Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial

Authors: Jade E Bilardi, Christopher K Fairley, Meredith J Temple-Smith, Marie V Pirotta, Kathleen M McNamee, Siobhan Bourke, Lyle C Gurrin, Margaret Hellard, Lena A Sanci, Michelle J Wills, Jennifer Walker, Marcus Y Chen, Jane S Hocking

Published in: BMC Public Health | Issue 1/2010

Login to get access

Abstract

Background

Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice.

Methods

General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed using a mixed effects logistic regression model, accommodating for clustering at GP level.

Results

Testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included a lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing.

Conclusions

A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments. Further research is required to determine if financial incentives can increase testing in Australian general practice, the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package.

Trial Registration

Australian New Zealand Clinical Trial Registry ACTRN12608000499381.
Appendix
Available only for authorised users
Literature
1.
2.
Cates WJ, Wasserheit J: Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol. 1991, 164 (6): 1771-1781.CrossRefPubMed
3.
Peipert JF: Clinical practice. Genital chlamydial infections. N Engl J Med. 2003, 349 (25): 2424-2430. 10.1056/NEJMcp030542.CrossRefPubMed
4.
Harris M, Bennett J, Del Mar C, Fasher M, Foreman L, Johnson C, Joyner B, Litt J, Mazza D, Smith J, Tomlins R, Bailey L, London J, Snowdon T: Guidelines for preventative activities in general practice. 2009, Melbourne, Australia: Royal Australian College of General Practitioners
5.
Hocking JS, Walker J, Regan D, Chen MY, Fairley CK: Chlamydia screening - Australia should strive to achieve what others have not. Med J Aust. 2008, 188 (2): 106-108.PubMed
6.
Medicare Australia: Medical Benefits Schedule Item numbers 69316, 69317 and 69319. 2007
7.
Regan D, Wilson D, Hocking J: Coverage is the key for effective screening of Chlamydia trachomatis in Australia. J Infect Dis. 2008, 198: 349-358. 10.1086/589883.CrossRefPubMed
8.
Allison JJ, Kiefe CI, Wall T, Casebeer L, Ray MN, Spettell CM, Hook EW, Oh MK, Person SD, Weissman NW: Multicomponent Internet continuing medical education to promote chlamydia screening. Am J Prev Med. 2005, 28 (3): 285-290. 10.1016/j.amepre.2004.12.013.CrossRefPubMed
9.
Verhoeven V, Avonts D, Vermeire E, Debaene L, Van Royen P: A short educational intervention on communication skills improves the quality of screening for Chlamydia in GPs in Belgium: a cluster randomised controlled trial. Patient Educ Couns. 2005, 57 (1): 101-105. 10.1016/j.pec.2004.05.001.CrossRefPubMed
10.
Walker J, Walker S, Fairley C, Gunn J, Pirotta M, Gurrin L, Carter R, Hocking J: Computer reminders for chlamydia screening in general practice: A randomised controlled trial. Sex Transm Dis. 2010,
11.
Bowden FJ, Currie MJ, Toyne H, McGuiness C, Lim LL, Butler JR, Glasgow NJ: Screening for Chlamydia trachomatis at the time of routine Pap smear in general practice: a cluster randomised controlled trial. Med J Aust. 2008, 188 (2): 76-80.PubMed
12.
Bilardi J, Sanci L, Fairley C, Hocking J, Mazza D, Henning D, Sawyer S, Wills M, Wilson D, Chen M: The experience of providing young people attending general practice with an online risk assessment tool to assess their own sexual health risk. BMC Infect Dis. 2009, 9: 29-10.1186/1471-2334-9-29. DOI:10.1186/1471-2334-9-29CrossRefPubMedPubMedCentral
13.
Hocking J, Parker R, Pavlin N, Fairley C, Gunn J: What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners. BMC Public Health. 2008, 8 (1): 425-10.1186/1471-2458-8-425.CrossRefPubMedPubMedCentral
14.
McNulty CA, Freeman E, Bowen J, Shefras J, Fenton KA: Barriers to opportunistic chlamydia testing in primary care. Br J Gen Pract. 2004, 54: 508-514.PubMedPubMedCentral
15.
Merritt TD, Durrheim DN, Hope K, Byron P: General practice intervention to increase opportunistic screening for chlamydia. Sex Health. 2007, 4 (4): 249-251. 10.1071/SH07033.CrossRefPubMed
16.
Boyden A, Carter R: The appropriate use of financial incentives to encourage preventative care in general practice. Centre for Health Program Evaluation. 2000, Research Report 18: 1-25.
17.
Petersen L, Woodard L, Urech T, Daw C, Sookanan S: Does pay-for-performance improve the quality of health care?. Ann Intern Med. 2006, 145 (4): 265-272.CrossRefPubMed
18.
Town R, Kane R, Johnson P, Butler M: Economic incentives and physicians' delivery of preventative care: A systematic review. Am J Prev Med. 2005, 28 (2): 234-240. 10.1016/j.amepre.2004.10.013.CrossRefPubMed
19.
Pimenta JM, Catchpole M, Rogers PA, Perkins E, Jackson N, Carlisle C, Randall S, Hopwood J, Hewitt G, Underhill G, Mallison H, McLean L, Gleave T, Tobin J, Harinda V, Ghosh A: Opportunistic screening for genital chlamydial infection. I: Acceptability of urine testing in primary and secondary healthcare settings. Sex Transm Infect. 2003, 79 (1): 16-21. 10.1136/sti.79.1.16.CrossRefPubMedPubMedCentral
20.
21.
22.
23.
Royal Australasian College of Physicians: Clinical guidelines for the management of sexually transmissible infections among priority populations. 2004, Sydney, NSW: Royal Australasian College of Physicians, Australasian Chapter of Sexual Health Medicine
24.
25.
Health Insurance Commission: Medicare Benefits Schedule Item numbers 69369 & 69370. 2005
26.
StataCorp: Stata Statistical Software: Release 10.2. 2007, College Station, TX: Stata Corporation
27.
SPSS Inc: Statistical Package for the Social Sciences (SPSS) 17.0. Chicago, IL. 2006
28.
Chaix-Couturier C, Durand-Zaleski I, Jolly D, Durieux P: Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues. Int J Qual Health Care. 2000, 12 (2): 133-142. 10.1093/intqhc/12.2.133.CrossRefPubMed
29.
Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes (Review). Cochrane Database Syst Rev. 2006, CD000259-DOI: 000210.001002/14651858.CD14000259.pub14651852, 2
30.
Bissell M: Chlamydia screening programs: A review of the literature. Part 2: Testing procedures and educational interventions for primary care physicians. Can J Hum Sex. 2006, 15 (1): 13-22.
31.
Ginige S, Fairley CK, Hocking JS, Bowden FJ, Chen MY: Interventions for increasing chlamydia screening in primary care: a review. BMC Public Health. 2007, 7: 95-10.1186/1471-2458-7-95.CrossRefPubMedPubMedCentral
32.
Wiesenfeld HC, Dennard-Hall K, Cook RL, Ashton M, Zamborsky T, Krohn MA: Knowledge about sexually transmitted diseases in women among primary care physicians. Sex Transm Dis. 2005, 32 (11): 649-653. 10.1097/01.olq.0000175393.71642.c8.CrossRefPubMed
33.
Grol R: Changing physicians competence and performance: Finding the balance between the individual and the organization. J Contin Educ Health Prof. 2002, 22: 244-251. 10.1002/chp.1340220409.CrossRefPubMed
34.
Ma R: With appropriate incentives, general practice can improve the coverage of the National Chlamydia Screening Programme. Br J Gen Pract. 2006, 56: 892-893.PubMedPubMedCentral
35.
Santer M, Warner P, Wyke S, Sutherland S: Opportunistic screening for chlamydia infection in general practice: can we reach young women?. J Med Screen. 2000, 7: 175-176. 10.1136/jms.7.4.175.CrossRefPubMed
36.
Boyden A, Carter R: The appropriate use of financial incentives to encourage preventative care in general practice. Centre for Health Program Evaluation. 2000, Research Report 18: 1-25.
37.
Grimshaw J, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Frilli R, Harvey E, Oxman A, O'Brien MA: Changing provider behaviour: An overview of systematic reviews of interventions. Med Care. 2001, 39 (8): 2-45. 10.1097/00005650-200108002-00002.
38.
Smith W: Evidence for the effectivess of techniques to change physician behaviour. Chest. 2000, 118: 8-17. 10.1378/chest.118.2_suppl.8S.CrossRef
39.
Shea S, DuMouchel W, Bahamonde L: A meta-analysis of 16 randomised controlled trials to evaluate computer based clinical reminder systems for preventative care in the ambulatory setting. J Am Med Inform Assoc. 1996, 3: 399-409.CrossRefPubMedPubMedCentral
40.
Austin S, Balas E, Mitchell J, Ewigman B: Effect of physician reminders on preventative care: meta-analysis of randomised clinical trials. Proc Annu Symp Comput Appl Med Care. 1994, 121-124.
41.
Dexheimer JW, Talbot TR, Sanders DL, Rosenbloom ST, Aronsky D: Prompting Clinicians about Preventive Care Measures: A Systematic Review of Randomized Controlled Trials. J Am Med Inform Assoc. 2008, 15 (3): 311-320. 10.1197/jamia.M2555.CrossRefPubMedPubMedCentral
Metadata
Title
Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial
Authors
Jade E Bilardi
Christopher K Fairley
Meredith J Temple-Smith
Marie V Pirotta
Kathleen M McNamee
Siobhan Bourke
Lyle C Gurrin
Margaret Hellard
Lena A Sanci
Michelle J Wills
Jennifer Walker
Marcus Y Chen
Jane S Hocking
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-70

Other articles of this Issue 1/2010

BMC Public Health 1/2010 Go to the issue

Research article

High risk behavior for HIV transmission among former injecting drug users:a survey from Indonesia

Study protocol

The effect of gold kiwifruit consumed with an iron fortified breakfast cereal meal on iron status in women with low iron stores: A 16 week randomised controlled intervention study

Research article

Vitamin D status among adults in the Aegean region of Turkey

Research article

A primary health-care intervention on pre- and postnatal risk factor behavior to prevent childhood allergy. The Prevention of Allergy among Children in Trondheim (PACT) study

Debate

Prevention among immigrants: the example of Germany

Study protocol

Healthy eating and obesity prevention for preschoolers: a randomised controlled trial