Abstract
BackgroundThe aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care.MethodsNegative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants.ResultsPrescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR = 1.20, 95% CI = 1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced.ConclusionsPay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods.
Highlights
Long-acting reversible contraception (LARC) is highly clinically effective compared with more widely used short term contraceptive methods
Sexual health indicators (SH1, SH2, SH3) introduced in April 2009 focused on provision of information on long acting reversible methods of contraception to women attending for contraceptive advice[11] aimed at increasing awareness of long-acting reversible contraceptives (LARC) methods among women seeking contraceptive advice in general
Prescribing rates before and after Quality and Outcome Framework (QOF) LARC prescribing was stable prior to April 2009, with a decreasing gradient of 20.4% annually (Table 1). This changed to an increasing trend in LARC prescribing of 4% annually after the introduction of QOF contraception incentives
Summary
Long-acting reversible contraception (LARC) is highly clinically effective compared with more widely used short term contraceptive methods. In the UK, several government initiatives have aimed to increase awareness and use of LARC including public policy initiatives such as National Institute for Health and Clinical Excellence (NICE) LARC guidelines and Quality and Outcome Framework (QOF)[1,11]. Sexual health indicators (SH1, SH2, SH3) introduced in April 2009 focused on provision of information on long acting reversible methods of contraception to women attending for contraceptive advice[11] aimed at increasing awareness of LARC methods among women seeking contraceptive advice in general. The aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-forperformance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care
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