Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2023 Aug 16;13(8):e074154. doi: 10.1136/bmjopen-2023-074154.
Adolescence is a period of major transition in physical, cognitive, social and emotional development, and the peak time for the onset of mental health conditions, substance use disorders and sexual and reproductive health risks. Prevention and treatment during this time can improve health and well-being now and into the future. However, despite clinical guidelines recommending annual preventive health assessments for young people, health professionals cite lack of consultation time and adequate funding as key barriers. This trial aims to determine whether a specific fee-for-service ('rebate payment') for a young person's health assessment, is effective and cost-effective at increasing the detection and management of health risk behaviours and conditions among young people.
This cluster randomised controlled trial will be conducted in Australian general practice. 42 general practices (clusters) will be randomly allocated 1:1 to either an intervention arm where general practitioners receive a rebate payment for each annual health assessment undertaken for 14-24-year-olds during a 2 year study period, or a control arm (no rebate). The rebate amount will be based on the Medical Benefits Schedule (Australia's list of health professional services subsidised by the Australian Government) currently available for similar age-based assessments. Our primary outcome will be the annual rate of risk behaviours and health conditions recorded in the patient electronic health record (eg, alcohol/drug use, sexual activity and mental health issues). Secondary outcomes include the annual rate of patient management activities related to health risks and conditions identified (eg, contraception prescribed, sexually transmitted infection tests ordered). A process evaluation will assess acceptability, adoption, fidelity and sustainability of the rebate; an economic evaluation will assess its cost-effectiveness. Analyses will be intention-to-treat.
Ethics approval has been obtained from University of Melbourne Human and Research Ethics Committee (2022-23435-29990-3). Findings will be published in peer-reviewed journals.
ACTRN12622000114741.
青春期是身体、认知、社会和情感发展的重大转变时期，也是心理健康状况、物质使用障碍和性与生殖健康风险开始出现的高峰期。在此期间进行预防和治疗可以改善现在和未来的健康和福祉。然而，尽管临床指南建议对年轻人进行年度预防保健评估，但卫生专业人员表示缺乏咨询时间和充足的资金是主要障碍。这项试验旨在确定为年轻人的健康评估收取特定的服务费用（“回扣支付”）是否能有效且具有成本效益地增加年轻人健康风险行为和状况的检测和管理。
这是一项在澳大利亚普通实践中进行的集群随机对照试验。42 个普通实践（集群）将被随机分配 1:1 到干预组或对照组。在 2 年的研究期间，干预组中的普通医生为 14-24 岁的年轻人进行的每一次年度健康评估收取回扣，而对照组则不收取回扣。回扣金额将基于澳大利亚政府为类似年龄的评估提供的医疗福利计划（澳大利亚政府补贴的医疗专业服务清单）。我们的主要结果将是患者电子健康记录中记录的每年风险行为和健康状况的发生率（例如，酒精/药物使用、性行为和心理健康问题）。次要结果包括与识别出的健康风险和状况相关的每年患者管理活动的发生率（例如，开具避孕措施、订购性传播感染检测）。过程评估将评估回扣的可接受性、采用、保真度和可持续性；经济评估将评估其成本效益。分析将采用意向治疗。
墨尔本大学人类研究伦理委员会已批准该研究（2022-23435-29990-3）。研究结果将发表在同行评议的期刊上。
ACTRN12622000114741。
