RT Journal Article
SR Electronic
T1 “It’s What We Should be doing Anyway”: Financial Incentives for Relational Continuity in Australian General Practice
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 4083
DO 10.1370/afm.21.s1.4083
VO 21
IS Supplement 1
A1 Russell, Grant
A1 Westbury, Susannah
A1 Advocat, Jenny
A1 Peterson, Gregory
A1 Eckermann, Simon
A1 Radford, Jan
A1 Metusela, Christine
A1 Bonney, Andrew
A1 Mazza, Danielle
A1 Zwar, Nicholas
A1 Batterham, Marijka
YR 2023
UL http://www.annfammed.org/content/21/Supplement_1/4083.abstract
AB Context: Relational continuity is a core value of primary care. Little is known as to how it can be promoted. EQuIP-GP was a 12-month cluster RCT in 36 practices exploring whether financial incentives can improve relational continuity in general practice (GP).Objective: We examined a) how financial incentives are perceived and experienced by patients and GP teams and b) how routines related to relational continuity are influenced by financial incentives.Study Design: Mixed methods case study.Setting: Maximum variation sample of 6 (2 per state) of the 18 EQuIP-GP intervention practices from the Australian states of New South Wales, Victoria and Tasmania.Population: Each practice provided quantitative data on 30 patients aged ≥55 and qualitative data from patients, GPs, practice nurses (PN) and practice managers (PM).Intervention: Intervention practices received quality-linked financial incentives for offering longer consultations and early post-hospital review for enrolled patients. Outreach facilitators worked with practices to modify continuity routines.Instruments: Baseline practice attributes survey; Patient Primary Care Assessment Tool (PCAT); semi-structured interviews (13 patients, 10 GPs, 1 PN and 5 PMs). The 3 facilitators collected reflective notes of practice visits and participated in post-study interviews.Outcome Measures: Change in pre-post PCAT relational continuity using paired t-tests and one-way ANOVA. Qualitative “practice intervention narratives” helped investigate the response to the intervention and concepts about financial incentives. Results. As with the EQuIP-GP trial, there was no change in relational continuity - PCAT and interview data both suggesting continuity was high at baseline. Participants saw relational continuity as a core component of primary care that should not need incentivising, seeing incentives as a “blunt instrument”. Both patients and GPs favoured rewarding, rather than incentivising, quality care. Many felt that Equip-GP’s incentive model increased attention to pre-existing routines rather than facilitating new ways of working.Conclusions: While financial incentives can help practices identify how existing routines can influence continuity, incentives for this core component of primary care seem better framed as a reward for good practice rather than an incentive for improvement. Further research could explore these issues in practices with lower baseline continuity of care.