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Table 1 Interventions used in quality improvement programs for GPs

From: Heterogeneity in general practitioners’ preferences for quality improvement programs: a choice experiment and policy simulation in France

Component of the QIP Justification
Financial component
 Amount of payment The literature suggests a threshold of 5 % of the doctors’ income as a minimum for the incentive to be effective [52].
 Method of remuneration Financial incentives can improve the quality of care, but depend on the method and frequency of payment [6, 53]a. The three remuneration methods used in France are pay-for-performance (P4P), fee-for-service (FFS) and a kind of partial capitation known as a forfait b.
Non-financial component
 Clinical guidelines The efficacy of clinical guidelines is ascertained [54]. However, the kind of guideline used matters, and guidelines to which individual clinicians have contributed may be more effective in changing their behaviour [55].
 Feedback on activity Performance feedback, where physicians get quantitative feedback relate to their practice, increases quality of care [56].
 Continuing education Participation in continuing education increases adherence to clinical recommendations [57].
Organisational component
 Type of practice There is an association between group practice and better quality of care [58, 59].
 Non-physician provider Quality of care is improved by cooperation of GPs with non-physician providers such as nurses [60].
  1. aThis point is subject to debate. Another study finds no effect of the frequency of P4P [61]. However, representative GPs in the focus group cited the importance of this attribute
  2. bThe French forfaits are a partial capitation payment that represents a small part of GPs income (6 % of income [62] for certain patients (chronically ill) or for the coordination and continuity of care). They complement the FFS but are absolutely not designed as a major payment. For example, the GP receives 40 euros a year for following each patient classified by the health insurance plan as chronically ill (forfait pour affection de longue durée (ALD)). In comparison, sector 1 GPs are paid 23 euros for each consultation at the physician’s office