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Multicenter Study
. 2007 Jun 5;176(12):1705-10.
doi: 10.1503/cmaj.061556.

Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes

Christopher Millett  1 , Jeremy Gray, Sonia Saxena, Gopalakrishnan Netuveli, Azeem Majeed
Affiliations
Multicenter Study

Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes

Christopher Millett et al. CMAJ. .

Abstract

Background: Many people with diabetes continue to smoke despite being at high risk of cardiovascular disease. We examined the impact of a pay-for-performance incentive in the United Kingdom introduced in 2004 as part of the new general practitioner contract to improve support for smoking cessation and to reduce the prevalence of smoking among people with chronic diseases such as diabetes.

Methods: We performed a population-based longitudinal study of the recorded delivery of cessation advice and the prevalence of smoking using electronic records of patients with diabetes obtained from participating general practices. The survey was carried out in an ethnically diverse part of southwest London before (June-October 2003) and after (November 2005-January 2006) the introduction of a pay-for-performance incentive.

Results: Significantly more patients with diabetes had their smoking status ever recorded in 2005 than in 2003 (98.8% v. 90.0%, p <0.001). The proportion of patients with documented smoking cessation advice also increased significantly over this period, from 48.0% to 83.5% (p < 0.001). The prevalence of smoking decreased significantly from 20.0% to 16.2% (p < 0.001). The reduction over the study period was lower among women (adjusted odds ratio 0.71, 95% confidence interval 0.53-0.95) but was not significantly different in the most and least affluent groups. In 2005, smoking rates continued to differ significantly with age (10.6%-25.1%), sex (women, 11.5%; men, 20.6%) and ethnic background (4.9%-24.9%).

Interpretation: The introduction of a pay-for-performance incentive in the United Kingdom increased the provision of support for smoking cessation and was associated with a reduction in smoking prevalence among patients with diabetes in primary health care settings. Health care planners in other countries may wish to consider introducing similar incentive schemes for primary care physicians.

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References

    1. International Diabetes Federation. Diabetes Atlas: prevalence. Brussels: The Federation; 2005. Available: www.eatlas.idf.org/prevalence (accessed 2007 Mar 26).
    1. Garcia M, McNamara P, Gordon T, et al. Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow up. Diabetes 1974;23:105-11. - PubMed
    1. Geiss L, Herman W, Smith P. Mortality in non-insulin-dependent diabetes. NIH Pub no 95-1468. In: National Diabetes Data Group. Diabetes in America. 2nd ed. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 1995. p. 233–58.
    1. Abraham W. Preventing cardiovascular events in patients with diabetes mellitus. Am J Med 2004;116(Suppl 5A):39S-46S. - PubMed
    1. Turner R, Millns H, Neil H, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS:23). BMJ 1998;316:823-8. - PMC - PubMed

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