Financial Incentives and Inequalities in Smoking Cessation Interventions in Primary Care
Thursday, June 11, 2015
Posted by: Natalia Gromov
Fiona L. Hamilton, PhD, Anthony A. Laverty, PhD, Kit Huckvale, MBBS, Josip Car, PhD, Azeem Maieed, MD and Christopher Millett, PhD.
Financial Incentives and Inequalities in Smoking Cessation Interventions in Primary Care: Before-and-after Study.
Nicotine Tob Res (2015)doi: 10.1093/ntr/ntv107First published online: May 19, 2015.
The Quality and Outcomes Framework (QOF) is a financial incentive scheme that rewards UK general practices for providing evidence-based care, including smoking cessation advice mainly as a secondary prevention intervention. We examined the effects on smoking outcomes and inequalities of a local version of QOF (QOF+), which ran from 2008 to 2011 and extended financial incentives to the provision of cessation advice as a primary prevention intervention. Methods: Before-and-after study using data from 28 general practices in Hammersmith & Fulham, London, UK. We used logistic regression to examine changes in smoking outcomes associated with QOF+ within and between socio-demographic groups. Results: Recording smoking status increased from 55.5% to 64.2% for men (p<0.001) and from 67.9% to 75.8% for women (p<0.001). All groups benefitted from the increase, but younger patients remained less likely to be asked about smoking than older patients. White patients were less likely to be asked than those from other ethnic groups. Smoking cessation advice increased from 32.7% to 54.0% for men (p<0.001) and from 35.4% to 54.1% for women (p<0.01) and there was little variation between groups for this outcome. Recorded smoking prevalence reduced from 25.0% to 20.8% for men (p<0.001) and from 16.1% to 12.5% for women (p<0.001). White patients and those from more deprived areas remained more likely to be smokers than other groups. Conclusion: The introduction of QOF+ was associated with general improvements in recording of smoking outcomes, but inequalities in ascertainment and smoking prevalence with respect to age, ethnicity and deprivation persisted.