title: [Contract for improving professional practices: What is the impact perceived by GPs?].
abstract: BACKGROUND
  The CAPI (contract for improving professional practices) is a voluntary pay for performance scheme for primary care physicians introduced in France in 2009. Our objective was to analyze general practitioners' (GPs) perceptions of the impact of the CAPI on their healthcare practices.
  
  
  METHODS
  The methodology was both qualitative, using thematic analysis of responses to three items of a questionnaire mailed to GPs in 2011, and quantitative using thematic multiple correspondence analysis of responses together with cluster analysis based on the ward aggregation criterion.
  
  
  RESULTS
  A total of 1050 general practitioners answered, 31% had signed a CAPI. For CAPI-participating GPs, the contract was mostly related to changing practices for drug prescription. GPs who did not participate in the CAPI focused on ethical issues. They denounced a conflict of interest between the doctor and the patient and also the risk of patient selection. They connected these concepts to selected indicators. Due to their relationship with the health insurance fund, they feared their freedom of practice would be restricted.
  
  
  CONCLUSIONS
  GP involvement in designing indicators would favor better balance between economic goals and values of care. The patients' viewpoint should be studied. Pay for performance has been renewed in the 2011. Further studies will analyze the impact of this new scheme in a medical and economic perspective.
authors.affiliation: Département de médecine générale, UFR des sciences de la santé Simone-Veil, université Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
authors.forename: F
authors.initials: F
authors.lastname: Laurent
authors.affiliation: CERMES3, UMR 8211, Inserm U988, 94800 Villejuif, France.
authors.forename: J
authors.initials: J
authors.lastname: Sicsic
authors.affiliation: Département de médecine générale, UFR des sciences de la santé Simone-Veil, université Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France. Electronic address: olivier.saint-lary@uvsq.fr.
authors.forename: O
authors.initials: O
authors.lastname: Saint-Lary
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires
keywords: Contract for improvement of individual practices (CAPI); Contrat d’amélioration des pratiques individuelles (CAPI); Fee-for-service; General medicine; Medical practices; Médecine générale; Paiement à la performance; Paiement à l’acte; Pay for performance; Pratiques médicales