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Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study

机译：财政激励措施对初级保健中酒精干预的影响：一项混合方法研究

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Background Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. Methods A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Results Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs’ beliefs about patient-centred practice. Conclusions Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs’ provide care.
机译：背景资料在2008年至2015年期间，英国引入了地方和国家财政激励措施，以鼓励在初级保健中进行筛查和简短的酒精干预措施。我们使用常规的阅读规范数据和对全科医生（GP）的访谈来评估其影响。方法采用循序渐进的解释性混合方法研究，对英格兰北部两个地区的106,700名患者和99名GP进行了16种常规治疗。提取了2010-11年度筛查和短暂酒精干预的数据，并根据实践激励状况计算了发病率。对14位全科医生的半结构式访谈探讨了哪些因素会影响干预措施的提供和常规咨询中的记录。结果财务激励措施的筛查和短暂的酒精干预率高于未激励措施。但是，在所有实践中，绝对率都很低。短期筛查试验的施用率范围从非激励措施的0.05％（95％CI：0.03-0.08）到全国激励措施的3.92％（95％CI：3.70-4.14）。对于完整的AUDIT，全国激励措施的费率也最高（3.68％，95％CI：3.47-3.90），最低激励措施的费率最低（0.17％，95％CI：0.13-0.22）。在签署了国家奖励计划的措施中，酒精干预措施的实施率最高（9.23％，95％CI：8.91-9.57），在未采取措施的实施中，酒精干预措施的实施率最低（4.73％，95％CI：4.50-4.96）。 GP访谈强调了对酒精干预措施的提供和后续记录的一系列影响，包括：不同财务激励计划的层次;对酒精干预功效的混合信念;编纂复杂条件的困难;和全科医生对以患者为中心的实践的信念。结论在英格兰，经济激励措施已经成功地鼓励了筛查和短暂的酒精干预，但是记录的活动水平仍然很低。为了提高绩效，未来的政策必须在质量和结果框架内优先考虑酒精预防工作，并解决影响全科医生提供护理的价值观，态度和信念。

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