Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

Abstract

Objectives To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. Design Qualitative, semistructured interview study. Setting 13 general practices in Leicester. Participants 18 general practitioners and 13 practice nurses.

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review

“…Payments that are linked to individual patient outcomes -for example, €x per successful quitter -do not appear to be associated with increased provision of cessation advice (based on patient recall and GP self-report). 54,55 It is possible that such payment schemes may encourage data manipulation and tokenistic activity. There is evidence from patient and prescription data that reducing or removing the cost of pharmacological treatments for cessation can increase GPs' prescribing or recommending of such treatments, 53,56 although some GPs are ambivalent about recommending NRT products.…”

Law of supply and demand applies in NHS

“…1 Poor ascertainment and low levels of reporting to the national congenital anomaly system at the Office for National Statistics in England and Wales is, as Elliott et al say, well recognised.…”

“…1 The potential press interest in the article by Elliott et al on birth defects and landfill sites is noted, and a thoughtful and balanced editorial by McNamee and Dolk accompanies the paper. 2 3 The relevant paragraph in This week in the BMJ then carries the headline: "People living near landfill sites have an increased risk of adverse birth outcomes."…”

“…1 Perhaps these patients are at low risk of myocardial infarction but not coronary artery disease. Another study, using a stress test or minimally invasive angiography, could elucidate this point.…”

“…1 Emerging diagnostic approaches, such as the use of ST segment monitoring in emergency departments, new cardiac markers, and chest pain units have been extensively investigated in the United States. [2][3][4] Yet evaluation in the United Kingdom has progressed little beyond audit.…”