Published 14 August 2008, doi:10.1136/bmj.a957
Cite this as: BMJ 2008;337:a957

Research

Self reported receipt of care consistent with 32 quality indicators: national population survey of adults aged 50 or more in England

Nicholas Steel, senior lecturer in primary care1, Max Bachmann, professor of health services research1, Susan Maisey, research associate1, Paul Shekelle, director, southern California evidence based practice center2, Elizabeth Breeze, senior lecturer and English longitudinal study of ageing team3, Michael Marmot, professor3, David Melzer, professor of epidemiology and public health4

1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, 2 RAND Corporation, Santa Monica, CA, USA, 3 Department of Epidemiology and Public Health, University College London, 4 Peninsula Medical School, Exeter

Correspondence to: N Steel n.steel{at}uea.ac.uk

Objective To assess the receipt of effective healthcare interventions in England by adults aged 50 or more with serious health conditions.

Design National structured survey questionnaire with face to face interviews covering medical panel endorsed quality of care indicators for both publicly and privately provided care.

Setting Private households across England.

Participants 8688 participants in the English longitudinal study of ageing, of whom 4417 reported diagnoses of one or more of 13 conditions.

Main outcome measures Percentage of indicated interventions received by eligible participants for 32 clinical indicators and seven questions on patient centred care, and aggregate scores.

Results Participants were eligible for 19 082 items of indicated care. Receipt of indicated care varied substantially by condition. The percentage of indicated care received by eligible participants was highest for ischaemic heart disease (83%, 95% confidence interval 80% to 86%), followed by hearing problems (79%, 77% to 81%), pain management (78%, 73% to 83%), diabetes (74%, 72% to 76%), smoking cessation (74%, 71% to 76%), hypertension (72%, 69% to 76%), stroke (65%, 54% to 76%), depression (64%, 57% to 70%), patient centred care (58%, 57% to 60%), poor vision (58%, 54% to 63%), osteoporosis (53%, 49% to 57%), urinary incontinence (51%, 47% to 54%), falls management (44%, 37% to 51%), osteoarthritis (29%, 26% to 32%), and overall (62%, 62% to 63%). Substantially more indicated care was received for general medical (74%, 73% to 76%) than for geriatric conditions (57%, 55% to 58%), and for conditions included in the general practice pay for performance contract (75%, 73% to 76%) than excluded from it (58%, 56% to 59%).

Conclusions Shortfalls in receipt of basic recommended care by adults aged 50 or more with common health conditions in England were most noticeable in areas associated with disability and frailty, but few areas were exempt. Efforts to improve care have substantial scope to achieve better health outcomes and particularly need to include chronic conditions that affect quality of life of older people.


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