Peterson Gregory M, Radford Jan, Russell Grant, Zwar Nicholas, Mullan Judy, Batterham Marijka, Mazza Danielle, Eckermann Simon, Metusela Christine, Saunder Timothy, Kitsos Alex, Bonney Andrew
School of Pharmacy and Pharmacology, University of Tasmania, Sandy Bay, Australia.
Tasmanian School of Medicine, University of Tasmania, Launceston, Australia.
Res Social Adm Pharm. 2023 May;19(5):836-840. doi: 10.1016/j.sapharm.2023.01.011. Epub 2023 Jan 29.
The Effectiveness of Quality Incentive Payments in General Practice (EQuIP-GP) study investigated whether targeted financial incentives promoting access to a preferred general practitioner, post-hospitalisation follow-up and longer consultations, increase patient-perceived relational continuity in primary care. Secondary outcomes included the use of medicines.
To evaluate whether introducing a general practice-level service model incorporating enrolment and continuous and graded quality improvement incentives influenced the total prescriptions written and potentially inappropriate prescribing of medicines.
A 12-month cluster-randomised controlled trial, whereby participating patients within intervention practices were offered enrolment with a preferred general practitioner, a minimum of three longer appointments, and review within seven days of hospital admission or emergency department attendance. Control practice patients received usual care. Differences between intervention and control groups pre-post trial for total prescriptions were analysed, as an indicator of polypharmacy, along with prescriptions for four groups of drugs known to have common quality of medicines issues: antibiotics, benzodiazepines, opioids and proton pump inhibitors (PPIs).
A total of 774 patients, aged 18-65 years with a chronic illness or aged over 65 years, from 34 general practices in metropolitan, regional and rural Australia participated. The mean number of medicine prescriptions per month at baseline was 4.19 (SD 3.27) and 4.34 (SD 3.75) in the control and intervention arms, respectively, with no significant between-group differences in changes pre-post trial and also no significant between-group or within-group differences of prescription rates for antibiotics, benzodiazepines, opioids or PPIs.
Total prescribing volume and the use of key medicines were not influenced by quality-linked financial incentives for offering longer consultations and early post-hospital review for enrolled patients.
全科医疗质量激励支付的有效性（EQuIP-GP）研究调查了针对性的经济激励措施，即促进患者就诊首选全科医生、出院后随访以及延长会诊时间，是否能提高患者在初级医疗中感知到的关系连续性。次要结果包括药物使用情况。
评估引入一种包含注册以及持续和分级质量改进激励措施的全科医疗服务模式是否会影响开具的总处方量以及潜在不适当的药物处方。
一项为期12个月的整群随机对照试验，干预组的参与患者可选择注册一位首选全科医生，至少进行三次较长时间的预约，并在入院或急诊就诊后7天内接受复查。对照组患者接受常规护理。分析试验前后干预组与对照组之间总处方量的差异，以此作为多重用药的指标，同时分析已知存在常见药品质量问题的四类药物的处方情况：抗生素、苯二氮䓬类药物、阿片类药物和质子泵抑制剂（PPI）。
来自澳大利亚大都市、地区和农村的34家全科诊所的774名患者参与了研究，这些患者年龄在18 - 65岁患有慢性病或年龄超过65岁。基线时，对照组和干预组每月的平均药物处方数分别为4.19（标准差3.27）和4.34（标准差3.75），试验前后组间变化无显著差异，抗生素、苯二氮䓬类药物、阿片类药物或PPI的处方率在组间和组内也无显著差异。
对于已注册患者提供延长会诊时间和出院早期复查的质量关联经济激励措施，并未影响总处方量和关键药物的使用。
