Bilardi et al. BMC Public Health 2010, 10:70 http://www.biomedcentral.com/1471-2458/10/70 R E S E A R C H A R T I C L E Open Access Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial Jade E Bilardi1*, Christopher K Fairley1,2, Meredith J Temple-Smith3, Marie V Pirotta3, Kathleen M McNamee4, Siobhan Bourke2, Lyle C Gurrin5, Margaret Hellard6, Lena A Sanci3, Michelle J Wills7, Jennifer Walker1, Marcus Y Chen1,2, Jane S Hocking8 Abstract Background: Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice. Methods: General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed using a mixed effects logistic regression model, accommodating for clustering at GP level. Results: Testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included a lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing. Conclusions: A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments. Further research is required to determine if financial incentives can increase testing in Australian general practice, the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12608000499381. Background Chlamydia trachomatis is the most commonly notified bacterial sexually transmitted infection (STI) in Austra- lia, with notification rates rising nearly fourfold over the past ten years, from 73.5 per 100,000 in 1999 to 273.8 per 100,000 in 2008 [1]. Left untreated, chlamydia can * Correspondence: jbilardi@mshc.org.au 1Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia lead to serious reproductive sequelae including pelvic inflammatory disease, ectopic pregnancy and infertility [2,3]. Given that up to 90% of infections are asympto- matic [3], increased testing is required to effectively detect and control chlamydia infection and limit its associated morbidity. In Australia, national chlamydia testing guidelines issued by the Royal Australian College of General Prac- titioners (RACGP) [4] recommend annual testing of © 2010 Bilardi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.