GP incentives not always best for improving healthy lifestyle

The incentives given to GPs to improve care do not automatically mean patients have a better quality of life or have healthier lifestyles, according to a study.

The study published online in Heart found that the UK has not done as well as the Republic of Ireland in getting people to engage with strategies designed to reduce cardiovascular disease.

Although the Quality and Outcomes Framework (QOF) in the NHS which rewards GPs for performance does improve clinical care, says the study, it does not promote healthier lifestyles or improve patients’ quality of life when it comes to coronary heart disease.

Researchers led by the Department of General Practice and Primary Care, Dunluce Health Centre, Belfast, looked at 903 patients with coronary heart disease at 48 GP practices – 16 of which were in Northern Ireland and 32 were in the Republic of Ireland.

It is generally accepted that the better a country’s primary care system is, the lower its rates of premature death are from various causes.

The researchers wanted to compare the Northern Ireland practices, which have a strong primary care infrastructure, including computerisation, disease records, and a reward scheme for GP performance, with those in the Republic of Ireland, where the healthcare economy is mixed, with much less infrastructure and no performance related pay.

Their analysis showed that blood pressure and cholesterol levels were better controlled among patients in the Northern Ireland practices and more of these patients had had these levels checked in the previous year.

Similar proportions were prescribed medicines for secondary prevention for coronary heart disease, including statins and ACE inhibitors, although fewer patients in the Republic of Ireland practices had been prescribed beta blockers.

Republic of Ireland patients also made more outpatient visits, and had more hospital admissions than their Northern Ireland counterparts.

However, patients in Northern Ireland ate a less healthy diet and took significantly less exercise than patients in the Republic, who scored higher on validated measures of physical and emotional wellbeing.

The researchers said that healthcare systems are complex, as are the results of strategies designed to improve health.

They concluded that the evidence suggests the quality of care was already improving in primary care before the new GP contract, with its inclusion of incentives, was introduced.

More work is needed, they added, to explore the differences in professionals’ and patients’ engagement in secondary prevention in different healthcare systems.

DOI: 10.1136/hrt.2008.145912