A test of financial incentives to improve warfarin adherence.
A test of financial incentives to improve warfarin adherence.
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DOI：
10.1186/1472-6963-8-272
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发表时间：
2008-12-23
影响因子：
2.8
通讯作者：
Kimmel SE
中科院分区：
文献类型：
--
作者：
Volpp KG;Loewenstein G;Troxel AB;Doshi J;Price M;Laskin M;Kimmel SE
每年，华法林的依从性不佳使数百万患者面临中风和出血并发症的风险。需要新的方法来提高华法林的依从性。我们进行了两项试点研究，以确定基于抽签的每日经济激励是否可行，并改善华法林的依从性和抗凝控制。来自宾夕法尼亚大学抗凝管理中心的服用华法林至少 3 个月的志愿者参加了一项试点研究，其中每日预期价值为 5 美元（N = 10）或每日预期价值为 3 美元（N = 10）。所有受试者均使用具有每日提醒功能的 Informedix Med-eMonitor™ 系统。如果受试者适当地打开他们的药盒，他们就会参加每日抽奖，五分之一的机会赢得 10 美元，百分之一的机会赢得 100 美元（试点 1），或者十分之一的机会赢得 10 美元，百分之一的机会赢得 100 美元（试点 2）。主要研究结果是错误华法林剂量的比例。次要结果是 INR 测量值不在治疗范围内的比例。对 INR 测量值进行受试者内前后比较，与历史平均值进行比较，或对不正确的华法林剂量进行受试者内比较。在第一个试点中，干预期间 INR 超出范围的百分比从 35.0% 下降到 12.2%，然后在干预后增加到 42%。干预期间错误服药的平均比例为 2.3%，而该诊所人群的历史平均错误服药率为 22%。在我们之前的研究中，有 5 名受试者也获得了华法林使用的 MEMS 帽依从性数据，平均错误服药率从试点前的 26% 下降到试点期间的 2.8%。在第二次试点中，超出 INR 范围的时间从 65.0% 下降到 40.4%，平均不正确服药比例下降到 1.6%。每日抽奖的经济激励措施表明，对于漏服华法林剂量和超出 INR 范围的时间有显着改善的潜力。应该对这种方法进行进一步的测试，以确定其有效性以及对华法林和其他慢性药物的潜在应用。
Sub-optimal adherence to warfarin places millions of patients at risk for stroke and bleeding complications each year. Novel methods are needed to improve adherence for warfarin. We conducted two pilot studies to determine whether a lottery-based daily financial incentive is feasible and improves warfarin adherence and anticoagulation control. Volunteers from the University of Pennsylvania Anticoagulation Management Center who had taken warfarin for at least 3 months participated in either a pilot study with a lottery with a daily expected value of $5 (N = 10) or a daily expected value of $3 (N = 10). All subjects received use of an Informedix Med-eMonitor™ System with a daily reminder feature. If subjects opened up their pill compartments appropriately, they were entered into a daily lottery with a 1 in 5 chance of winning $10 and a 1 in 100 chance of winning $100 (pilot 1) or a 1 in 10 chance of winning $10 and a 1 in 100 chance of winning $100 (pilot 2). The primary study outcome was proportion of incorrect warfarin doses. The secondary outcome was proportion of INR measurements not within therapeutic range. Within-subject pre-post comparisons were done of INR measurements with comparisons with either historic means or within-subject comparisons of incorrect warfarin doses. In the first pilot, the percent of out-of-range INRs decreased from 35.0% to 12.2% during the intervention, before increasing to 42% post-intervention. The mean proportion of incorrect pills taken during the intervention was 2.3% incorrect pills, compared with a historic mean of 22% incorrect pill taking in this clinic population. Among the five subjects who also had MEMS cap adherence data from warfarin use in our prior study, mean incorrect pill taking decreased from 26% pre-pilot to 2.8% in the pilot. In the second pilot, the time out of INR range decreased from 65.0% to 40.4%, with the proportion of mean incorrect pill taking dropping to 1.6%. A daily lottery-based financial incentive demonstrated the potential for significant improvements in missed doses of warfarin and time out of INR range. Further testing should be done of this approach to determine its effectiveness and potential application to both warfarin and other chronic medications.
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影响因子：
--
作者：
Gullov, AL;Koefoed, BG;Boysen, G
通讯作者：
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影响因子：
168.9
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