Hamilton F L, Laverty A A, Gluvajic D, Huckvale K, Car J, Majeed A, Millett C
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.
J Public Health (Oxf). 2014 Sep;36(3):450-9. doi: 10.1093/pubmed/fdt121. Epub 2013 Dec 26.
Alcohol screening and brief intervention (ASBI) is effective but underprovided in primary care. Financial incentives may help address this. This study assesses the impact of a local pay-for-performance programme on delivery of ASBI in UK primary care.
Longitudinal study using data from 30 general practices in north-west London from 2008 to 2011 with logistic regression to examine disparities in ASBI delivery.
Of 211 834 registered patients, 45 040 were targeted by the incentive (cardiovascular conditions or high risk; mental health conditions), of whom 65.7% were screened (up from a baseline of 4.8%, P < 0.001), compared with 14.7% of non-targeted patients (P < 0.001). Screening rates were lower after adjustment in younger patients, White patients, less deprived areas and in patients with mental health conditions (P < 0.05). Of those screened, 11.5% were positive and 88.6% received BI. Men and White patients were significantly more likely to screen positive. Women and younger patients were less likely to receive BI. 30.1% of patients re-screened were now negative. However, patients with mental health conditions were less likely to re-screen negative than those with cardiovascular conditions.
Financial incentives appear to be effective in increasing delivery of ASBI in primary care and may reduce hazardous and harmful drinking in some patients. The findings support universal rather than targeted screening.
酒精筛查与简短干预（ASBI）有效，但在初级医疗保健中提供不足。经济激励措施可能有助于解决这一问题。本研究评估了一项地方绩效薪酬计划对英国初级医疗保健中ASBI实施情况的影响。
采用2008年至2011年伦敦西北部30家全科诊所的数据进行纵向研究，并使用逻辑回归分析来检验ASBI实施情况的差异。
在211834名注册患者中，45040名患者被激励措施纳入目标人群（患有心血管疾病或高危人群；患有心理健康疾病），其中65.7%接受了筛查（从基线的4.8%上升，P<0.001），而非目标人群的筛查率为14.7%（P<0.001）。在年轻患者、白人患者、贫困程度较低地区的患者以及患有心理健康疾病的患者中，调整后筛查率较低（P<0.05）。在接受筛查的患者中，11.5%呈阳性，88.6%接受了简短干预。男性和白人患者筛查呈阳性的可能性显著更高。女性和年轻患者接受简短干预的可能性较小。再次接受筛查的患者中有30.1%现在呈阴性。然而，患有心理健康疾病的患者再次筛查呈阴性的可能性低于患有心血管疾病的患者。
经济激励措施似乎有助于提高初级医疗保健中ASBI的实施率，并可能减少部分患者的危险和有害饮酒行为。研究结果支持进行普遍筛查而非针对性筛查。
