Perceptions among primary care staff towards financial incentives to promote implementation of asthma self-management: a qualitative study in Northern Ireland

Background: In 2008, Northern Ireland introduced a healthcare scheme that pays financial incentives to primary care practices for providing self-management education to patients with asthma.

Aim: To explore how practices responded to this scheme, their strategies for achieving the required standards, and the impact on implementation of asthma self-management, including asthma action plan provision.

Methods: We recruited 23 participants (five GPs; five nurses; 13 administrative staff) from 15 practices. The 15 telephone interviews, six in-depth individual interviews and two group interviews were transcribed, coded and analysed using a Grounded Theory approach.

Results: Themes clustered around targeting poor asthma control; communicating with patients; strategies for achieving targets; financial incentives. All participants highlighted the difficulty of getting patients with asthma to attend appointments. Developing strategies to increase attendance for patients with asthma was discussed, with a number of participants specifically targeting patients with poorly controlled asthma. Participants were positive about receiving financial incentives for the extra work undertaken, but the main motivator was providing best quality of care for patients.

Conclusion: Financial incentives are viewed positively in primary care, however patient health was the highest priority. Practices are continually developing strategies to increase patient attendance at annual reviews, particularly among those with poorly controlled asthma. Understanding how practices responded to this scheme could inform future policy on similar initiatives.