Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care

Background: A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams. Objective: To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction. Methods: Before–after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002–2003. QPL and end-user satisfaction were used as outcome measures. Results: QPL was improved in terms of the dimension “perception of support from the management structure” among physicians (4.897 versus 5.220; p < 0.001) as well as nurses (5.272 versus 5.638; p < 0.001). Further, physicians perceived an increase in the dimension “demands made upon them” (6.124 versus 6.364; p < 0.001), differently from the nurses group (5.8191 versus 5.929; p = 0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between “perception of support from the management structure” and user satisfaction among nurses (β = 0.078, p = 0.007), and a negative relationship between “demands made upon them” and user satisfaction in the case of physicians (β = −0.057, p = 0.011). Conclusions: Incentives related to quality of care annual targets may increase physicians’ perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase