Improving attendance for cardiovascular risk assessment in Australian general practice: an RCT of a monetary incentive for patients

Abstract

BackgroundPreventive health care is an important part of general practice however uptake of activities by patients is variable. Monetary incentives for doctors have been used in the UK and Australia to improve rates of screening and immunisation. Few studies have focussed on incentives for patients to attend preventive health care examinations. Our objective was to investigate the use of a monetary incentive to increase patient attendance with their general practitioner for a cardiovascular risk assessment (CVRA).MethodsA pragmatic RCT was conducted in two Australian general practices. Participating GPs underwent academic detailing for cardiovascular risk assessment. 301 patients aged 40–74, who did not have cardiovascular disease, were independently randomised to receive a letter inviting them to a no cost cardiovascular risk assessment with their GP, or the same letter plus an offer of a $25 shopping voucher if they attended. An audit of patient medical records was also undertaken and a patient questionnaire administered to a sub sample of participants. Our main outcome measure was attendance for cardiovascular risk assessment.ResultsIn the RCT, 56/301(18.6%) patients attended for cardiovascular risk assessment, 29/182 (15.9%) in the control group and 27/119 (22.7%) in the intervention group. The estimated difference of 6.8% (95% CI: -2.5% to 16.0%) was not statistically significant, P = 0.15. The audit showed that GPs may underestimate patients’ absolute cardiovascular risk and the questionnaire that mailed invitations from GPs for a CVRA may encourage patients to attend.ConclusionsA small monetary incentive does not improve attendance for cardiovascular risk assessment. Further research should be undertaken to determine if there are other incentives that may increase attendance for preventive activities in the general practice setting.Clinical trials registrationACTRN12608000183381

The Role of Prospect Theory in Screening Behavior Decision-Making in a Health-Insured Population of South Africa

“…However, females in the Vitality program who had a family member diagnosed with a chronic disease screened more for breast cancer over time. he role of incentives in this instance, proved to be inconsistent, in line with previous indings where incentives are found to be efective and applicable in certain settings, but do not work in others [31,38]. It may be that prospect theory has greater utility in predicting screening behavior in certain populations, under certain circumstances and with certain diseases.…”

Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis

“…One study published three papers from data obtained at different periods [32–34], and the most recent paper was included [33]. A total of 9 studies fulfilled the inclusion criteria and were included [27, 33, 35, 36, 47, 54, 55, 58, 59]. Forward and backward searches of the reference lists and bibliography citations of the 9 studies yielded an additional 16 studies [37, 39, 48–53, 56, 57, 60–65] and resulted in a total of 25 studies for qualitative synthesis.…”

“…Among the 21 studies, ten were randomized or cluster randomized controlled trials [27, 37, 47–52, 58, 60], six were non-randomized trials with controlled group [53–55, 59, 61, 62] and five were pre and post- studies [33, 56, 57, 63, 64]. Eleven studies analyzed CVD risk factors screening [33, 37, 47, 49, 53, 58–63] and 10 studies focused on multiple preventive services including screening for cancer, vitamin B 12 , vaccination promotion, and others [27, 48, 50–52, 54–57, 64] (refer to Table 2).…”

“…Eleven studies analyzed CVD risk factors screening [33, 37, 47, 49, 53, 58–63] and 10 studies focused on multiple preventive services including screening for cancer, vitamin B 12 , vaccination promotion, and others [27, 48, 50–52, 54–57, 64] (refer to Table 2). The follow-up period of these studies ranged from 2 months to 3 years.…”

The Heart Health Study - increasing cardiovascular risk assessment in family practice for first degree relatives of patients with premature ischaemic heart disease: a randomised controlled trial

“…Considering that approximately 80 % of all GP service are currently bulk billed (at no cost to the patient) [21] the impact might be limited and in addition there is mixed evidence that financial incentives improve attendance rates for CVD risk assessment [22]. …”