Russell Grant, Westbury Susannah, Advocat Jenny, Zwar Nicholas, Metusela Christine, Batterham Marijka, Peterson Gregory M, Mullan Judy, Mazza Danielle, Radford Jan, Eckermann Simon, Bonney Andrew
Department of General Practice, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
School of Primary and Allied Health Care, Building G, Level 3, Monash University, Peninsula Campus, Frankston, Victoria 3199, Melbourne, Australia.
Fam Pract. 2025 Jan 17;42(1). doi: 10.1093/fampra/cmae071.
Relational continuity is a fundamental component of primary care. The 'Quality in General Practice Trial' (EQuIP-GP), was a 12-month cluster randomized trial, designed to investigate whether financial incentives can improve relational continuity in primary care.
To examine (i) how financial incentives are perceived and experienced by primary care patients, providers, and practice staff, and (ii) how clinical and organizational routines related to relational continuity are influenced by the introduction of a financial model designed to incentivize relational continuity.
We used a mixed methods case study approach with six of the intervention arm practices participating in the EQuIP-GP trial.
Semi-structured interviews were conducted with patients, providers, practice staff, and intervention facilitators. Intervention facilitators kept structured diaries to capture reflective notes. To contextualize results, practices completed a modified practice attributes survey and patients completed the Primary Care Assessment Tool at baseline and 12 months.
Patient-perceived relational continuity was not impacted by the intervention. Financial incentives were preferred for rewarding, as opposed to incentivizing, quality care; however, they were perceived as a blunt and inflexible instrument. The introduction of the incentive model increased attention to pre-existing organizational routines rather than creating new ones.
Incentive models should be suitably flexible to accommodate diversity in patient and practice needs. Small changes can be made to existing practice routines that will improve awareness and conscientiousness of relational continuity. Further research should examine how feasible these routine changes would be in practices that do not already focus on continuity.
关系连续性是初级保健的一个基本组成部分。“全科医疗质量试验”（EQuIP-GP）是一项为期12个月的整群随机试验，旨在调查经济激励措施是否能改善初级保健中的关系连续性。
研究（i）初级保健患者、提供者和实践工作人员如何看待和体验经济激励措施，以及（ii）旨在激励关系连续性的财务模型的引入如何影响与关系连续性相关的临床和组织常规。
我们采用了混合方法案例研究方法，干预组的六个实践参与了EQuIP-GP试验。
对患者、提供者、实践工作人员和干预促进者进行了半结构化访谈。干预促进者保留结构化日记以记录反思笔记。为了将结果置于背景中，实践机构完成了一份修改后的实践属性调查，患者在基线和12个月时完成了初级保健评估工具。
患者感知到的关系连续性不受干预影响。经济激励措施更适合用于奖励优质护理，而非激励优质护理；然而，它们被视为一种生硬且不灵活的手段。激励模型的引入增加了对现有组织常规的关注，而非创造新的常规。
激励模型应具有适当的灵活性，以适应患者和实践需求的多样性。可以对现有的实践常规进行小的改变，这将提高对关系连续性的认识和自觉性。进一步的研究应考察这些常规改变在尚未关注连续性的实践中可行性如何。
