Impact of pay for performance on prescribing of long- Acting reversible contraception in primary care: An interrupted time series study

Abstract

Background: 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. Methods: Negative 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. Results: Prescribing 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. Conclusions: Pay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods. © 2014 Arrowsmith et al.