Incentivizing appropriate prescribing in primary care:Development and first results of an electronic health record-based pay-for-performance scheme

Objective Part of the funding of Dutch General Practitioners (GPs) care is based on pay-for-performance, including an incentive for appropriate prescribing according to guidelines in national formularies. Aim of this paper is to describe the development of an indicator and an infrastructure based on prescription data from GP Electronic Health Records (EHR), to assess the level of adherence to formularies and the effects of the pay-for-performance scheme, thereby assessing the usefulness of the infrastructure and the indicator. Methods Adherence to formularies was calculated as the percentage of first prescriptions by the GP for medications that were included in one of the national formularies used by the GP, based on prescription data from EHRs. Adherence scores were collected quarterly for 2018 and 2019 and subsequently sent to health insurance companies for the pay-for-performance scheme. Adherence scores were used to monitor the effect of the pay-for-performance scheme. Results 75% (2018) and 83% (2019) of all GP practicesparticipated. Adherence to formularies was around 85% or 95%, depending on the formulary used. Adherence improved significantly, especially for practices that scored lowest in 2018. Discussion We found high levels of adherence to national formularies, with small improvements after one year. The infrastructure will be used to further stimulate formulary-based prescribing by implementing more actionable and relevant indicators on adherence scores for GPs

Do intrapersonal factors mediate the association of social support with physical activity in young women living in socioeconomically disadvantaged neighbourhoods? A longitudinal mediation analysis

BackgroundLevels of physical activity (PA) decrease when transitioning from adolescence into young adulthood. Evidence suggests that social support and intrapersonal factors (self-efficacy, outcome expectations, PA enjoyment) are associated with PA. The aim of the present study was to explore whether cross-sectional and longitudinal associations of social support from family and friends with leisure-time PA (LTPA) among young women living in disadvantaged areas were mediated by intrapersonal factors (PA enjoyment, outcome expectations, self-efficacy).MethodsSurvey data were collected from 18&ndash;30 year-old women living in disadvantaged suburbs of Victoria, Australia as part of the READI study in 2007&ndash;2008 (T0, N = 1197), with follow-up data collected in 2010&ndash;2011 (T1, N = 357) and 2012&ndash;2013 (T2, N = 271). A series of single-mediator models were tested using baseline (T0) and longitudinal data from all three time points with residual change scores for changes between measurements.ResultsCross-sectional analyses showed that social support was associated with LTPA both directly and indirectly, mediated by intrapersonal factors. Each intrapersonal factor explained between 5.9&ndash;37.5% of the associations. None of the intrapersonal factors were significant mediators in the longitudinal analyses.ConclusionsResults from the cross-sectional analyses suggest that the associations of social support from family and from friends with LTPA are mediated by intrapersonal factors (PA enjoyment, outcome expectations and self-efficacy). However, longitudinal analyses did not confirm these findings.<br /

Evaluation of a personalized coaching system for physical activity: user appreciation and adherence

Physical inactivity is an increasingly serious global health problem, which implies a strong need for effective and engaging interventions. Smartphone technology offers new possibilities to address physical activity promotion. For app-based interventions to have an impact, both the effectiveness and user appreciation of the app are important. In this paper, we explore the user appreciation of the Active2Gether intervention, which offers personalized coaching to increase physical activity levels in daily life. The results are compared to the evaluation of a simplified version of the Active2Gether app (in which no coaching messages are sent) and the Fitbit app. Overall, the results reveal that users of a physical activity app appreciate a coaching feature to be included (on top of self-monitoring functionalities), but are also critical of how it is implemented (in terms of the number and content of the messages). The results also show that it is important to find a balance in the number of messages sent: too many messages seem to be perceived as annoying, but on the other hand, such system-initiated user interaction seems to reduce dropout