Impact of pay for performance on prescribing of long-acting reversible contraception in primary care: an interrupted time series study.
BACKGROUND
The aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care.


METHODS
Negative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants.


RESULTS
Prescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios  = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR =  1.20, 95% CI =  1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced.


CONCLUSIONS
Pay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods.
Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
Myat E
ME
Arrowsmith
Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
Azeem
A
Majeed
Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
John Tayu
JT
Lee
Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
Sonia
S
Saxena
D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000191:economics*; D005260:Female; D006801:Humans; D011320:Primary Health Care / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics* / Q000458:organization & administration
D003271:Contraceptive Agents, Female