August 3, 2012
A new study suggests that weekly rewards of as little as $5 can help patients adhere to their medication regimens.
Dr. Nancy Petry, and her University of Connecticut team, conducted a meta-analysis comprising 21 studies in which incentives were offered to people taking drugs for TB, substance abuse, HIV, hepatitis, schizophrenia, and stroke prevention. In the studies, researchers monitored adherence either by directly observing patients or by using electronic caps that recorded when medicine bottles were opened. The available incentives included money, food, clothing, grocery vouchers, and bus tokens.
In one study, HIV patients could earn up to $70 a week for taking their drugs correctly during a four-week period. Ninety percent of those offered the reward took their pills, compared to 69 percent who received no financial incentive. In another, 64 percent of TB patients who received a $5 reward for each clinic visit completed the nine- to 12-month regimen, compared to 27 percent who did not get a reward.
The highest levels of adherence were seen in programs where patients could earn $50 a week or more. Rewards offered at least once a week were more likely to encourage compliance, and the longer the incentive was available, the better.
Petry noted that the issue becomes more complicated in regard to drugs that must be taken lifelong, such as HIV medications. But, she said, offering incentives also could be cost-effective for health insurers, especially for blood pressure and cholesterol drugs.
Recent studies have found that fewer than half of patients follow doctors' medication orders, even for life-threatening conditions, and an estimated 130,000 Americans die annually because they did not take their drugs to prevent heart disease.
But Dr. Mark Pauly, a health care cost researcher at the University of Pennsylvania, commented that many doctors would find themselves paying patients who would have taken their prescriptions anyway.
[PNU editor's note: The study, "Financial Reinforcers for Improving Medication Adherence: Findings From a Meta-Analysis," was published online in the American Journal of Medicine (07.16.12).]