Time trends in contraceptive prescribing in UK primary care 2000–2018: a repeated cross-sectional study

BackgroundOver the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018.MethodsA repeated cross-sectional study using patient data from the IQVIA Medical Research Data (IMRD) database. The proportion (95% CI) of women prescribed non-barrier contraception per year was captured.ResultsA total of 2 705 638 women aged 15–49 years were included. Between 2000 and 2018, the proportion of women prescribed combined hormonal contraception (CHC) fell from 26.2% (26.0%–26.3%) to 14.3% (14.2%–14.3%). Prescriptions for progestogen-only pills (POPs) and long-acting reversible contraception (LARC) rose from 4.3% (4.3%–4.4%) to 10.8% (10.7%–10.9%) and 4.2% (4.1%–4.2%) to 6.5% (6.5%–6.6%), respectively. Comparing 2018 data for most deprived versus least deprived areas, women from the most deprived areas were more likely to be prescribed LARC (7.7% (7.5%–7.9%) vs 5.6% (5.4%–5.8%)) while women from the least deprived areas were more likely to be prescribed contraceptive pills (20.8% (21.1%–21.5%) vs 26.2% (26.5%–26.9%)). In 2009, LARC prescriptions increased irrespective of age and social deprivation in line with a pay-for-performance incentive. However, following the incentive's withdrawal in 2014, LARC prescriptions for adolescents aged 15–19 years fell from 6.8% (6.6%–7.0%) in 2013 to 5.6% (5.4%–5.8%) in 2018.ConclusionsCHC prescribing fell by 46% while POP prescribing more than doubled. The type of contraception prescribed was influenced by social deprivation. Withdrawal of a pay-for-performance incentive may have adversely affected adolescent LARC uptake, highlighting the need for further intervention to target this at-risk group.

Effects of incentive framing on performance and effort: evidence from a medically framed experiment

We study the effects on performance of incentives framed as gains or losses, as well as the effort channels through which individuals increase performance. We also explore potential spill-over effects on a non-incentivised activity. Subjects participated in a medically framed real-effort task under one of the three contracts, varying the type of performance incentive received: (1) no incentive; (2) incentive framed as a gain; or (3) incentive framed as a loss. We find that performance improved similarly with incentives framed as losses or gains. However, individuals increase performance differently under the two frames: potential losses increase participants’ performance through a greater attention (fewer mistakes), while bonuses increase the time spent on the rewarded activity. There is no spill-over effect, either negative or positive, on the non-incentivised activity. We discuss the meaning and implications of our results for the design of performance contracts.

DOES INTERNAL MARKETING CONTRIBUTE TO CUSTOMER SATISFACTION?

This study used a quantitative approach to measure the extent to which the implementation of aspects of Internal Marketing can increase job satisfaction of PNM Ulamm Gorontalo employees and their impact on customer satisfaction. The study involved 144 respondents from employee and customer clusters. Data sourced from questionnaires were analyzed using path analysis. The results showed that the internal marketing variable indicator namely service training program had a positive and significant effect on employee job satisfaction; internal marketing variable indicator namely performance incentive has positive and significant effect on employee job satisfaction; internal marketing variable indicators namely vision of service excellence have a positive and significant effect on employee job satisfaction; internal marketing variable indicators namely service training programs do not significantly influence customer satisfaction; indicator of internal marketing variable, performance incentive, does not significantly influence customer satisfaction; internal marketing variable indicator namely vision about service excellence has a significant effect on customer satisfaction; job satisfaction of Ulamm PNM employees has a positive and significant effect on customer satisfaction; Employee job satisfaction in this research model plays a full role as a mediating variable. From the conclusions obtained, the researcher recommends further researchers to be able to broaden the scope of research by involving other banking companies to obtain research results with a broader level of generalization.