The impact of financial incentives on implementation of asthma self-management: a mixed methods programme of work
In 2008 The Northern Ireland (NI) healthcare service introduced the Local Enhanced Service for (LES) which provided financial incentives to general practices for implementing asthma self-management. This project aimed to observe trends in implementation and health outcomes associated with the introduction of the LES and explore the process by which organisational change was implemented in primary care in Northern Ireland from the perspective of primary care staff.
This involved exploring the context of Northern Ireland and its healthcare system using routine data to observe trends in: asthma-related hospitalisations; asthma-related deaths and asthma action plan provision across Northern Ireland over a five-year period. Telephone interviews were conducted with 15 practices to provide an overview of the practice’s approach to the LES. Four practices with diverse approaches and different success rates were selected for in-depth case study investigation to provide a deeper understanding of their strategies for achieving the targets.
In Northern Ireland, three quarters of people with asthma have been provided with an action plan over the last five years of the LES; alongside a possible trend to an increase in asthma-related hospital admissions and deaths. The financial incentives of the LES were received positively by primary care staff; however patient health was the highest priority when delivering care. Primary care staff identified multi-disciplinary teamwork throughout the lifespan of the LES as key to its “normalization”, which was now so embedded that concerns were expressed regarding threats to funding and withdrawal of external support. Understanding how practices reacted to the LES and normalized this healthcare scheme could inform further policy on similar initiatives.
My research interests include health psychology, health promotion, determinants of health and health behaviours, mixed methods research and self-management education for people with chronic illnesses.
Research activity (conferences, congress, annual scientific meeting)
Funded by The University of Edinburgh