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Is pay for performance promoting inverse inequality in Irish general practice?
Sarah Linnane1, Sarah Mullarkey1, Eoin Kyne1
1ICGP Mid West GP Training Scheme.
Insights
The Chronic Disease Management (CDM) program in Ireland may provide unequal care. Preliminary findings suggest private patients receive poorer management for chronic diseases compared to publicly funded patients.
Area of Science:
- General Practice and Primary Care
- Health Services Research
- Chronic Disease Management
Background:
- The Irish Chronic Disease Management (CDM) programme, established in 2020, provides resources for General Practitioners (GPs) to conduct twice-yearly reviews for public (GMS) patients with eight specified chronic diseases.
- This pay-for-performance initiative has seen widespread GP adoption.
- A hypothesis exists that private patients (PPs) may receive a lower standard of care due to potential reluctance to attend appointments because of associated costs.
Purpose of the Study:
- To evaluate if the management standards for eight chronic diseases under the CDM program are equivalent between private patients (PPs) and GMS patients.
- To investigate potential disparities in chronic disease care influenced by patient funding status.
Main Methods:
- A retrospective audit was conducted across GP practices in the Midwest of Ireland.
- Data were collected for 25 GMS patients and 25 PPs per practice, matched by age, gender, and clinical condition, with each patient having at least one of the eight specified chronic diseases.
- Key parameters assessed included vaccination status (influenza, pneumococcal, COVID-19), BMI, blood pressure, smoking status, renal function, HbA1c, lipid profile, BNP for heart failure patients, and lung function for COPD/asthma patients. COVID-19 vaccination status served as a control.
Main Results:
- Preliminary results from two GP practices indicate significant and consistent differences in the management of most parameters between PPs and GMS patients.
- These disparities suggest a potential inequality in care delivery based on patient funding status.
Conclusions:
- Restricting pay-for-performance initiatives solely to GMS patients, based on age or income, can exacerbate health inequalities.
- The study advocates for extending Chronic Disease Management care to all patients, irrespective of their funding status, to ensure equitable healthcare access and outcomes.
Background:
In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved.
Aim:
To assess whether the management of eight chronic diseases named in the CDM programme is to the same standard among both PPs and GMS patients.
Method:
A retrospective audit of GP practices in the Midwest of Ireland. Data relating to 25 GMS patients and 25 PPs, matched by age, gender, and clinical condition, is collected from each practice. Patients have at least 1 of the eight named chronic diseases. Parameters include vaccination status (influenza, pneumococcal, COVID); body mass index; blood pressure; smoking status; renal function; HbA1c; lipid profile; brain natriuretic peptide (BNP) in patients with heart failure; and lung function tests in patients with COPD or asthma. COVID vaccination status acts as a control because it is freely available for both PPs and GMS patients.
Results:
Preliminary results from 2 GP practices show large consistent disparities in management between PPs and GMS patients in most parameters.
Conclusion:
Limiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.
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