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Truly equitable QOF has improved blood pressure monitoring

29 October 2008

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The Quality and Outcomes Framework (QOF) has “substantially” improved blood pressure monitoring and control in England, in a study by King’s College London.

In an accompanying online British Medical Journal article, QOF is lauded as a “truly equitable public health intervention” by Professor Helen Lester from the National Primary Care Research and Development Centre.

High blood pressure is the single most important risk factor for developing heart disease and adds significantly to the gap in life expectancy between deprived and affluent areas.

Studies have shown that successful blood pressure control could prevent 43,000 strokes and 83,000 cases of heart disease in the UK each year, but this is less likely to be achieved in socially deprived areas.

In the first year of the QOF, practices in socially deprived areas reported lower achievement scores (6.1% of the total QOF score) and therefore less financial reward than the more affluent areas, but by year 2 the gap had reduced to 2.9%.

Dr Mark Ashworth and colleagues from Kings College London report on the data from the first three years (2004–07) of the QOF’s implementation, including more than 8,515 (97%) of practices in England involving 53 million people.

They examined the effect of social deprivation on the achievement of blood pressure targets between general practices in deprived and less deprived communities in England.

The authors found that blood pressure recording increased from 82.3% (52.8 million) of adults in 2005 to 88.3% (53.2 million) in 2007, and that the gap between median blood pressure recording levels narrowed from 1.7% to 0.2% between practices in the most deprived and least deprived areas.

In addition, the achievement of blood pressure targets for the five chronic diseases improved substantially, particularly in diabetics in the most deprived practices, which improved by more than 10%, with over 79% achieving target blood pressure levels by 2007.

The study shows that performance indicators linked to financial incentives result in improved achievement of targets, which at the same time narrows health inequalities, conclude the authors.


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