title: Commitment questions targeting patients promotes uptake of under-used health services: Findings from a national quality improvement program in Australia.
abstract: BACKGROUND
  Interventions asking patients to commit to speaking with their doctor about a health-related issue could be used to improve quality of care.
  
  
  OBJECTIVE
  To evaluate the impact of commitment questions targeting patients on the uptake of recommended health services within a national quality improvement program (Veterans' MATES).
  
  
  METHODS
  Patients targeted in the home medicines reviews (HMRs), dose administration aids (DAAs), renal function testing and diabetes interventions were posted educational information and response forms which asked whether they intended to talk to their general practitioner (GP) about the targeted service. Uptake of the service after each intervention was determined using health claims data. Log binomial regression models compared the monthly rate of service use in the nine months post-intervention among patients answering 'yes' to a commitment question with non-responders and patients answering 'no' or 'unsure'.
  
  
  RESULTS
  Each intervention targeted up to 58,000 patients. The average response rate was 28%. Positive responses were associated with increased uptake of HMRs (rate ratio (RR) 2.64, 95% CI 2.39-2.92; p < 0.0001), dose administration aids (RR 2.53, 95% CI 2.29-2.79; p < 0.0001), renal function tests (RR 1.18, 95% CI 1.13-1.24; p < 0.0001), GP management plans (RR 1.30, 95% CI 1.14-1.48; p < 0.0001) and diabetes care plans (RR 1.47, 95% CI 1.24-1.75; p < 0.0001) compared to non-responders. Similar increases in uptake were also observed among positive responders when compared to patients responding 'no' or 'unsure' to the commitment question.
  
  
  CONCLUSIONS
  Positive responses to commitment questions distributed as part of national, multifaceted interventions were consistently associated with increased uptake of targeted services.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Nicole.Pratt@unisa.edu.au.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Lisa.Kalisch@unisa.edu.au.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kalisch Ellett
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Janet.Sluggett@unisa.edu.au.
authors.forename: Janet K
authors.initials: JK
authors.lastname: Sluggett
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Emmae.Ramsay@unisa.edu.au.
authors.forename: Emmae N
authors.initials: EN
authors.lastname: Ramsay
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Mhairi.Kerr@unisa.edu.au.
authors.forename: Mhairi
authors.initials: M
authors.lastname: Kerr
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Tammy.LeBlanc@unisa.edu.au.
authors.forename: Vanessa T
authors.initials: VT
authors.lastname: LeBlanc
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: John.Barratt@unisa.edu.au.
authors.forename: John D
authors.initials: JD
authors.lastname: Barratt
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. Electronic address: Libby.Roughead@unisa.edu.au.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D058005:General Practitioners; D006293:Health Promotion / Q000379:methods*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012044:Regression Analysis; D014728:Veterans
keywords: Australia; Behaviour change; Commitment; Health behaviour; Health services; Patients; Quality improvement; Questionnaire