Patient preferences for medication adherence financial incentive structures: A discrete choice experiment.
Patient preferences for medication adherence financial incentive structures: A discrete choice experiment.
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DOI：
10.1016/j.sapharm.2021.01.018
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发表时间：
2021-10
影响因子：
3.9
通讯作者：
Garza, Kimberly B.
中科院分区：
文献类型：
--
作者：
Hohmann, Natalie S.;Hastings, Tessa J.;Jeminiwa, Ruth N.;Qian, Jingjing;Hansen, Richard A.;Ngorsuraches, Surachat;Garza, Kimberly B.
关键词：
慢性疾病的药物依从性仍然是患者面临的挑战。鼓励患者坚持服药可能会有所帮助。在护理点提供的经济激励可能会作为服药行为的线索。本研究的目的是调查患者的偏好，具体结构的金融药物依从性的激励措施，可以切实可行地提供在护理点。离散选择实验（DCE）进行了全国在线调查。研究参与者是自我报告服用至少一种处方药治疗一种或多种慢性疾病的成年人。在SAS中生成的正交设计之后，DCE包括32个配对选择任务。数据采用混合logit模型进行分析，并根据参与者的收入水平进行分层。在整个队列（n=933）中，经济奖励的形式（如礼品卡或现金）对参与者的重要性是激励接收概率的1.02倍，是货币价值的1.58倍，是接收时间的1.93倍。参与者愿意放弃31.04美元的奖励货币价值（95% CI= 27.11 - 34.98美元）提前5个月获得激励（1个月vs. 6个月时滞）; $60.79（95% CI=$53.19-$68.39）接收概率从1/100增加到1/20;和10.52美元（95% CI= 6.46 - 14.58美元），以Visa®礼品卡而不是杂货店代金券的形式获得奖励。这些属性之间的权衡模式在低收入和高收入的参与者中基本一致。无论社会经济地位如何，患者对在护理点提供的财务药物依从性激励的偏好可能受激励形式和接收概率的影响最大。这对在激励可持续性、患者参与、计划星星评级和患者结果方面设计药物依从性计划具有影响。一项离散选择实验发现，患者对治疗依从性的即时经济激励的偏好受激励形式和接收概率的影响最大。
Medication adherence for chronic conditions continues to be a challenge for patients. Patient incentives for medication adherence may help. Financial incentives delivered at the point of care may act as cues for medication-taking behavior. The purpose of this study was to investigate patient preferences for specific structures of financial medication adherence incentives that could feasibly be delivered at the point of care. A discrete choice experiment (DCE) was performed using a national online survey. Study participants were adults who self-reported taking at least one prescription medication for one or more chronic conditions. Following an orthogonal design generated in SAS, the DCE included 32 paired-choice tasks. Data were analyzed using mixed logit models and stratified on participants’ income level. In the full cohort (n=933), form of financial reward (such as gift-card or cash) was 1.02 times as important to participants as the probability of incentive receipt, 1.58 times as important as monetary value, and 1.93 times as important as timing of receipt. Participants were willing to give up $31.04 of an incentive’s monetary value (95% CI=$27.11-$34.98) to receive the incentive 5 months sooner (1-month vs. 6-month time-lag); $60.79 (95% CI=$53.19-$68.39) for probability of receipt to increase from a 1 out of 100 chance to a 1 out of 20 chance; and $10.52 (95% CI=$6.46-$14.58) to receive an incentive in the form of a Visa® gift-card instead of grocery store voucher. These patterns of trade-offs between attributes were generally consistent among participants with lower and higher income. Regardless of socioeconomic status, patient preferences for financial medication adherence incentives delivered at the point of care may be most heavily influenced by incentive form and probability of receipt. This has implications for designing medication adherence programs in terms of incentive sustainability, patient engagement, plan star ratings, and patient outcomes. A discrete choice experiment found that patient preferences for point-of-care financial incentives for medication adherence are most heavily influenced by incentive form and probability of receipt.
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