O'Donnell, A., Angus, C. orcid.org/0000-0003-0529-4135, Hanratty, B. et al. (3 more authors) (2019) Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care : an interrupted time–series analysis. Addiction, 115 (1). pp. 49-60. ISSN 0965-2140
Abstract
Aim
To evaluate the impact of the introduction and withdrawal of financial incentives on alcohol screening and brief advice delivery in English primary care.
Design
Interrupted time–series using data from The Health Improvement Network (THIN) database. Data were split into three periods: (1) before the introduction of financial incentives (1 January 2006–31 March 2008); (2) during the implementation of financial incentives (1 April 2008–31 March 2015); and (3) after the withdrawal of financial incentives (1 April 2015–31 December 2016). Segmented regression models were fitted, with slope and step change coefficients at both intervention points.
Setting
England.
Participants
Newly registered patients (16+) in 500 primary care practices for 2006–16 (n = 4 278 723).
Measurements
The outcome measures were percentage of patients each month who: (1) were screened for alcohol use; (2) screened positive for higher‐risk drinking; and (3) were reported as having received brief advice on alcohol consumption.
Findings
There was no significant change in the percentage of newly registered patients who were screened for alcohol use when financial incentives were introduced. However, the percentage fell (P < 0.001) immediately when incentives were withdrawn, and fell by a further 2.96 [95% confidence interval (CI) = 2.21–3.70] patients per 1000 each month thereafter. After the introduction of incentives, there was an immediate increase of 9.05 (95% CI = 3.87–14.23) per 1000 patients screening positive for higher‐risk drinking, but no significant further change over time. Withdrawal of financial incentives was associated with an immediate fall in screen‐positive rates of 29.96 (95% CI = 19.56–40.35) per 1000 patients, followed by a rise each month thereafter of 2.14 (95% CI = 1.51–2.77) per 1000. Screen‐positive patients recorded as receiving alcohol brief advice increased by 20.15 (95% CI = 12.30–28.00) per 1000 following the introduction of financial incentives, and continued to increase by 0.39 (95% CI = 0.26–0.53) per 1000 monthly until withdrawal. At this point, delivery of brief advice fell by 18.33 (95% CI = 11.97–24.69) per 1000 patients and continued to fall by a further 0.70 (95% CI = 0.28–1.12) per 1000 per month.
Conclusions
Removing a financial incentive for alcohol prevention in English primary care was associated with an immediate and sustained reduction in the rate of screening for alcohol use and brief advice provision. This contrasts with no, or limited, increase in screening and brief advice delivery rates following the introduction of the scheme.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 Society for the Study of Addiction. This is an author-produced version of a paper subsequently published in Addiction. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Alcohol prevention; financial incentives; interrupted time–series; intervention; policy; primary health‐care; screening |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number National Institute for Health Research School for Primary Care Research (NIHR SPCR) N/A Alcohol Change UK R2016/01 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 10 Oct 2019 09:32 |
Last Modified: | 16 Dec 2021 12:03 |
Status: | Published |
Publisher: | Wiley |
Refereed: | Yes |
Identification Number: | 10.1111/add.14778 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:151988 |