Impact of contractual financial incentives on the ascertainment and management of smoking in primary care
Impact of contractual financial incentives on the ascertainment and management of smoking in primary care
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DOI：
10.1111/j.1360-0443.2007.01766.x
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发表时间：
2007-05-01
期刊：
影响因子：
6
通讯作者：
Smith, Christopher
中科院分区：
文献类型：
--
作者：
Coleman, Tim;Lewis, Sarah;Smith, Christopher
背景2004年4月签订的英国全科医生(GP)合同是一项雄心勃勃的尝试，目的是在临床实践中产生实质性的变化。我们调查了这对提供初级保健戒烟干预的影响。方法我们分析了患者医疗记录中的数据，这些数据保存在一个名为健康改善网络(Thin)的大型数据库中。我们计算了从1990年到2005年的每一年和从2003年开始的每个季度的医疗记录中记录吸烟状态的发生率，以及吸烟者接受全科医生的戒烟建议和尼古丁成瘾治疗处方的发生率。调查结果显示，吸烟情况在1993-2004年前后暂时增加，然后从2000年开始逐渐增加。与2003年相比，这一增长更为明显，2003年第一季度至2004年第一季度的增幅为88%。后一个季度正好是在引入全科医生合同之前，在接下来的一年中，记录吸烟状况的比率保持较高水平。在吸烟者中，记录的接受过短暂戒烟建议的比例也有大致相似的模式。然而，尽管尼古丁成瘾治疗的处方自2000年以来急剧增加，但这一趋势与2003年相比并没有明显的加速。解释2004年的全科医生合同增加了吸烟状况的初级保健率，并记录了反对吸烟的建议。如果这份合同还改善了全科医生对尼古丁成瘾治疗的处方，那么这份合同对公众健康的影响可能会最大化。
Background The April 2004 contract for UK general practitioners (GPs) is an ambitious attempt to produce substantial changes in clinical practice. We investigated the impact of this on delivery of primary care smoking cessation interventions. Methods We analysed data from patients' medical records that were held within a large database called The Health Improvement Network (THIN). We calculated for each year between 1990 and 2005 and for each quarter-year from 2003 the incidence of recording of smoking status in medical records and, in smokers, the receipt of GPs' smoking cessation advice and prescriptions for nicotine addiction treatments. Findings Recording of smoking status increased temporarily around 1993-4 and then rose gradually from the year 2000. This rise was more marked from 2003, with an 88% increase between the first quarters of 2003 and 2004. The latter quarter was just prior to the introduction of the GP contract and higher rates of recording smoking status were sustained for the subsequent year. In smokers, there was a broadly similar pattern for the proportion recorded as having received brief cessation advice. However, while there was a sharp increase in prescriptions for nicotine addiction treatments from 2000, no comparable acceleration in this trend from 2003 was apparent. Interpreation The 2004 GP contract increased primary care rates of smoking status ascertainment and recording of advice against smoking. The public health impact of this contract could be maximized if it also improved GPs' prescribing of nicotine addiction treatments.