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How did a Quality Premium financial incentive influence antibiotic prescribing in primary care? Views of Clinical Commissioning Group and general practice professionals
- Source :
- The journal of antimicrobial chemotherapy
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
Abstract
- BackgroundThe Quality Premium (QP) was introduced for Clinical Commissioning Groups (CCGs) in England to optimize antibiotic prescribing, but it remains unclear how it was implemented.ObjectivesTo understand responses to the QP and how it was perceived to influence antibiotic prescribing.MethodsSemi-structured telephone interviews were conducted with 22 CCG and 19 general practice professionals. Interviews were analysed thematically.ResultsThe findings were organized into four categories. (i) Communication: this was perceived as unstructured and infrequent, and CCG professionals were unsure whether they received QP funding. (ii) Implementation: this was influenced by available local resources and competing priorities, with multifaceted and tailored strategies seen as most helpful for engaging general practices. Many antimicrobial stewardship (AMS) strategies were implemented independently from the QP, motivated by quality improvement. (iii) Mechanisms: the QP raised the priority of AMS nationally and locally, and provided prescribing targets to aim for and benchmark against, but money was not seen as reinvested into AMS. (iv) Impact and sustainability: the QP was perceived as successful, but targets were considered challenging for a minority of CCGs and practices due to contextual factors (e.g. deprivation, understaffing). CCG professionals were concerned with potential discontinuation of the QP and prescribing rates levelling off.ConclusionsCCG and practice professionals expressed positive views of the QP and associated prescribing targets and feedback. The QP helped influence change mainly by raising the priority of AMS and defining change targets rather than providing additional funding. To maximize impact, behavioural mechanisms of financial incentives should be considered pre-implementation.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Quality management
Project commissioning
media_common.quotation_subject
General Practice
030106 microbiology
MEDLINE
Antibiotic prescribing
03 medical and health sciences
0302 clinical medicine
Nursing
Humans
Antimicrobial stewardship
Pharmacology (medical)
Quality (business)
030212 general & internal medicine
Practice Patterns, Physicians'
Biology
media_common
Pharmacology
Motivation
Primary Health Care
Pharmacology. Therapy
Anti-Bacterial Agents
Infectious Diseases
Incentive
England
General practice
Human medicine
Psychology
Subjects
Details
- ISSN :
- 14602091 and 03057453
- Volume :
- 75
- Database :
- OpenAIRE
- Journal :
- Journal of Antimicrobial Chemotherapy
- Accession number :
- edsair.doi.dedup.....58f2679f1849510849decc4d26a7d5a0