چکیده (انگلیسی):

Background:Local and national financial incentives were introduced in England between 2008 and 2015 to
encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and
interviews with General Practitioners (GPs) to assess their impact.
Methods:A sequential explanatory mixed-methods study was conducted in 16 general practices representing
106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief
alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured
interviews with 14 GPs explored which factors influence intervention delivery and recording in routine
consultations.
Results:Screening and brief alcohol intervention rates were higher in financially incentivised compared to nonincentivised practices. However absolute rates were low across all practices. Rates of short screening test
administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in
nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices
(3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol
interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and
lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on
alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive
schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and
GPs’ beliefs about patient-centred practice.
Conclusions:Financial incentives have had some success in encouraging screening and brief alcohol interventions
in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise
alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs
that shape how GPs’ provide care.