Financial incentives only partial solution for hypertension control

By Eleanor McDermid, Senior medwireNews Reporter

Providing financial incentives to general practitioners goes some way toward improving hypertension control in their patients, shows research published in JAMA.

The findings suggest that physicians were more likely to initiate or adjust medication in patients with uncontrolled hypertension if financial incentives were available, but were no more likely to use guideline-recommended medications.

Also, the improvements did not last beyond the end of the intervention, although the researchers, led by Laura Petersen (Michael E DeBakey Veterans Affairs [VA] Medical Center, Houston, Texas, USA), believe this may have been due to the absence of continued feedback, rather than the absence of payments.

All participants were able to access feedback during the 16-month intervention period, by means of a secure website. In all, 67% of the 58 physicians based at the nine practices that were randomly assigned to receive the financial intervention accessed this resource, compared with just 25% of the 19 physicians in the three control practices.

Average total payments to participating practices during the intervention period ranged from US$ 1648 (€ 1244) to $ 4270 (€ 3224). The researchers note that these somewhat small amounts, relative to the size of a doctor’s salary, were determined by VA budgetary constraints, making them applicable to the real world.

After accounting for practice, physician, and patient variables, the absolute increase in the proportion of patients achieving blood pressure control or receiving appropriate treatment was 8.84% in practices receiving payments to individual physicians, 3.70% in those receiving per-practice payments, and 5.54% in those receiving a combined payment, compared with 0.47% in the control group.

For a physician with 1000 patients with hypertension, this would amount to an extra 84 achieving blood pressure control or being given suitable treatment, says the team. The overall rate of blood pressure control or appropriate treatment by the end of the study was about 86%.

Physicians in the intervention groups achieved a 15% absolute increase over controls in the number of medications prescribed or adjusted, but their use of guideline-approved medications did not significantly increase.

In an accompanying editorial, Rowena Dolor and Kevin Schulman, from Duke University School of Medicine in Durham, North Carolina, USA, say the findings indicate the need for a broader, system-wide approach.

They also question the exclusive focus on specific performance goals for primary care physicians, asking whether this should include “some other set of services that only primary care physicians can provide,” such as care coordination, counseling, or personal health planning.

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The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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