BACKGROUND: The 'inverse care law' suggests that populations with the poorest health outcomes also tend to have poorer access to high-quality care. The new general practitioner (GP) contract in the UK aimed to reduce variations in care between areas by collecting information on processes and outcomes of chronic disease management. This study investigated whether, despite reductions in inequalities, primary care in deprived areas is still at a disadvantage due to the higher prevalence of chronic diseases, using chronic kidney disease (CKD) as an example. METHODS: Initially, data from a hospital-based cohort of CKD patients were analysed to investigate the clustering of CKD patients across area-level deprivation using a geographical information system that employed kernel density estimation. Data from the Quality and Outcomes Framework were then analysed to explore the burden of CKD and associated non-communicable chronic diseases (NCD) and assess the potential impact on GPs' workload by area-level deprivation. RESULTS: There was a significant clustering of CKD patients referred to the hospital in the most deprived areas. Both the prevalence of CKD and associated conditions and caseload per GP were significantly higher in deprived areas. CONCLUSION: In the most deprived areas, there is an increased burden of major chronic disease and a higher caseload for clinicians. These reflect significant differences in workload for practices in deprived areas, which needs to be addressed.
BACKGROUND: The 'inverse care law' suggests that populations with the poorest health outcomes also tend to have poorer access to high-quality care. The new general practitioner (GP) contract in the UK aimed to reduce variations in care between areas by collecting information on processes and outcomes of chronic disease management. This study investigated whether, despite reductions in inequalities, primary care in deprived areas is still at a disadvantage due to the higher prevalence of chronic diseases, using chronic kidney disease (CKD) as an example. METHODS: Initially, data from a hospital-based cohort of CKDpatients were analysed to investigate the clustering of CKDpatients across area-level deprivation using a geographical information system that employed kernel density estimation. Data from the Quality and Outcomes Framework were then analysed to explore the burden of CKD and associated non-communicable chronic diseases (NCD) and assess the potential impact on GPs' workload by area-level deprivation. RESULTS: There was a significant clustering of CKDpatients referred to the hospital in the most deprived areas. Both the prevalence of CKD and associated conditions and caseload per GP were significantly higher in deprived areas. CONCLUSION: In the most deprived areas, there is an increased burden of major chronic disease and a higher caseload for clinicians. These reflect significant differences in workload for practices in deprived areas, which needs to be addressed.
Authors: Jennifer Holmes; Timothy Rainer; John Geen; Gethin Roberts; Kate May; Nick Wilson; John D Williams; Aled O Phillips Journal: Clin J Am Soc Nephrol Date: 2016-10-28 Impact factor: 8.237
Authors: Tom Blakeman; Christian Blickem; Anne Kennedy; David Reeves; Peter Bower; Hannah Gaffney; Caroline Gardner; Victoria Lee; Praksha Jariwala; Shoba Dawson; Rahena Mossabir; Helen Brooks; Gerry Richardson; Eldon Spackman; Ivaylo Vassilev; Carolyn Chew-Graham; Anne Rogers Journal: PLoS One Date: 2014-10-16 Impact factor: 3.240
Authors: Emily P McQuarrie; Bruce Mackinnon; Samira Bell; Stewart Fleming; Valerie McNeice; Graham Stewart; Jonathan G Fox; Colin C Geddes Journal: Clin Kidney J Date: 2017-01-07