Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial.
BACKGROUND
Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice.


METHODS
General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed using a mixed effects logistic regression model, accommodating for clustering at GP level.


RESULTS
Testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included a lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing.


CONCLUSIONS
A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments. Further research is required to determine if financial incentives can increase testing in Australian general practice, the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package.


BACKGROUND
Australian New Zealand Clinical Trial Registry ACTRN12608000499381.
Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia. jbilardi@mshc.org.au
Jade E
JE
Bilardi
Christopher K
CK
Fairley
Meredith J
MJ
Temple-Smith
Marie V
MV
Pirotta
Kathleen M
KM
McNamee
Siobhan
S
Bourke
Lyle C
LC
Gurrin
Margaret
M
Hellard
Lena A
LA
Sanci
Michelle J
MJ
Wills
Jennifer
J
Walker
Marcus Y
MY
Chen
Jane S
JS
Hocking
D000293:Adolescent; D001291:Attitude of Health Personnel; D002689:Chlamydia / Q000302:isolation & purification*; D002690:Chlamydia Infections / Q000175:diagnosis*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D010821:Physicians, Family / Q000191:economics*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires; D014739:Victoria; D055815:Young Adult