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Health inequalities remain after QOF

The GP contract has failed to iron out inequalities in heart disease care, despite a steep rise in the number of people on registers, researchers suggest.

Prescribing for coronary heart disease increased by 17% after the introduction of QOF, the study found. But disparities persisted, with women less likely to be recorded than men in 9 of 11 indicators and older patients and the most deprived also missing out.

Study leader Matt McGovern, a researcher at the department of general practice and primary care, University of Aberdeen, said the analysis had also found a substantial increase in exception reporting which need examining further. Not all patients with CHD had ‘benefited equally' from the contract, he said, and work was needed to improve care for certain groups of patients.

The Aberdeen team studied how 58,406 patients with CHD from 310 Scottish practices were managed before and after the introduction of the GP contract.

Work done prior to the contract showed secondary prevention was better in some groups than others and the researchers thought the contract would reduce gender, age and deprivation inequalities in the population. But women with a history of CHD were less likely than men to be referred for an exercise test or specialist assessment for angina, have blood pressure or cholesterol recorded and controlled, be prescribed an anticoagulant, beta-blocker or ACE inhibitor or receive influenza vaccination.

And patients over the age of 75 were similarly found to be missing out compared with younger patients, although they were more likely to have cholesterol levels controlled.

The study, published online by Family Practice, also found most deprived patients were less likely to have their blood pressure measured, receive beta-blocker therapy or have flu vaccination or their smoking status recorded.

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