What is the acceptability of sustainable, continuous quality incentives in primary care in the EQuIP-GP trial?

Problem

There are major challenges in delivering Universal Health Care, as advocated in the Declaration of Astana, with economic sustainability. The RACGP funded EQuIP-GP trial, currently underway in 33 general practices in three states in Australia, investigates a funding model that provides targeted, continuous quality incentive payments. The trial is unique in that the incentives are continuous, without threshold entry levels, and designed to be cost-neutral or -saving to the health system through reduced prescriptions, pathology/imaging tests and hospitalisations. Implementation of this model will be dependent on its acceptability to stakeholders. We report preliminary baseline qualitative analyses of interviews with participants investigating incentive acceptability.

Approach

Interviews were conducted with consenting patients, staff and GPs within six practices; two purposively selected in each of the three states. Interview transcripts were analysed independently by two researchers using a realist inquiry approach, applying an analysis template to elucidate contexts (e.g. practice structures) and mechanisms (attitudes and beliefs) in which the payment structure would operate. Agreement regarding coding and interpretation was reached by consensus.

Findings

Twenty-eight interviews were conducted with patients, staff and GPs. Eighteen transcripts from two states were included in this preliminary analysis within the broad framework categories. Context: Across the varied geographic and socioeconomic contexts of the practices, patients and practice staff alike felt the care provided was of good quality. Beliefs: Patients believed GPs should provide quality care as a professional duty. The GPs were comfortable with the concept of reward for quality care but did not believe they needed money for motivation. Attitudes: Patients and practices all agreed that continuity of care and sufficient time in consultations were key markers of quality and highly valued.

Consequences

This study provides a unique opportunity to understand the baseline contexts and mechanisms in which a cost-neutral quality incentive funding model in primary care might operate. Among participants in these preliminary analyses, quality was synonymous with patient-centred care. Within this patient-centred paradigm, participants found the term ‘incentive’ discordant. Further analyses will enable a fully developed understanding of baseline contexts, beliefs and attitudes in which the intervention will operate and inform our approach to follow-up qualitative investigation. Working with both patients and providers to harness the existing positive attitudes and address core concerns may maximize the chances of successful implementation of the EQuIP-GP model.