Reader in Primary Care, UK Centre for Tobacco Control Studies, Division of Primary Care, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
BMC Public Health. 2010 Mar 26;10:167. doi: 10.1186/1471-2458-10-167.
A substantial fraction of UK general practitioners' salaries is now intended to reflect the quality of care provided. This performance-related pay system has probably improved aspects of primary health care but, using the observational data available, disentangling the impacts of different types of targets set within this unique payment system is challenging.
Financial incentives undoubtedly influence GPs' activities, however, those aimed at encouraging GPs' delivery of health promotion counselling may not always have the effects intended. There is strong, observational evidence that targets and incentives intended to increase smoking cessation counselling by GPs have merely increased their propensity to record this activity in patients' medical records. The limitations of using financial incentives to stimulate the delivery of counselling in primary care are discussed and a re-appraisal of their use within UK GPs' performance-related pay system is argued for.
The utility of targets employed by the system for UK General Practitioners' performance related pay may be inappropriate for encouraging the delivery of health promotion counselling interventions. An evaluation of these targets is essential before they are further developed or added to.
目前，英国相当一部分全科医生的薪酬旨在反映其提供的医疗服务质量。这种与绩效挂钩的薪酬制度可能改善了初级卫生保健的某些方面，但利用现有的观察性数据，要厘清在这一独特支付系统中设定的不同类型目标的影响具有一定难度。
经济激励无疑会影响全科医生的行为，但旨在鼓励全科医生开展健康促进咨询的激励措施并不总是能达到预期效果。有强有力的观察证据表明，旨在提高全科医生戒烟咨询率的目标和激励措施，仅仅增加了他们在患者病历中记录这项活动的意愿。本文讨论了使用经济激励措施来促进初级保健中的咨询服务的局限性，并主张对英国全科医生绩效薪酬体系中使用这些激励措施进行重新评估。
英国全科医生绩效薪酬系统中使用的目标对于鼓励提供健康促进咨询干预措施的效果可能并不合适。在进一步开发或添加这些目标之前，对这些目标进行评估是必要的。
