FI should be routinely available in practice with many barriers being espoused in the literature. It appears that nurses are increasingly expected to take on more responsibilities for little practical reward. Money being a great motivator, I am surprised not to have stumbled across financial reward, or lack of as a factor for limited delivery.
Perhaps this interests you:
Ann Fam Med. 2008 May-Jun;6(3):228-34. doi: 10.1370/afm.844.
The experience of pay for performance in English family practice: a qualitative study.
Campbell SM, McDonald R, Lester H.
Abstract
PURPOSE: We conducted an in-depth exploration of family physicians' and nurses' beliefs and concerns about changes to the family health care service as a result of the new pay-for-performance scheme in the United Kingdom (Quality and Outcomes Framework [QOF]).
METHODS: Using a semistructured interview format, we interviewed 21 family doctors and 20 nurses in 22 nationally representative practices across England between February and August 2007.
RESULTS: Participants believed the financial incentives had been sufficient to change behavior and to achieve targets. The findings suggest that it is not necessary to align targets to professional priorities and values to obtain behavior change, although doing so enhances enthusiasm and understanding. Participants agreed that the aims of the pay-for-performance scheme had been met in terms of improvements in disease-specific processes of patient care and physician income, as well as improved data capture. It also led to unintended effects, such as the emergence of a dual QOF-patient agenda within consultations, potential deskilling of doctors as a result of the enhanced role for nurses in managing long-term conditions, a decline in personal/relational continuity of care between doctors and patients, resentment by team members not benefiting financially from payments, and concerns about an ongoing culture of performance monitoring in the United Kingdom.
CONCLUSIONS: The QOF scheme may have achieved its declared objectives of improving disease-specific processes of patient care through the achievement of clinical and organizational targets and increased physician income, but our findings suggest that it has changed the dynamic between doctors and nurses and the nature of the practitioner-patient consultation.
Some research point out that there is a lack of incentives:
Am J Hypertens. 2014 Mar;27(3):489-96. doi: 10.1093/ajh/hpt204. Epub 2013 Nov 1.
Lack of impact of a comprehensive intervention on hypertension in the primary care setting.
Niiranen TJ1, Leino K, Puukka P, Kantola I, Karanko H, Jula AM.
Abstract
BACKGROUND: The implementation of lifestyle modifications, home blood pressure (BP) measurement, and optimization of antihypertensive drug therapy have been shown to improve BP control in tightly controlled research settings. Our objective was to determine the effect of these interventions in a primary care setting, with the family practitioners and nurses serving as the interventionists.
METHODS: Two hundred twenty hypertensive patients were recruited from 2 health centers that operated in the same building and covered similar populations, with the health centers randomized to function as intervention or control sites. Participants in the intervention group received repeated individual and group counseling from the centrally trained staff of the health center on healthy lifestyles. In addition, their antihypertensive drug therapy was guided by home BP measurements performed at 3-month intervals instead of by conventional office measurements.
RESULTS: After 12 months of follow-up, the between-group differences in the changes of lifestyle variables (body mass index, physical activity, dietary recalls, and urinary sodium/potassium) were nonsignificant. Antihypertensive treatment intensity increased in both groups, but the between-group difference was nonsignificant (P = 0.63). Office systolic/diastolic BP decreased significantly in the intervention (8/6 mm Hg; P < 0.001) and control (11/7 mm Hg; P < 0.001) groups, but the between-group differences were nonsignificant (P = 0.25/0.16).
CONCLUSIONS: Our intervention did not improve BP control as suggested by many prior studies performed in controlled academic settings. This result could be attributed to a lack of motivation and incentives among the staff or because the population was relatively unselected. Greater attention to education and financial incentives might be required in typical primary care settings to obtain better results.
Thank you Béatrice Ewalds-Kvist I will certainly be interested in reading this article. Many thanks.