Christos Grigoroglou1, Luke Munford2, Roger T Webb3, Nav Kapur4, Tim Doran5, Darren M Ashcroft6, Evangelos Kontopantelis7. 1. NIHR School for Primary Care Research,Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK. 2. Research Fellow in Health Economics,Centre for Health Economics,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK. 3. Professor in Mental Health Epidemiology,Centre for Mental Health and Safety,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK. 4. Professor of Psychiatry and Population Health,Centre for Suicide Prevention,University of Manchester, Greater Manchester Mental Health Trust and NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK. 5. Professor of Health Policy,Department of Health Sciences,University of York,UK. 6. Professor of Pharmacoepidemiology,Centre for Pharmacoepidemiology and Drug Safety,School of Health Sciences,Faculty of Biology, Medicine and Health,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK. 7. Professor of Data Science and Health Services Research,Faculty of Biology, Medicine and Health,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK.
Abstract
BACKGROUND: Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014. METHOD: Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables. RESULTS: No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092). CONCLUSIONS: Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
BACKGROUND: Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014. METHOD: Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables. RESULTS: No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092). CONCLUSIONS: Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
Authors: Esmaeil Khedmati Morasae; Tanith C Rose; Mark Gabbay; Laura Buckels; Colette Morris; Sharon Poll; Mark Goodall; Rob Barnett; Ben Barr Journal: Med Care Res Rev Date: 2021-07-29 Impact factor: 2.971
Authors: Laura Anselmi; Josephine Borghi; Garrett Wallace Brown; Eleonora Fichera; Kara Hanson; Artwell Kadungure; Roxanne Kovacs; Søren Rud Kristensen; Neha S Singh; Matt Sutton Journal: Int J Health Policy Manag Date: 2020-09-01