Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

Area of Science:

• Public Health
• Health Economics
• Infectious Diseases

Background:

• Antibiotic resistance is a critical global health challenge.
• Inappropriate antibiotic use, particularly for respiratory tract infections (RTI), contributes significantly to resistance.
• Primary care physicians' prescribing habits are a key target for interventions.

Purpose of the Study:

• To evaluate the impact of pay-for-performance (P4P) on primary care physicians' antibiotic prescribing choices.
• To determine if P4P can promote the use of narrow-spectrum antibiotics for pediatric RTI.
• To assess whether P4P influences overall antibiotic prescription volume.

Main Methods:

• A difference-in-differences analysis was employed.
• Register data on all antibiotic purchases for RTI in Sweden (2006-2013) were utilized.
• The study compared 8 healthcare authorities that adopted P4P with control groups.

Main Results:

• P4P significantly increased the proportion of narrow-spectrum antibiotics prescribed for pediatric RTI.
• No evidence suggests physicians increased overall antibiotic prescriptions to game the P4P system.
• The findings indicate P4P is an effective tool for antibiotic stewardship.

Conclusions:

• Pay-for-performance can be a successful strategy to improve antibiotic prescribing practices in primary care.
• Targeting antibiotic choice, rather than volume, is achievable with P4P incentives.
• Interventions like P4P are crucial for combating antibiotic resistance globally.