Millett Christopher, Gray Jeremy, Saxena Sonia, Netuveli Gopalakrishnan, Majeed Azeem
Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust, London, England.
CMAJ. 2007 Jun 5;176(12):1705-10. doi: 10.1503/cmaj.061556.
Many people with diabetes continue to smoke despite being at high risk of cardiovascular disease. We examined the impact of a pay-for-performance incentive in the United Kingdom introduced in 2004 as part of the new general practitioner contract to improve support for smoking cessation and to reduce the prevalence of smoking among people with chronic diseases such as diabetes.
We performed a population-based longitudinal study of the recorded delivery of cessation advice and the prevalence of smoking using electronic records of patients with diabetes obtained from participating general practices. The survey was carried out in an ethnically diverse part of southwest London before (June-October 2003) and after (November 2005-January 2006) the introduction of a pay-for-performance incentive.
Significantly more patients with diabetes had their smoking status ever recorded in 2005 than in 2003 (98.8% v. 90.0%, p <0.001). The proportion of patients with documented smoking cessation advice also increased significantly over this period, from 48.0% to 83.5% (p < 0.001). The prevalence of smoking decreased significantly from 20.0% to 16.2% (p < 0.001). The reduction over the study period was lower among women (adjusted odds ratio 0.71, 95% confidence interval 0.53-0.95) but was not significantly different in the most and least affluent groups. In 2005, smoking rates continued to differ significantly with age (10.6%-25.1%), sex (women, 11.5%; men, 20.6%) and ethnic background (4.9%-24.9%).
The introduction of a pay-for-performance incentive in the United Kingdom increased the provision of support for smoking cessation and was associated with a reduction in smoking prevalence among patients with diabetes in primary health care settings. Health care planners in other countries may wish to consider introducing similar incentive schemes for primary care physicians.
许多糖尿病患者尽管心血管疾病风险很高，但仍继续吸烟。我们研究了2004年在英国引入的绩效薪酬激励措施的影响，该措施是新的全科医生合同的一部分，旨在加强对戒烟的支持，并降低糖尿病等慢性病患者中的吸烟率。
我们利用从参与研究的全科诊所获取的糖尿病患者电子记录，对戒烟建议的记录提供情况和吸烟率进行了一项基于人群的纵向研究。该调查在伦敦西南部一个种族多样化的地区于引入绩效薪酬激励措施之前（2003年6月至10月）和之后（2005年11月至2006年1月）进行。
2005年记录吸烟状况的糖尿病患者显著多于2003年（98.8%对90.0%，p<0.001）。在此期间，有记录的戒烟建议患者比例也显著增加，从48.0%增至83.5%（p<0.001）。吸烟率从20.0%显著降至16.2%（p<0.001）。研究期间女性的降幅较小（调整后的优势比为0.71，95%置信区间为0.53 - 0.95），但在最富裕和最不富裕群体中没有显著差异。2005年，吸烟率在年龄（10.6% - 25.1%）、性别（女性为11.5%；男性为20.6%）和种族背景（4.9% - 24.9%）方面仍存在显著差异。
英国引入的绩效薪酬激励措施增加了对戒烟的支持，并与初级卫生保健机构中糖尿病患者吸烟率的降低相关。其他国家的卫生保健规划者可能希望考虑为初级保健医生引入类似的激励计划。
