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AbstractWe explore the effects of occasional smoking on body mass index (BMI) in comparison to non‐smoking and daily smoking in adults age 18–50. Data are compiled from the 2005–2008 Behavioral Risk Factor Surveillance System. Though smaller than that of daily smoking, occasional smoking is found to have a negative and substantial effect on body weight. Differences in the effect of occasional smoking on body weight across BMI categories are small. Unlike daily smoking, the effects of occasional smoking on BMI are larger for females, exceeding 50% of the effects of daily smoking on BMI. These large effects constitute a threat as occasional smoking might be seen by females as an effective weight control strategy that carries lower health risks than daily smoking. Strategies to reduce smoking should then emphasize the proportional health risks of occasional smoking.

BACKGROUND: The UK government introduced two financial incentive schemes for primary care to tackle underdiagnosis in dementia: the 3-year Directed Enhanced Service 18 (DES18) and the 6-month Dementia Identification Scheme (DIS). The schemes appear to have been effective in boosting dementia diagnosis rates, but their unintended effects are unknown. AIM: To identify and quantify unintended consequences associated with the DES18 and DIS schemes. DESIGN AND SETTING: A retrospective cohort quantitative study of 7079 English primary care practices. METHOD: Potential unintended effects of financial incentive schemes, both positive and negative, were identified from a literature review. A practice-level dataset covering the period 2006/2007 to 2015/2016 was constructed. Difference-in-differences analysis was employed to test the effects of the incentive schemes on quality measures from the Quality and Outcomes Framework (QOF); and four measures of patient experience from the GP Patient Survey (GPPS): patient-centred care, access to care, continuity of care, and the doctor–patient relationship. The researchers controlled for effects of the contemporaneous hospital incentive scheme for dementia and for practice characteristics. RESULTS: National practice participation rates in DES18 and DIS were 98.5% and 76% respectively. Both schemes were associated not only with a positive impact on QOF quality outcomes, but also with negative impacts on some patient experience indicators. CONCLUSION: The primary care incentive schemes for dementia appear to have enhanced QOF performance for the dementia review, and have had beneficial spillover effects on QOF performance in other clinical areas. However, the schemes may have had negative impacts on several aspects of patient experience.

Background The UK government introduced two financial incentive schemes for primary care to tackle underdiagnosis in dementia: the 3-year Directed Enhanced Service 18 (DES18) and the 6-month Dementia Identification Scheme (DIS). The schemes appear to have been effective in boosting dementia diagnosis rates, but their unintended effects are unknown. Aim To identify and quantify unintended consequences associated with the DES18 and DIS schemes. Design and setting A retrospective cohort quantitative study of 7079 English primary care practices. Method Potential unintended effects of financial incentive schemes, both positive and negative, were identified from a literature review. A practice-level dataset covering the period 2006/2007 to 2015/2016 was constructed. Difference-in-differences analysis was employed to test the effects of the incentive schemes on quality measures from the Quality and Outcomes Framework (QOF); and four measures of patient experience from the GP Patient Survey (GPPS): patient-centred care, access to care, continuity of care, and the doctor–patient relationship. The researchers controlled for effects of the contemporaneous hospital incentive scheme for dementia and for practice characteristics. Results National practice participation rates in DES18 and DIS were 98.5% and 76% respectively. Both schemes were associated not only with a positive impact on QOF quality outcomes, but also with negative impacts on some patient experience indicators. Conclusion The primary care incentive schemes for dementia appear to have enhanced QOF performance for the dementia review, and have had beneficial spillover effects on QOF performance in other clinical areas. However, the schemes may have had negative impacts on several aspects of patient experience.