Randomized trial of lottery-based incentives to improve warfarin adherence.
Randomized trial of lottery-based incentives to improve warfarin adherence.
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DOI：
10.1016/j.ahj.2012.05.005
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发表时间：
2012-08
影响因子：
4.8
通讯作者：
Volpp K
中科院分区：
文献类型：
--
作者：
Kimmel SE;Troxel AB;Loewenstein G;Brensinger CM;Jaskowiak J;Doshi JA;Laskin M;Volpp K
服药依从性差是导致发病率和药效不足的主要原因。改善依从性的努力通常要么无效，要么过于复杂，无法在临床实践中实施。基于彩票的激励干预可能是提高遵从性的一种可扩展的方法。这是一项随机对照临床试验，根据基线国际标准化比率(INR)对服用华法林的患者进行每日基于彩票的激励。这项试验将100名患者随机分为基于彩票的激励组和不使用彩票的干预组。主要结果是INRS超出范围。在6个月的时间里，两组的总超出范围INRS的百分比没有差异(平均23.0%在彩票组和25.9%在对照组，调整后的优势比[OR]0.93，95%可信区间0.62-1.41)。然而，在基线INR低于治疗范围的先验亚组中，与对照组相比，彩票组的超范围INR显著减少(调整后的OR为0.39，95%CI为0.25-0.62)，而在基线为治疗性INR的患者中则没有这种影响(调整后的OR为1.26，95%CI，0.76-2.09，交互作用的P值=0.0016)。在基线INR低的患者中，不遵守干预措施的几率降低了49%(OR 0.51，95%CI 0.23-1.14)，但无统计学意义。尽管基于彩票的干预与所有研究参与者抗凝控制的显著改善无关，但它改善了依从性差的风险较高的先验患者组的控制。
Poor adherence to medications is a major cause of morbidity and inadequate drug effectiveness. Efforts to improve adherence have typically been either ineffective or too complex to implement in clinical practice. Lottery-based incentive interventions could be a scalable approach to improving adherence. This was a randomized, controlled clinical trial of a daily lottery-based incentive in patients on warfarin stratified by baseline international normalized ratio (INR). The trial randomized 100 patients to either a lottery-based incentive or no lottery intervention. Main outcome was out-of-range INRs. Over 6 months, the overall percentage of out-of-range INRs did not differ between the 2 arms (mean 23.0% in lottery arm and 25.9% in control arm, adjusted odds ratio [OR] 0.93, 95% CI 0.62–1.41). However, among the a priori subgroup with a baseline INR below therapeutic range, there was a significant reduction in out-of-range INR in the lottery arm versus the control arm (adjusted OR 0.39, 95% CI 0.25–0.62), whereas there was no such effect among those with therapeutic INRs at baseline (adjusted OR 1.26, 95% CI, 0.76–2.09, P value for interaction = .0016). Among those with low INR at baseline, there was a nonsignificant 49% reduction in the odds of nonadherence with the intervention (OR 0.51, 95% CI 0.23–1.14). Although a lottery-based intervention was not associated with a significant improvement in anticoagulation control among all study participants, it improved control among an a priori group of patients at higher risk for poor adherence.