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Effect of the UK Incentive–Based Contract on the Management of Patients With Stroke in Primary Care

Background and Purpose— We wished to ascertain whether a new contract based on financial incentives for general practitioners has been associated with improved recording of quality indicators for patients with stroke and whether there was evidence of any difference in change between sex, age, and deprivation groups. Methods— In a serial cross-sectional study, patients from 310 general practices with a computer record of transient ischemic attack or stroke in Scotland were analyzed for their recording of quality indicators before and after the introduction of a new quality-based contract on March 31, 2004. Multivariate analyses were used to explore any differences in recording between age, sex, and deprivation groups. Results— Documentation of quality indicators increased over time, with absolute increases for individual indicators ranging from 32.3% to 52.1%. There was a large increase in the documentation of quality indicators among the oldest patients (>75 years) and the most affluent patients. This tended to attenuate age groups differences and to exacerbate differences between deprivation groups. Women tended to have larger increases in documentation than men; however, sex differences persisted, with women less likely than men to have smoking habits recorded (adjusted odds ratio, 0.87; 95% confidence interval, 0.81 to 0.95) or to receive antiplatelet or anticoagulant therapy (adjusted odds ratio, 0.93; 95% confidence interval, 0.86 to 0.99). Conclusions— The recording and management of quality indicators among patients with stroke increased substantially. However, inequitable care exists, which may have important implications for female, older, and more deprived subgroups in terms of stroke recurrence and mortality.