Article

Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care.

Consorci d'Atenció Primària de Salut de l'Eixample (CAPSE), Barcelona, Spain.
Health Policy (Impact Factor: 1.73). 01/2007; 80(1):2-10. DOI: 10.1016/j.healthpol.2006.02.008
Source: PubMed

ABSTRACT A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams.
To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction.
Before-after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002-2003. QPL and end-user satisfaction were used as outcome measures.
QPL was improved in terms of the dimension "perception of support from the management structure" among physicians (4.897 versus 5.220; p<0.001) as well as nurses (5.272 versus 5.638; p<0.001). Further, physicians perceived an increase in the dimension "demands made upon them" (6.124 versus 6.364; p<0.001), differently from the nurses group (5.8191 versus 5.929; p=0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses (beta=0.078, p=0.007), and a negative relationship between "demands made upon them" and user satisfaction in the case of physicians (beta=-0.057, p=0.011).
Incentives related to quality of care annual targets may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase in professionals' perception of support from the management structure. Among nurses, this increase is related to an improvement of user satisfaction.

Full-text

Available from: Carmen Cabezas, Jun 02, 2015
0 Followers
 · 
144 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: For a long time antennas for handsets were seen as a necessary piece of wire at the end of a high tech system. Due to a strong demand for better performance, lower price and better design the antenna element is getting more and more in the focus of interest This paper presents some actual trends of today's handset antennas. The interaction with the user, the technology of integrated antennas and dualband antenna concepts are explained.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prior research has examined clinical effects of performance measurement systems. To the extent that non-clinical effects have been researched, the focus has been on negative unintended consequences. Yet, these same systems may also have ancillary benefits for patients and providers-that is, benefits that extend beyond improvements on clinical measures. The purpose of this study is to identify and describe potential ancillary benefits of performance measures as perceived by primary care staff and facility leaders in a large US healthcare system. In-person individual semistructured interviews were conducted with 59 primary care staff and facility leaders at four Veterans Health Administration facilities. Transcribed interviews were coded and organised into thematic categories. Interviewed staff observed that local performance measurement implementation practices can result in increased patient knowledge and motivation. These effects on patients can lead to improved performance scores and additional ancillary benefits. Performance measurement implementation can also directly result in ancillary benefits for the patients and providers. Patients may experience greater satisfaction with care and psychosocial benefits associated with increased provider-patient communication. Ancillary benefits of performance measurement for providers include increased pride in individual or organisational performance and greater confidence that one's practice is grounded in evidence-based medicine. A comprehensive understanding of the effects of performance measurement systems needs to incorporate ancillary benefits as well as effects on clinical performance scores and negative unintended consequences. Although clinical performance has been the focus of most evaluations of performance measurement to date, both patient care and provider satisfaction may improve more rapidly if all three categories of effects are considered when designing and evaluating performance measurement systems.
    BMJ quality & safety 02/2014; 23(8). DOI:10.1136/bmjqs-2013-002149 · 3.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In 2009, a voluntary pay for performance (P4P) scheme for primary care physicians was introduced in France through the 'Contract for Improving Individual Practice' (CAPI). Although the contract could be interrupted at any time and without any penalty, two-thirds of French general practitioners chose not to participate. We studied what factors motivated general practitioners not to subscribe to the P4P contract, and particularly their perception of the ethical risks that may be associated with adhering to a CAPI. A cross-sectional survey among French general practitioners using an online questionnaire based on focus group discussion results. Descriptive and multivariate statistical analyses with logistic regression. A sample of 1,016 respondents, representative of French GPs. The variables that were associated with the probability of not signing a CAPI were "discomfort that patients were not informed of the signing of a P4P contract by their doctors" (OR = 8.24, 95% CI = 4.61-14.71), "the risk of conflicts of interest" (OR = 4.50, 95% CI = 2.42-8.35), "perceptions by patients that doctors may risk breaching professional ethics" (OR = 4. 35, 95% CI = 2.43-7.80) and "the risk of excluding the poorest patients" (OR = 2.66, 95% CI = 1.53-4.63). The perception of ethical risks associated with P4P may have hampered its success. Although the CAPI was extended to all GPs in 2012, our results question the relevance of the program itself by shedding light on potential adverse effects.
    PLoS ONE 09/2013; 8(9):e72684. DOI:10.1371/journal.pone.0072684 · 3.53 Impact Factor