Background Financial incentives (FI) and audit+feedback (AF) are often used to improve general practitioner (GP) performance. In the Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a cluster-randomised controlled trial (RCT), GPs in the intervention arm received a FI of $5-$8 per chlamydia test and a quarterly AF report of chlamydia testing rates for their 16–29 year old patients. The objective of this present study was to examine the effects of removal of these measures on chlamydia testing rates.
Methods At the end of the ACCEPt trial, we designed a new 2X2 factorial cluster-RCT. ACCEPt intervention clinics were re-randomised to four arms: remove AF/retain FI, remove FI/retain AF, remove both AF and FI, or retain both FI and AF. The main comparisons were: removal vs. retention of FI and removal vs. retention of AF. The primary outcome was the absolute difference in chlamydia testing rates (proportion of 16–29 year old patients tested for chlamydia within a 12-month period) at year 2 compared with baseline, estimated using mixed-effect logistic regression models accounting for clustering at the clinical level.
Results 55 clinics were re-randomised. Chlamydia testing decreased from 20.0% to 11.7% in clinics with FI removed and from 20.1% to 14.4% in clinics that retained FI, with no evidence of a treatment effect between arms (difference=2.6%; 95%CI: -0.1, 5.7). Testing decreased from 20.8% to 11.5% in clinics with AF reports removed and from 19.7% to 14.8% in clinics that retained AF, with a larger reduction for removal than for retention of AF (difference=4.4% (1.1, 7.8).
Conclusion Chlamydia testing rates declined in all clinics after the end of ACCEPt. Chlamydia testing rates fell more when quarterly audit+feedback reports were removed than when financial incentives were removed. Policy makers and clinicians should be aware of the challenge to sustaining chlamydia testing uptake in GP clinics.
Disclosure No significant relationships.
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