title: Effect of financial incentives on delivery of alcohol screening and brief intervention (ASBI) in primary care: longitudinal study.
abstract: BACKGROUND
  Alcohol screening and brief intervention (ASBI) is effective but underprovided in primary care. Financial incentives may help address this. This study assesses the impact of a local pay-for-performance programme on delivery of ASBI in UK primary care.
  
  
  METHODS
  Longitudinal study using data from 30 general practices in north-west London from 2008 to 2011 with logistic regression to examine disparities in ASBI delivery.
  
  
  RESULTS
  Of 211 834 registered patients, 45 040 were targeted by the incentive (cardiovascular conditions or high risk; mental health conditions), of whom 65.7% were screened (up from a baseline of 4.8%, P < 0.001), compared with 14.7% of non-targeted patients (P < 0.001). Screening rates were lower after adjustment in younger patients, White patients, less deprived areas and in patients with mental health conditions (P < 0.05). Of those screened, 11.5% were positive and 88.6% received BI. Men and White patients were significantly more likely to screen positive. Women and younger patients were less likely to receive BI. 30.1% of patients re-screened were now negative. However, patients with mental health conditions were less likely to re-screen negative than those with cardiovascular conditions.
  
  
  CONCLUSIONS
  Financial incentives appear to be effective in increasing delivery of ASBI in primary care and may reduce hazardous and harmful drinking in some patients. The findings support universal rather than targeted screening.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: F L
authors.initials: FL
authors.lastname: Hamilton
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Laverty
authors.affiliation: Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.
authors.forename: D
authors.initials: D
authors.lastname: Gluvajic
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: K
authors.initials: K
authors.lastname: Huckvale
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: J
authors.initials: J
authors.lastname: Car
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: C
authors.initials: C
authors.lastname: Millett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D008131:London; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D055815:Young Adult
keywords: alcohol; inequalities; prevention; primary care; screening