Tracy Jackson

The impact of financial incentives on implementation of asthma self-management: a mixed methods programme of work

In 2008 The Northern Ireland (NI) healthcare service introduced the Local Enhanced Service for (LES) which provided financial incentives to general practices for implementing asthma self-management. This project aimed to observe trends in implementation and health outcomes associated with the introduction of the LES and explore the process by which organisational change was implemented in primary care in Northern Ireland from the perspective of primary care staff.

This involved exploring the context of Northern Ireland and its healthcare system using routine data to observe trends in: asthma-related hospitalisations; asthma-related deaths and asthma action plan provision across Northern Ireland over a five-year period.  Telephone interviews were conducted with 15 practices to provide an overview of the practice’s approach to the LES. Four practices with diverse approaches and different success rates were selected for in-depth case study investigation to provide a deeper understanding of their strategies for achieving the targets.

In Northern Ireland, three quarters of people with asthma have been provided with an action plan over the last five years of the LES; alongside a possible trend to an increase in asthma-related hospital admissions and deaths. The financial incentives of the LES were received positively by primary care staff; however patient health was the highest priority when delivering care. Primary care staff identified multi-disciplinary teamwork throughout the lifespan of the LES as key to its “normalization”, which was now so embedded that concerns were expressed regarding threats to funding and withdrawal of external support. Understanding how practices reacted to the LES and normalized this healthcare scheme could inform further policy on similar initiatives.

About me

My research interests include health psychology, health promotion, determinants of health and health behaviours, mixed methods research and self-management education for people with chronic illnesses.

Publications

• Hui CY, Walton R, McKinstry B, Jackson T, Parker R, Pinnock H. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. Journal of the American Medical Informatics Association. 2016 Oct 2;24(3):619-32.
• Jackson T, Shields MD, Heaney LG, Kendall M, Pearce CJ, Hui CY, Pinnock, H. The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review. PLoS ONE. 2017 12(11): e0187478.

Research activity (conferences, congress, annual scientific meeting)

• Poster presentation: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. Exploring primary care staff experiences of financial incentives for implementing asthma self-management: a qualitative study in Northern Ireland using Normalization Process Theory. Presented at European Respiratory Society International Congress (Paris, September 2018)
• Oral presentation: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. Exploring primary care staff experiences of financial incentives for implementing asthma self-management: a qualitative study in Northern Ireland using Normalization Process Theory. Presented at Society for Academic Primary Care Annual Scientific Meeting (London, July 2018)
• Oral presentation: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. Perceptions among primary care staff towards financial incentives to promote implementation of asthma self-management: a qualitative study in Northern Ireland. Presented at International Primary Care Respiratory Group 9th World Conference (Porto, June 2018)
• Oral presentation: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. Professional and staff perceptions of financial incentives promoting implementation of asthma self-management: a qualitative study in Northern Ireland primary care practices. Presented at AUKCAR Annual Scientific Meeting (Bristol, January 2018)
• Oral Presentation: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. Professional and staff perceptions of financial incentives promoting implementation of asthma self-management: a qualitative study in Northern Ireland primary care practices. Presented at Primary Care Respiratory Society UK Conference (Telford, September 2017)
• Oral Presentation: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. Professional and staff perceptions of financial incentives promoting implementation of asthma self-management: a qualitative study in Northern Ireland primary care practices. Presented at AUKCAR - MRC Asthma UK Joint meeting (London, September 2017)
• Oral Presentation: Jackson T. Researcher perspective: Impact of PPI. AUKCAR Patient Involvement Fair (Edinburgh, March 2017)
• Poster: Jackson T, Heaney L, Shields M, Kendall M, Hui CY, Pearce C, Pinnock H. The impact of incentives on the implementation of asthma self-management: a systematic review. Presented at AUKCAR Annual Scientific Meeting (Edinburgh, November 2016)
• Poster: Jackson T, Heaney L, Shields M, Kendall M, Hui CY, Pearce C, Pinnock H. The impact of incentives on the implementation of asthma self-management: a systematic review. Presented at Primary Care Respiratory Society UK Conference (Telford, October 2016)
• Poster: Jackson T, Heaney L, Shields M, Kendall M, Hui CY, Pearce C, Pinnock H. The impact of incentives on the implementation of asthma self-management: a systematic review. Presented at European Respiratory Society International Congress (London, September 2016)
• Poster: Jackson T, Heaney L, Shields M, Kendall M, Hui CY, Pearce C, Pinnock H. The impact of incentives on the implementation of asthma self-management: a systematic review. Presented at Usher Institute Annual Research day (Edinburgh, June 2016)
• Oral Presentation: Jackson T, Heaney L, Shields M, Kendall M, Hui CY, Pearce C, Pinnock H. The impact of incentives on the implementation of asthma self-management: a systematic review. Presented at International Primary Care Respiratory Group 8th World Conference (Amsterdam, May 2016)
• Poster: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. The impact of incentives on the implementation of asthma self-management: a mixed methods assessment. Presented at AUKCAR Annual Scientific Meeting (Manchester, November 2015)
• Poster: Jackson T, Heaney L, Shields M, Kendall M, Pinnock H. The impact of incentives on the implementation of asthma self-management: a mixed methods assessment. Presented at Annual Research day at the Centre for Population Health Sciences (Edinburgh, June 2015)

Acknowledgements

Funded by The University of Edinburgh