title: Financial Incentives and Inequalities in Smoking Cessation Interventions in Primary Care: Before-and-After Study.
abstract: BACKGROUND
  The Quality and Outcomes Framework (QOF) is a financial incentive scheme that rewards UK general practices for providing evidence-based care, including smoking cessation advice mainly as a secondary prevention intervention. We examined the effects on smoking outcomes and inequalities of a local version of QOF (QOF+), which ran from 2008 to 2011 and extended financial incentives to the provision of cessation advice as a primary prevention intervention.
  
  
  METHODS
  Before-and-after study using data from 28 general practices in Hammersmith & Fulham, London, United Kingdom. We used logistic regression to examine changes in smoking outcomes associated with QOF+ within and between sociodemographic groups.
  
  
  RESULTS
  Recording of smoking status increased from 55.5% to 64.3% for men (P < .001) and from 67.9% to 75.8% for women (P < .001). All groups benefitted from the increase, but younger patients remained less likely to be asked about smoking than older patients. White patients were less likely to be asked than those from other ethnic groups. Smoking cessation advice increased from 32.7% to 54.0% for men (P < .001) and from 35.4% to 54.1% for women (P < .01) and there was little variation between groups for this outcome. Recorded smoking prevalence reduced from 25.0% to 20.8% for men (P < .001) and from 16.1% to 12.5% for women (P < .001). White patients and those from more deprived areas remained more likely to be smokers than other groups.
  
  
  CONCLUSIONS
  The introduction of QOF+ was associated with general improvements in recording of smoking outcomes, but inequalities in ascertainment and smoking prevalence with respect to age, ethnicity, and deprivation persisted.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Fiona L
authors.initials: FL
authors.lastname: Hamilton
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom a.laverty@imperial.ac.uk.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Laverty
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Kit
authors.initials: K
authors.lastname: Huckvale
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055317:Evidence-Based Practice / Q000191:economics / Q000379:methods; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D012201:Reward; D012907:Smoking / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult