Financial incentives did not significantly increase the rate of alcohol screening of newly registered patients by English primary care physicians. However, the removal of the incentives immediately and significantly decreased both screening and counseling, according to a study published in Addiction.
A team of UK-based investigators aimed to determine the effects of the inclusion and removal of financial incentives on alcohol screening and counseling in a primary care setting. The primary outcome measured the monthly percentage of patients who were screened for alcohol use, screened positive for high-risk drinking, and were reported as having brief counseling on alcohol consumption.
A total of 4,278,723 newly registered participants aged 16 years and older were included in the analysis. At the start of the analysis, 92 of 1000 patients were screened each month. Following the initiation of financial incentives, there was no significant change in the number of newly registered patients who were screened for alcohol use; however, the percentage of patients who were screened for alcohol use significantly declined once incentives were withdrawn and fell additionally by 2.96 for 1000 patients every month after.
At baseline, 104 in every 1000 patients who were screened were also screening positive for higher-risk drinking, which increased prior to the introduction of financial incentives. Screening positive for higher-risk drinking immediately increased to 9.05 per 1000 patients after the initiation of financial incentives but no significant changes were observed in the later months. Withdrawal of financial incentives resulted in an immediate drop in positive screening rates of 29.96 per 1000 patients, which increased thereafter by 2.14 per 1000 patients each month.
Fewer than 15 in every 1000 people who screened positive received a brief advice session at baseline. Following the initiation of financial incentives, the rate increased by 20.15 per 1000 patients and continued to increase by 0.39 per 1000 patients until the incentive was withdrawn, at which time brief advice rates declined by 18.33 per 1000 patients. The rates continued to decrease by 0.70 per 1000 patients each month after the withdrawal of financial incentives.
“Removing a financial incentive for alcohol prevention led to an immediate and sustained reduction in recorded rates of screening and brief advice delivered to newly registered patients in English primary care,” the authors noted.
“These findings highlight the potential adverse consequences of using short-term financial incentives to boost implementation of alcohol prevention in primary health care,” concluded the investigators.
O’Donnell A, Angus C, Hanratty B, Hamilton FL, Petersen I, Kaner E. Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time-series analysis [published online October 9, 2019]. Addiction. doi:10.1111/add.14778