Primary care centers' extra payment for medication reviews ineffective
Recent research shows that the system of special remuneration for drug reviews with older patients in primary care has not had the desired effect. The primary care centers (PCCs) in Region Västra Götaland (VGR) that most frequently reported, and were paid for, these reviews improved no more than the others.
“There’s a very weak association between reporting the reviews in the system and getting the result you’re really looking for,” says Helena Ödesjö, a primary care physician at the Närhälsan Tjörn PCC, who has a PhD from Sahlgrenska Academy at the University of Gothenburg.
The study, part of her thesis, comprises all patients aged 75 and over in VGR’s primary care sector in 2009–2013, when older patients’ medication was a major focus of attention.
The main purpose of the reviews is to safeguard the quality of drug treatment for older patients by assessing the number of drugs and their indications, combinations, and dosages. A further purpose is to reduce the use of certain pharmaceuticals with a high risk of side effects in older patients.
Same change over time
In VGR, reviewing older patients’ medication is one of several activities for which PCCs receive separate remuneration. The researchers grouped the PCCs according to how often the activity was reported.
Overall, medication management improved in the period, nationwide as well, but those PCCs in VGR that reported performing reviews for older patients more frequently than the others did not improve more.
“The change over time was the same, but the centers that reported more medication reviews had already been performing better before, with fewer unsuitable drugs for older patients, for example. Our interpretation is that these are probably centers with more appropriate structures and working methods that enable effective adaptation to existing payment systems,” Ödesjö says.
Medication reviews and other, similarly remunerated activities, do not generate huge sums for PCCs. However, Ödesjö believe the money can have an impact at the margin in primary care services, which are often under heavy pressure. In terms of care choice, the study made no distinction between publicly or privately run PCCs.
Questioning remuneration
“There can hardly be any payment system that doesn’t affect behavior. So it’s important to take great care in selecting what’s reported and paid for separately. The act of entering data from medication reviews doesn’t help me in my clinical work and in meeting patients.”
Ödesjö draws a comparison with another part of her thesis: her study of PCCs’ reporting to the Swedish National Diabetes Register, which is an important database for monitoring diabetes care and for research. In this study, a clear association emerged between separate remuneration and extensive reporting of the kind of data used in interactions with patients, such as blood pressure. Good reporting of such data is vital for an ability to monitor care quality and ensure it is high.
“We don’t question the need for medication reviews. Reviewing drug use is a key part of the doctor’s job. What the study results give reason to question is the reporting and associated funds.
“Given the results and the clinical nature of my work, I think this funding is of doubtful value. It prompts behavior where we risk focusing on the reporting of review data, rather than on discussing how to ensure good drug treatment.”
Title: Register-based evaluation of primary care: Focus on chronic disease
Contact: Helena Ödesjö
Images: Genre image (photo: Mattonstock) and portrait picture of Helena Ödesjö (photo: Ulf Ödesjö)