Financial incentives linked to quality improvement projects in Swedish primary care: a model for improving quality of care

Fernholm, Rita; Arvidsson, Eva; Wettermark, Björn

doi:10.1136/bmjoq-2018-000402

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…In fact, a recent study from the UK reported that only 20% of GPs and 33% of practice managers knew about the PDSA model [ 62 ]. Financial incentives for using PDSA in QI in Swedish PC have been tested [ 63 ] but the impact on the care provided is yet to be studied. Although they accepted the need for external support, the participants in our study stressed the need to adapt the methods of QI to their own needs and capabilities, and to focus on results rather than strict compliance with methods.…”

Section: Discussionmentioning

confidence: 99%

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

2021

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Background High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement. Methods We used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis. Results Four different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres. Conclusions Professionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.

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Section: Discussionmentioning

confidence: 99%

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

2021

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“…immunisation) and non-financial incentives (i.e. continuing professional development -CPD points) to promote the recording and monitoring of medicinal cannabis prescribing by GPs (Fernholm et al 2019;Hallinan 2019).…”

Section: Discussionmentioning

confidence: 99%

Use of electronic medical records to monitor the safe and effective prescribing of medicinal cannabis: is it feasible?

Hallinan

Gunn

Bonomo

2022

Aust. J. Prim. Health

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Background. General practitioners are well positioned to contribute to the pharmacovigilance of medical cannabis via the general practice electronic medical record (EMR). The aim of this research is to interrogate de-identified patient data from the Patron primary care data repository for reports of medicinal cannabis to ascertain the feasibility of using EMRs to monitor medicinal cannabis prescribing in Australia. Methods. EMR rule-based digital phenotyping of 1 164 846 active patients from 109 practices was undertaken to investigate reports of medicinal cannabis use from September 2017 to September 2020. Results. Eighty patients with 170 prescriptions of medicinal cannabis were identified in the Patron repository. Reasons for prescription included anxiety, multiple sclerosis, cancer, nausea, and Crohn's disease. Nine patients showed symptoms of a possible adverse event, including depression, motor vehicle accident, gastrointestinal symptoms, and anxiety. Conclusions. The recording of medicinal cannabis effects in the patient EMR provides potential for medicinal cannabis monitoring in the community. This is especially feasible if monitoring were to be embedded into general practitioner workflow.

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“…This has implications for our findings which suggest a preference for a localised approach to QI. A study in Sweden in which Stockholm general practices were financially incentivised to carry out QI projects, found that the number of QI projects reported more than doubled compared with the year before the intervention 23. It seems likely that this was due to the financial incentivisation, although in the absence of a control group it is not possible to attribute the outcome to the intervention with confidence.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the introduction of QOF quality improvement modules in English general practice: early findings from a rapid, qualitative exploration of implementation

et al. 2022

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BackgroundA 2018 review of the English primary care pay-for-performance scheme, the Quality and Outcomes Framework, suggested that it should evolve to better support holistic, patient-centred care and leadership for quality improvement (QI). From 2019, as part of the vision of change, financially incentivised QI cycles (initially in prescribing safety and end-of-life care), were introduced into the scheme.ObjectivesTo conduct a rapid evaluation of general practice staff attitudes, experiences and plans in relation to the implementation of the first two QI modules. This study was commissioned by NHS England and will inform development of the QI programme.MethodsSemistructured telephone interviews were conducted with 25 practice managers from a range of practices across England. Interviews were audio recorded with consent and transcribed verbatim. Anonymised data were reflexively thematically analysed using the framework method of analysis to identify common themes across the interviews.ResultsParticipants reported broadly favourable views of incentivised QI, suggesting the prescribing safety module was easier to implement than the end-of-life module. Additional staff time needed and challenges of reviewing activities with other practices were reported as concerns. Some highlighted that local flexibility and influence on subject matter may improve the effectiveness of QI. Several questioned the choices of topic, recognising greater need and potential for improving quality of care in other clinical areas.ConclusionPractices supported the idea of financial incentivisation of QI, however, it will be important to ensure that focus on QI cycles in specific clinical areas does not have unintended effects. A key issue will be keeping up momentum with the introduction of new modules each year which are time consuming to carry out for time poor General Practitioners (GPs)/practices.

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Financial incentives linked to quality improvement projects in Swedish primary care: a model for improving quality of care

Cited by 9 publications

References 29 publications

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

Use of electronic medical records to monitor the safe and effective prescribing of medicinal cannabis: is it feasible?

Evaluation of the introduction of QOF quality improvement modules in English general practice: early findings from a rapid, qualitative exploration of implementation

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