Journal of Public Health Advance Access originally published online on July 5, 2006
Journal of Public Health 2006 28(3):294; doi:10.1093/pubmed/fdl021
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Correspondence |
Reply
Mark Strong
Clinical Lecturer in Public Health, Section of Public Health, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
Ravi Maheswaran
Public Health GIS Unit, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
John Radford
Rotherham Primary Care Trust, Oak House, Moorhead Way, Rotherham S66 1YY, UK
E-mail: m.strong{at}sheffield.ac.uk
Sirs,
Low and Low make two interesting points in their letter.1
The first concerns equity pre- and post-access to services. The clinical indicators within QOF are designed to reflect the care provided to those patients on the chronic disease registers, and in this respect, they are purely a post-access measure. Low and Low are correct in saying that an absence of inequity in post-access coronary heart disease (CHD) care does not necessarily mean that there is equitable access onto the CHD register in the first place. However, our finding of a lack of an association between quality of post-access CHD care and deprivation at a practice level is still interesting and is contrary to patterns shown by previous research.2
With regard to the second point, we did not attempt to assess the equity of access to the QOF CHD registers. Unfortunately, the ‘true’ prevalence of CHD in any GP practice population is unknown, which makes measuring the equity of access to a disease register difficult. Using inequalities in CHD mortality between practices to predict inequalities in CHD prevalence as Low and Low suggest may itself present analytical difficulties. Mortality reflects both incidence and case fatality, and the latter might also correlate with deprivation.
The QOF does give us a new window on quality of care. We are only just beginning to understand the view.
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- Low A, Low A. The QOF equity window: an illusion or a different view? J Public Health. 10.1093/pubmed/fdl014.
- Ward PR, Noyce PR, St Leger AS. Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England. J Epidemiol Community Health 2004;58:89–96.
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