Incentives make doctors ignore ethnic differences in the management of coronary heart disease (CHD), thus providing better treatment for South Asians in the UK, according to a new study.
Dr. Christopher Millett, Consultant in Public Health at Imperial College Faculty of Medicine in London in the UK, and his colleagues have said that money can turn out to be a great motivation behind doctors ignoring ethnic differences in quality of and access to care in CHD.
AdvertisementFor the study, they evaluated the benefits of pay for performance schemes launched in 2004 in the UK, for the management of coronary heart disease, with a particular focus on ethnic differences.
Already, it's known that there are marked differences in cardiovascular disease prevalence and subsequent health outcomes between ethnic groups, as well as potential unequal access to high-quality care.
The researchers focussed on whether financial incentives for doctors would address these differences in management of CHD across ethnic groups.
They looked at electronic records from 32 family practices in inner city London, before and after the introduction of the new contract in 2004. They identified 2,891 people with CHD in 2003 and 3,101 in 2005 and examined 10 quality indicators for CHD management.
There were incentives for recording smoking status, measuring cholesterol and blood pressure, prescribing aspirin, beta-blockers and ACE inhibitors, as well as for controlling cholesterol and blood pressure. There were no incentives for either BMI measurement or prescription of statins.
It was found that more patients were reaching national treatment targets for both blood pressure and total cholesterol since the implementation of the pay for performance initiative in April 2004.
With the scheme, CHD management also improved across both incentivized and non-incentivized indicators. There were also fewer differences in prescribing and clinical outcomes between ethnic groups in 2005 than in 2003.
For example, improvements in blood pressure control were greater in the black group than amongst the whites over the two year period, with the treatment gap between the two groups closing between 2003 and 2005.
More South Asians also had their blood pressure recorded in 2005 than in 2003.
However, black patients were still less likely to be prescribed statins than South Asians or whites in 2005.
The authors concluded: "Whilst the management of CHD remains suboptimal in many patients, improvements in the quality of care seen since the new contract are impressive....most patients, including those from ethnic minority groups and living in areas of low socio-economic status, appear to have benefited from the scheme."
They added that healthcare planners in other countries might want to consider introducing similar initiatives for their own primary care physicians.
The study was published online in Springer's Journal of General Internal Medicine.
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