{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:26:26Z","timestamp":1783340786243,"version":"3.54.6"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1063597"],"award-info":[{"award-number":["1063597"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1042907"],"award-info":[{"award-number":["1042907"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["1061035"],"award-info":[{"award-number":["1061035"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Financial incentives and audit\/feedback are widely used in primary care to influence clinician behaviour and increase quality of care. While observational data suggest a decline in quality when these interventions are stopped, their removal has not been evaluated in a randomised controlled trial (RCT), to our knowledge. This trial aimed to determine whether chlamydia testing in general practice is sustained when financial incentives and\/or audit\/feedback are removed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We undertook a 2 \u00d7 2 factorial cluster RCT in 60 general practices in 4 Australian states targeting 49,525 patients aged 16\u201329 years for annual chlamydia testing. Clinics were recruited between July 2014 and September 2015 and were followed for up to 2 years or until 31 December 2016. Clinics were eligible if they were in the intervention group of a previous cluster RCT where general practitioners (GPs) received financial incentives (AU$5\u2013AU$8) for each chlamydia test and quarterly audit\/feedback reports of their chlamydia testing rates. Clinics were randomised into 1 of 4 groups: incentives removed but audit\/feedback retained (group A), audit\/feedback removed but incentives retained (group B), both removed (group C), or both retained (group D). The primary outcome was the annual chlamydia testing rate among 16- to 29-year-old patients, where the numerator was the number who had at least 1 chlamydia test within 12 months and the denominator was the number who had at least 1 consultation during the same 12 months. We undertook a factorial analysis in which we investigated the effects of removal versus retention of incentives (groups A + C versus groups B + D) and the effects of removal versus retention of audit\/feedback (group B + C versus groups A + D) separately. Of 60 clinics, 59 were randomised and 55 (91.7%) provided data (group A: 15 clinics, 11,196 patients; group B: 14, 11,944; group C: 13, 11,566; group D: 13, 14,819). Annual testing decreased from 20.2% to 11.7% (difference \u22128.8%; 95% CI \u221210.5% to \u22127.0%) in clinics with incentives removed and decreased from 20.6% to 14.3% (difference \u22127.1%; 95% CI \u22129.6% to \u22124.7%) where incentives were retained. The adjusted absolute difference in treatment effect was \u22120.9% (95% CI \u22123.5% to 1.7%; <jats:italic>p =<\/jats:italic> 0.2267). Annual testing decreased from 21.0% to 11.6% (difference \u22129.5%; 95% CI \u221211.7% to \u22127.4%) in clinics where audit\/feedback was removed and decreased from 19.9% to 14.5% (difference \u22126.4%; 95% CI \u22128.6% to \u22124.2%) where audit\/feedback was retained. The adjusted absolute difference in treatment effect was \u22122.6% (95% CI \u22125.4% to \u22120.1%; <jats:italic>p =<\/jats:italic> 0.0336). Study limitations included an unexpected reduction in testing across all groups impacting statistical power, loss of 4 clinics after randomisation, and inclusion of rural clinics only.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Audit\/feedback is more effective than financial incentives of AU$5\u2013AU$8 per chlamydia test at sustaining GP chlamydia testing practices over time in Australian general practice.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Australian New Zealand Clinical Trials Registry <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=595617\" xlink:type=\"simple\">ACTRN12614000595617<\/jats:ext-link><\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003858","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T18:22:53Z","timestamp":1641320573000},"page":"e1003858","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["The impact of removing financial incentives and\/or audit and feedback on chlamydia testing in general practice: A cluster randomised controlled trial (ACCEPt-able)"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-8501","authenticated-orcid":true,"given":"Jane S.","family":"Hocking","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0637-2481","authenticated-orcid":true,"given":"Anna","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1296-9591","authenticated-orcid":true,"given":"Meredith","family":"Temple-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1997-3999","authenticated-orcid":true,"given":"Sabine","family":"Braat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-8837","authenticated-orcid":true,"given":"Matthew","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6406-5231","authenticated-orcid":true,"given":"Liliana","family":"Bulfone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callum","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1711-9553","authenticated-orcid":true,"given":"Mieke","family":"van Driel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K.","family":"Fairley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8851-4126","authenticated-orcid":true,"given":"Basil","family":"Donovan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2929-4634","authenticated-orcid":true,"given":"Rebecca","family":"Guy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4817-8986","authenticated-orcid":true,"given":"Nicola","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7639-4355","authenticated-orcid":true,"given":"John","family":"Kaldor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8836-7525","authenticated-orcid":true,"given":"Jane","family":"Gunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,4]]},"reference":[{"issue":"1","key":"pmed.1003858.ref001","first-page":"CD000362","article-title":"Interventions to implement prevention in primary care.","volume":"2001","author":"ME Hulscher","year":"2001","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"pmed.1003858.ref002","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/1077558711432891","article-title":"Pay for performance in health care: an international overview of initiatives","volume":"69","author":"F. 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