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Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time-series analysis

Lookup NU author(s): Professor Amy O'DonnellORCiD, Professor Barbara Hanratty, Professor Eileen KanerORCiD



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley-Blackwell Publishing Ltd., 2020.

For re-use rights please refer to the publisher's terms and conditions.


Aim: To evaluate the impact of the introduction and withdrawal of financial incentives on alcohol screening and brief advice delivery in English primary care. Design: Interrupted time series using data from The Health Improvement Network (THIN) database. Data were split into three periods: 1) before the introduction of financial incentives (1st January 2006 to 31st March 2008); 2) during the implementation of financial incentives (1st April 2008 to 31st March 2015); and 3) after the withdrawal of financial incentives (1st April 2015 to 31st December 2016). Segmented regression models were fitted, with slope and step change coefficients at both intervention points. Setting: England. Participants: Newly-registered patients (16+) in 500 primary care practices for 2006-2016 (N=4,278,723). Measurements: The outcome measures were percentage of patients each month who: 1) were screened for alcohol use; 2) screened-positive for higher-risk drinking; 3) were reported as having received brief advice on alcohol consumption. Findings: There was no significant change in the percentage of newly-registered patients who were screened for alcohol use when financial incentives were introduced. However, the percentage fell (p<0.001) immediately when incentives were withdrawn, and fell by a further 2.96 (95% CI 2.21-3.70) patients per 1,000 each month thereafter. After the introduction of incentives, there was an immediate increase of 9.05 (95% CI 3.87-14.23) per 1,000 patients screening positive for higher-risk drinking, but no significant further change over time. Withdrawal of financial incentives was associated with an immediate fall in screen-positive rates of 29.96 (95% CI 19.56-40.35) per 1,000 patients, followed by a rise each month thereafter of 2.14 (95% CI 1.51-2.77) per 1,000. Screen-positive patients recorded as receiving alcohol brief advice increased by 20.15 (95% CI 12.30-28.00) per 1,000 following the introduction of financial incentives, and continued to increase by 0.39 (95% CI 0.26-0.53) per 1,000 monthly until withdrawal. At this point, delivery of brief advice fell by 18.33 (95% CI 11.97-24.69) per 1,000 patients and continued to fall by a further 0.70 (95% CI 0.28-1.12) per 1,000 per month. Conclusions: Removing a financial incentive for alcohol prevention in English primary care was associated with an immediate and sustained reduction in the rate of screening for alcohol use and brief advice provision. This contrasts with no, or limited, increase in screening and brief advice delivery rates following the introduction of the scheme.

Publication metadata

Author(s): O'Donnell A, Angus C, Hanratty B, Hamilton F, Petersen I, Kaner E

Publication type: Article

Publication status: Published

Journal: Addiction

Year: 2020

Volume: 115

Issue: 1

Pages: 49-60

Print publication date: 01/01/2020

Online publication date: 09/10/2019

Acceptance date: 06/08/2019

Date deposited: 07/08/2019

ISSN (print): 0965-2140

ISSN (electronic): 1360-0443

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/add.14778


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