title: Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes.
abstract: BACKGROUND
  Many people with diabetes continue to smoke despite being at high risk of cardiovascular disease. We examined the impact of a pay-for-performance incentive in the United Kingdom introduced in 2004 as part of the new general practitioner contract to improve support for smoking cessation and to reduce the prevalence of smoking among people with chronic diseases such as diabetes.
  
  
  METHODS
  We performed a population-based longitudinal study of the recorded delivery of cessation advice and the prevalence of smoking using electronic records of patients with diabetes obtained from participating general practices. The survey was carried out in an ethnically diverse part of southwest London before (June-October 2003) and after (November 2005-January 2006) the introduction of a pay-for-performance incentive.
  
  
  RESULTS
  Significantly more patients with diabetes had their smoking status ever recorded in 2005 than in 2003 (98.8% v. 90.0%, p <0.001). The proportion of patients with documented smoking cessation advice also increased significantly over this period, from 48.0% to 83.5% (p < 0.001). The prevalence of smoking decreased significantly from 20.0% to 16.2% (p < 0.001). The reduction over the study period was lower among women (adjusted odds ratio 0.71, 95% confidence interval 0.53-0.95) but was not significantly different in the most and least affluent groups. In 2005, smoking rates continued to differ significantly with age (10.6%-25.1%), sex (women, 11.5%; men, 20.6%) and ethnic background (4.9%-24.9%).
  
  
  CONCLUSIONS
  The introduction of a pay-for-performance incentive in the United Kingdom increased the provision of support for smoking cessation and was associated with a reduction in smoking prevalence among patients with diabetes in primary health care settings. Health care planners in other countries may wish to consider introducing similar incentive schemes for primary care physicians.
authors.affiliation: Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust, London, England. c.millett@imperial.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.forename: Jeremy
authors.initials: J
authors.lastname: Gray
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
authors.forename: Gopalakrishnan
authors.initials: G
authors.lastname: Netuveli
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000517:prevention & control*; D005194:Family Practice / Q000191:economics* / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000191:economics; D015995:Prevalence; D015397:Program Evaluation; D012052:Reimbursement, Incentive / Q000331:legislation & jurisprudence; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology; D016540:Smoking Cessation / Q000191:economics* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012959:Socioeconomic Factors