May/June 2008 Annals of Family Medicine...( The Unintended Consequences of Pay-...),Health

At a time when pay-for-performance programs are proliferating, this study finds that while such programs may succeed in improving clinical outcomes and increasing physician income, they also change the nature of patient consultations and the way doctors and nurses work together. In-depth interviews with 41 family physicians and nurses working in the United Kingdom three years after implementation of a new pay-for-performance initiative revealed that participants believed the aims of the program had been met in terms of improvements in disease-specific processes of patient care and physician income, as well as improved data capture. Participants also reported unintended consequences of the program, including reduced continuity of care and care fragmentation. While acknowledging the positive impact of the program, many physicians expressed concern that the guideline-driven process of care leaves them feeling they are becoming less skilled, are losing their sense of place in the enterprise and are less connected with patients.

The Experience of Pay for Performance in English Family Practice: A Qualitative Study
By Stephen M. Campbell, Ph.D., et al

A meta-analysis of 14 trials involving 3,197 patients with restless legs syndrome finds that although drug therapy using nonergot dopamine agonists the mainstay of therapy for patients with the condition reduces the severity of symptoms, significant numbers of patients discontinue their use because of adverse side effects, including nausea, dizziness, drowsiness and fatigue. Further analysis suggests these treatments are most beneficial in the first weeks of therapy, with their effects diminishing somewhat over time. The researchers call for future research to compare directly the efficacy of individual nonergot dopamine agonists
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