Providing GPs with financial incentives to offer information about long-acting contraceptives is associated with an increase in their use, and a fall in the number of abortions.
This is the finding of the first large-scale analysis of an incentive scheme for GPs to provide women with information about long-acting reversible contraceptives (LARCs). The study analysed data from the anonymised health records of over 3 million women in England, Wales and Scotland between financial years 2004/2005 to 2013/2014. The study examined the number of LARCs prescribed for five years before and four years after providing contraceptive information was included in the pay for performance (P4P) scheme in 2009/10.
The study, published in PLoS Medicine, found that the scheme was associated with a 13 per cent increase in LARC prescriptions (absolute increase of 4.5 prescriptions per 1,000 women) above what would have been expected four years after the scheme was introduced.
This was accompanied by a fall of nearly 17 per cent in number of prescriptions for non-LARC contraception (absolute decrease of 42 prescriptions per 1,000 women) in the same four-year period, suggesting a switch in the choice of contraceptive method used.
The findings also showed a 38 per cent more than expected reduction in abortions (absolute reduction of 5.3 per 1,000 women) four years after the incentive was introduced. This is the equivalent of 95,170 fewer abortions than expected, if the results were extrapolated across the whole UK population.
Most of the impact on LARC prescriptions and abortions were among women under 25 years of age, and those from poorer areas.
Dr Richard Ma, a GP and lead researcher on the study from Imperial’s School of Public Health said: “Our study suggests if women were better informed about more effective and reliable methods such as long-acting contraceptives, they might choose these over less reliable methods. This could reduce the number of unplanned and unwanted pregnancies. We expected this study would show the incentive had led to some change in behaviour but we never expected it to reveal such a profound effect, especially for a simple intervention and a relatively modest incentive.”