diagnosed with diabetes. We conclude that a greater proportion of people with newly diagnosed diabetes are being initiated on medication within 1 and 2 years of diagnosis as a result of the introduction of financial incentives for tight glycaemic control.
authors.affiliation: Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
authors.forename: N
authors.initials: N
authors.lastname: Gallagher
authors.forename: C
authors.initials: C
authors.lastname: Cardwell
authors.forename: C
authors.initials: C
authors.lastname: Hughes
authors.forename: D
authors.initials: D
authors.lastname: O'Reilly
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000191:economics; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D010816:Physician Incentive Plans / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011320:Primary Health Care / Q000191:economics; D058996:Quality Improvement; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human