'It's what we should be doing anyway': using financial incentives to promote relational continuity in Australian General Practice-a nested case study analysis

Grant Russell; Susannah Westbury; Jenny Advocat; Nicholas Zwar; Christine Metusela; Marijka Batterham; Gregory M Peterson; Judy Mullan; Danielle Mazza; Jan Radford; Simon Eckermann; Andrew Bonney

doi:10.1093/fampra/cmae071

'It's what we should be doing anyway': using financial incentives to promote relational continuity in Australian General Practice-a nested case study analysis

Fam Pract. 2024 Dec 13:cmae071. doi: 10.1093/fampra/cmae071. Online ahead of print.

Authors

Affiliations

¹ Department of General Practice, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
² School of Primary and Allied Health Care, Building G, Level 3, Monash University, Peninsula Campus, Frankston, Victoria 3199, Melbourne, Australia.
³ Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD 4226, Gold Coast, Australia.
⁴ School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
⁵ School of Mathematics and Applied Statistics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
⁶ School of Pharmacy and Pharmacology, University of Tasmania, Churchill Avenue, Sandy Bay, TAS 7005, Australia.
⁷ School of Medicine, University of Tasmania, Level 3, 43 Collins Street, Hobart, TAS 7000, Australia.
⁸ School of Health and Society, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.

PMID: 39671407
DOI: 10.1093/fampra/cmae071

Abstract

Background: Relational continuity is a fundamental component of primary care. The 'Quality in General Practice Trial' (EQuIP-GP), was a 12-month cluster randomized trial, designed to investigate whether financial incentives can improve relational continuity in primary care.

Aim: To examine (i) how financial incentives are perceived and experienced by primary care patients, providers, and practice staff, and (ii) how clinical and organizational routines related to relational continuity are influenced by the introduction of a financial model designed to incentivize relational continuity.

Design and setting: We used a mixed methods case study approach with six of the intervention arm practices participating in the EQuIP-GP trial.

Method: Semi-structured interviews were conducted with patients, providers, practice staff, and intervention facilitators. Intervention facilitators kept structured diaries to capture reflective notes. To contextualize results, practices completed a modified practice attributes survey and patients completed the Primary Care Assessment Tool at baseline and 12 months.

Results: Patient-perceived relational continuity was not impacted by the intervention. Financial incentives were preferred for rewarding, as opposed to incentivizing, quality care; however, they were perceived as a blunt and inflexible instrument. The introduction of the incentive model increased attention to pre-existing organizational routines rather than creating new ones.

Conclusion: Incentive models should be suitably flexible to accommodate diversity in patient and practice needs. Small changes can be made to existing practice routines that will improve awareness and conscientiousness of relational continuity. Further research should examine how feasible these routine changes would be in practices that do not already focus on continuity.

Keywords: Primary health care; continuity of care; financial incentives; general practice; pay for performance; relational continuity.

Abstract

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