Removing 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, a new research suggests.
Using data from The Health Improvement Network (THIN) database, the study reports that there was no significant change in the screening of newly registered patients when financial incentives were introduced in April 2008. However, there was a significant shift in this trend when incentives were withdrawn in March 2015, with rates falling by 2.96 patients per 1000 each month thereafter.
After the introduction of incentives, there was an immediate increase of 9.05 per 1000 in the rate of newly registered patients screening positive for heavy drinking. Withdrawal of financial incentives was associated with a fall in screen-positive rates of 29.96 per 1000, but a rise in the monthly increase in this rate of 2.14 per1000.
Fewer than 15 in every 1000 screen-positive patients were recorded as receiving brief advice at the start of the analysis period. This increased by 20.15 per 1000 following the introduction of financial incentives and continued to increase by 0.39 per 1000 each month up to the point at which incentives were withdrawn. At this point, delivery of brief advice fell by 18.33 per 1000 and continued to fall by a further 0.70 per 1000 per month.
Presenting the findings in the journal Addiction, the authors estimate that between April 2015 and December 2016, 36,223 fewer patients were screened and 1646 fewer patients received brief advice than if the incentives had not been withdrawn.
They say the findings highlight the potential adverse consequences of short-term financial incentives to boost implementation of alcohol prevention in primary health care.