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Pay for performance associated with increased volume of medication reviews but not with less inappropriate use of medications among the elderly - an observational study

Artikel i vetenskaplig tidskrift
Författare Helena Ödesjö
A. Anell
Anders Boman
J. Fastbom
S. Franzen
Jörgen Thorn
S. Bjorck
Publicerad i Scandinavian Journal of Primary Health Care
Volym 35
Nummer/häfte 3
Sidor 271-278
ISSN 0281-3432
Publiceringsår 2017
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
Institutionen för nationalekonomi med statistik
Sidor 271-278
Språk en
Länkar doi.org/10.1080/02813432.2017.13584...
Ämnesord Primary health care, Sweden, pay for performance, health care quality assessment, quality indicators, drug-use, register, care, experience, mortality, quality, program, people, Health Care Sciences & Services, General & Internal Medicine
Ämneskategorier Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

Sammanfattning

Objective: A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline. Design and setting: Observational study that compared medication for elderly patients enrolled at primary care units that coded for a high or low volume of medication reviews. Patients: 144,222 individuals at 196 primary care centres, age 75 or older. Main outcome measures: Percentage of patients receiving inappropriate drugs or polypharmacy during five years at primary care units with various levels of reported medication reviews. Results: The proportion of patients with a registered medication review had increased from 3.2% to 44.1% after five years. The high-coding units performed better for most indicators but had already done so at baseline. Primary care units with the lowest payment for coding for medication reviews improved just as well in terms of inappropriate drugs as units with the highest payment - from 13.0 to 8.5%, compared to 11.6 to 7.4% and from 13.6 to 7.2% vs 11.8 to 6.5% for polypharmacy. Conclusions: Payment linked to coding for medication reviews was associated with an increase in the percentage of patients for whom a medication review had been registered. However, the impact of payment on quality improvement is uncertain, given that units with the lowest payment for medication reviews improved equally well as units with the highest payment.

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