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Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay-for-performance
  1. Margaret E Cupples (m.cupples{at}qub.ac.uk)
  1. Queen's University, Belfast, Republic of Ireland
    1. Mary C Byrne (mary.byrne{at}nuigalway.ie)
    1. National University of Ireland, Galway, Republic of Ireland
      1. Susan M Smith (susmith{at}tcd.ie)
      1. Trinity College, Dublin, Republic of Ireland
        1. Claire S Leathem (c.leathem{at}qub.ac.uk)
        1. Queen's University, Belfast, Republic of Ireland
          1. Andrew W Murphy (andrew.murphy{at}nuigalway.ie)
          1. National University of Ireland, Galway, Republic of Ireland

            Abstract

            Objective To compare baseline cardiovascular risk management between people recruited from two different healthcare systems, to a research trial of an intervention to optimize secondary prevention.

            Design Cross-sectional study.

            Setting General practices, randomly selected: 16 in Northern Ireland (NI) (UK NHS, infrastructure, pay-for-performance); 32 in Republic of Ireland (RoI) (mixed healthcare economy, less infrastructure, no pay-for-performance).

            Patients 903 (mean age 67.5 years; 69.9% male); randomly selected, known coronary heart disease.

            Main outcome measures Blood pressure, cholesterol, medications; validated questionnaires for diet (DINE), exercise (Godin), quality of life (SF12); healthcare usage.

            Results More RoI than NI participants had systolic BP>140 mmHg (37% v 28%, p=0.01) and cholesterol >5mmol/l (24% v 17%, p=0.02): RoI mean systolic BP was higher (139 v 132 mm Hg). More RoI participants reported a high fibre intake (35% v 23%), higher levels of physical activity (62% v 44%), and better physical and mental health (SF12); they had more GP (5.6 v 4.4) and fewer nurse visits (1.6 v 2.1) in the previous year. Fewer in RoI (55% v 70%) were prescribed B blockers. Both groups ACE inhibitor (41%; 48%) prescribing was similar; high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%).

            Conclusions Blood pressure and cholesterol are better controlled among patients in a primary healthcare system with a strong infrastructure supporting computerization and rewarding measured performance but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals and patients engagement in secondary prevention in different healthcare systems is needed.

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