Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

Jan, Chyi-Feng; Lee, Meng-Chih; Chiu, Ching-Ming; Huang, Cheng-Kuo; Hwang, Shinn‐Jang; Chang, Che-Jui; Chiu, Tai-Yuan

doi:10.1186/s12875-020-01118-9

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…Interviewed physicians saw P4P strategies as a key element for behavior change, yet the uptake in ARena did not match this perception. A recent survey study conducted among family physicians to understand awareness and attitudes towards participation in P4P programs identified major reasons for rejecting additional reimbursements in increased loads of administrative work (79.6%) and inadequate understandings of the P4P content (62.9%) [40]. This cannot be supported by our data, but could explain the heterogenous results.…”

Section: Comparison To Prior Researchcontrasting

confidence: 73%

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Poß-Doering¹,

Kühn²,

Kamradt³

et al. 2020

Preprint

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The cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted the appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation aimed to provide insights into determinants of practice and explored factors associated with antibiotic prescribing patterns. In a nested mixed-methods approach, a three-waves survey used study-specific questionnaires for participating physicians and medical assistants to assess potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews with a purposive sample of physicians, medical assistants and stakeholders explored aspects regarding the acceptance of the program components for daily practice and the perceived sustainability of intervention component effects. The intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for the educational components: feedback reports, background information, e-learning modules, and disease specific quality circles. Participation in PCNs was seen as motivational factor for guideline-oriented patient care and the adoption of new routines Future approaches to fostering appropriate use of antibiotics by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

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Section: Comparison To Prior Researchcontrasting

confidence: 73%

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Poß-Doering¹,

Kühn²,

Kamradt³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, additional compensation might only be an incentive to participate in a study, but of lesser importance after this decision is taken [ 41 ]. Jan et al [ 46 ] also identified increased administrative workloads and inadequate understandings of performance-based payment contents as principal reasons for aversions of family practitioners to engage. These aspects are not echoed in this study but can be considered for explanation.…”

Section: Discussionmentioning

confidence: 99%

Implementation fidelity in a multifaceted program to foster rational antibiotics use in primary care: an observational study

Kühn

Kronsteiner

Kaufmann‐Kolle³

et al. 2022

BMC Med Res Methodol

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Background The ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program. Methods This observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants’ views on five domains of the implementation were also measured. Binary logistic and multiple linear regression analyses were used to explore which views on the implementation were associated with participants’ adherence to quality circles and use of additional bonus compensation. Results The analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n = 158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants’ views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants’ views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance. Conclusion This study showed an overall high fidelity to the implementation program. Participants’ views on the implementation were associated with degree of intervention fidelity. Trial registration ISRCTN, ISRCTN58150046.

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“…However, additional compensation might only be an incentive to participate in a study, but of lesser importance after this decision is taken [39]. Jan et al [44] also identi ed increased administrative workloads and inadequate understandings of performance-based payment contents as principal reasons for aversions of family practitioners to engage. These aspects are not echoed in this study but can be considered for explanation.…”

Section: Discussionmentioning

confidence: 99%

Implementation Fidelity In A Multifaceted Program To Foster Rational Antibiotics Use In Primary Care: An Observational Study

Kühn¹,

Kronsteiner²,

Kaufmann‐Kolle³

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundThe ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program.MethodsThis observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants’ views on five domains of the implementation were also measured. Binary logistic and linear regression analyses were used to explore which views on the implementation were associated with participants’ adherence to quality circles and use of additional bonus compensation. ResultsThe analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n=158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants’ views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants’ views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance.ConclusionThis study showed an overall high fidelity to the implementation program. Participants’ views on the implementation were associated with degree of intervention fidelity. Trial registration: ISRCTN, ISRCTN58150046

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Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

Cited by 6 publications

References 29 publications

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Implementation fidelity in a multifaceted program to foster rational antibiotics use in primary care: an observational study

Implementation Fidelity In A Multifaceted Program To Foster Rational Antibiotics Use In Primary Care: An Observational Study

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