The effect of financial incentives on the quality of health care provided by primary care physicians

Scott, Anthony; Sivey, Peter; Ouakrim, Driss Ait; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

doi:10.1002/14651858.cd008451.pub2

Cited by 403 publications

(321 citation statements)

References 56 publications

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“…These findings contradict earlier claims of improved continuity and cost savings based on cross-sectional comparisons, 8,[10][11][12][13] but are generally consistent with previous research that has found limited impact of incentives within primary care. 24 The interrupted time series design allowed us to control for physician and patient characteristics that shape both billing of incentives and other aspects of patient care, a weakness of earlier analysis within BC 8,10-13 and the likely reason our conclusions differ.…”

Section: Discussionmentioning

confidence: 96%

“…28,29 Research to date, largely from the United Kingdom and United States, has provided mixed evidence of the effectiveness of these programs. 24,[30][31][32][33][34] Studies of Ontario's pay-forperformance initiatives showed modest improvements in delivery of some preventive services 35,36 and no change in management of patients with diabetes. 37 The Ontario picture is complicated by the fact that physician payment mechanisms were also modified, which may have influenced both care for patients with chronic disease 38 and uptake of incentives.…”

Section: Discussionmentioning

confidence: 99%

“…39 Most research in this area focuses on care for individual diseases, using the delivery of specific services as indicators of quality. 24,[30][31][32][33][34] Evidence of the effect of incentive-based programs on broader outcomes such as access to primary care, continuity of care, 40 hospital admissions [25][26][27][28][29]41,42 and overall resource use 30,34,43 has been inconclusive.…”

Section: Discussionmentioning

confidence: 99%

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A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

Lavergne

Law

Peterson

et al. 2016

CMAJ

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

Lavergne

Law

Peterson

et al. 2016

CMAJ

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“…Some providers are financially incentivized to aggressively treat pain because their salaries are tied to patient satisfaction scores that encompass pain control metrics. [48][49][50][51][52][53][54][55] Balancing the risks and benefits of opioid prescribing is difficult when the physician faces pressure from the patient and healthcare system. 18,56 We characterized opioid receipt at hospital discharge among opioid naïve medical and surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

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“…This resonate with the Cochrane review on healthcare quality provided by primary care physicians under the payment for performance scheme 50 . Thus, it seems that £1bn (€1.2bn; $1.4bn) a year "is not good value for money" for UK general practices, since quality in health in the UK would reach nearly the same level of standards according to the "secular trends" before QOF was introduced 6,51 .…”

Section: Discussionmentioning

confidence: 83%

The payment for performance model and its influence on British general practitioners' principles and practice

2014

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This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

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The effect of financial incentives on the quality of health care provided by primary care physicians

Cited by 403 publications

References 56 publications

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

The payment for performance model and its influence on British general practitioners' principles and practice

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