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首页> 外文期刊>BMC Family Practice >‘Just another incentive scheme’: a qualitative interview study of a local pay-for-performance scheme for primary care
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‘Just another incentive scheme’: a qualitative interview study of a local pay-for-performance scheme for primary care

机译：“另一种激励计划”：对当地基层医疗绩效工资计划的定性访谈研究

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Background A range of policy initiatives have addressed inequalities in healthcare and health outcomes. Local pay-for-performance schemes for primary care have been advocated as means of enhancing clinical ownership of the quality agenda and better targeting local need compared with national schemes such as the UK Quality and Outcomes Framework (QOF). We investigated whether professionals’ experience of a local scheme in one English National Health Service (NHS) former primary care trust (PCT) differed from that of the national QOF in relation to the goal of reducing inequalities. Methods We conducted retrospective semi-structured interviews with primary care professionals implementing the scheme and those involved in its development. We purposively sampled practices with varying levels of population socio-economic deprivation and achievement. Interviews explored perceptions of the scheme and indicators, likely mechanisms of influence on practice, perceived benefits and harms, and how future schemes could be improved. We used a framework approach to analysis. Results Thirty-eight professionals from 16 general practices and six professionals involved in developing local indicators participated. Our findings cover four themes: ownership, credibility of the indicators, influences on behaviour, and exacerbated tensions. We found little evidence that the scheme engendered any distinctive sense of ownership or experiences different from the national scheme. Although the indicators and their evidence base were seldom actively questioned, doubts were expressed about their focus on health promotion given that eventual benefits relied upon patient action and availability of local resources. Whilst practices serving more affluent populations reported status and patient benefit as motivators for participating in the scheme, those serving more deprived populations highlighted financial reward. The scheme exacerbated tensions between patient and professional consultation agendas, general practitioners benefitting directly from incentives and nurses who did much of the work, and practices serving more and less affluent populations which faced different challenges in achieving targets. Conclusions The contentious nature of pay-for-performance was not necessarily reduced by local adaptation. Those developing future schemes should consider differential rewards and supportive resources for practices serving more deprived populations, and employing a wider range of levers to promote professional understanding and ownership of indicators.
机译：背景技术一系列政策措施已经解决了医疗保健和健康结果方面的不平等现象。与诸如英国质量与成果框架（QOF）之类的国家计划相比，已经提倡以本地为基础的按绩效付费计划，以增强临床对质量议程的主人翁意识，并更好地针对当地需求。我们调查了在减少不平等的目标方面，专业人员在一个英国国家卫生局（NHS）以前的初级医疗信托（PCT）中对本地计划的经验是否与国家QOF有所不同。方法我们对实施该方案及其开发人员的初级保健专业人员进行了回顾性半结构化访谈。我们针对性地抽样了具有不同水平的人口社会经济剥夺和成就的做法。访谈探讨了对计划和指标的看法，对实践的影响的可能机制，感知的利弊，以及如何改进未来的计划。我们使用框架方法进行分析。结果来自16个一般实践的38名专业人员和6名参与制定当地指标的专业人员参加了会议。我们的发现涵盖四个主题：所有权，指标的可信度，对行为的影响以及紧张局势的加剧。我们发现几乎没有证据表明该计划产生了与国家计划不同的所有权或经历。尽管很少主动质疑指标及其证据基础，但由于最终的收益取决于患者的行动和当地资源的可用性，因此人们对它们对促进健康的关注表示怀疑。为更多的富裕人群服务的实践报告说，其地位和患者受益是参与该计划的动机，而为更多的贫困人群服务的实践则突出了经济回报。该计划加剧了患者咨询和专业咨询议程之间的紧张关系，全科医生直接受益于激励措施和从事很多工作的护士，以及为越来越少的富裕人群服务的实践，这些人群在实现目标方面面临着不同的挑战。结论本地适应并不一定减少绩效工资的争议性。那些正在制定未来计划的人应考虑为服务于更多贫困人口的做法提供不同的奖励和支持性资源，并采用更广泛的手段来促进对指标的专业理解和掌握。

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