Effect of Patient Financial Incentives on Statin Adherence and Lipid Control: A Randomized Clinical Trial.
Effect of Patient Financial Incentives on Statin Adherence and Lipid Control: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2020.19429
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Volpp KG
中科院分区：
文献类型：
--
作者：
Barankay I;Reese PP;Putt ME;Russell LB;Loewenstein G;Pagnotti D;Yan J;Zhu J;McGilloway R;Brennan T;Finnerty D;Hoffer K;Chadha S;Volpp KG
即使在经济激励措施停止后，对药物依从性的日常经济激励是否可以诱导持久的他汀类药物依从性习惯并持续降低低密度脂蛋白胆固醇（LDL-C）水平？在一项针对心血管疾病风险较高、胆固醇水平欠佳且依从性不理想的个体的随机临床试验中，干预组的参与者获得了为期 6 个月的他汀类药物依从性经济激励。接受经济激励的个体的测量依从性更好，但 LDL-C 水平从基线到 12 个月的变化（主要结果）在干预组和对照组之间没有差异。经济激励后依从性的测量改善并没有转化为低密度脂蛋白胆固醇水平的改善。这项随机临床试验检验了为期 6 个月的干预措施（涉及不同的经济激励措施），以鼓励他汀类药物的依从性，是否可以将低密度脂蛋白胆固醇水平从基线降低到 12 个月。经济激励措施可以提高药物依从性和心血管疾病风险，但在激励措施停止后促进持续依从性的最佳设计尚不清楚。确定为期 6 个月的干预措施（涉及不同的经济激励措施，以鼓励他汀类药物依从性）是否可以将低密度脂蛋白胆固醇 (LDL-C) 水平从基线降低到 12 个月。这项 4 组随机临床试验于 2013 年 8 月至 2018 年 7 月在美国几家大型保险公司或雇主群体以及宾夕法尼亚大学医疗系统中进行。研究人群包括心血管疾病风险较高、LDL-C 控制不佳以及他汀类药物依从性不理想的成年人。数据分析于2017年7月至2019年6月进行。干预持续6个月，期间所有参与者均收到每日用药提醒和电子药瓶。通过打开瓶子来测量他汀类药物的依从性。对于随机分配到 3 个干预组的参与者，坚持执行的人会获得经济奖励。抽奖活动涉及对日常遵守的激励。在截止日期抽奖组中，如果参与者在提醒后才遵守，奖励就会减少。抽奖加存款合同组将奖励分为每日遵守和按每天不遵守而减少的每月存款。主要结果是 LDL-C 水平从基线到 12 个月的变化。在 805 名随机参与者中（简单每日抽奖组 199 名，截止日期抽奖组 204 名，抽奖加存款合同组 201 名，对照组 201 名），平均 (SD) 年龄为 58.5 (10.3) 岁； 519 名参与者 (64.5%) 为女性，514 名参与者 (63.9%) 患有糖尿病，273 名参与者 (33.9%) 患有心血管疾病。平均 (SD) 基线 LDL-C 水平为 143.2 (42.5) mg/dL。对照组 (0.69; 95% CI, 0.66-0.72) 6 个月时测量的依从性 (定义为电子药瓶开瓶的 180 天比例) 低于简单抽奖组 (0.84; 95% CI, 0.81-0.87)、截止日期抽奖组 (0.86; 95% CI, 0.83-0.89），抽奖加存款合同组（0.87；95% CI，0.84-0.90）（每个激励组与对照组的 P < .001）。在 12 个月内测量了 636 名参与者的 LDL-C 水平。 12 个月时，对照组平均 LDL-C 水平从基线降低 33.6 mg/dL (95% CI, 28.4-38.8 mg/dL)，抽奖组为 32.4 mg/dL (95% CI, 27.3-37.6 mg/dL)，抽奖组为 33.2 mg/dL (95% CI, 28.1-38.3)。 mg/dL）在截止日期抽奖组中，36.5 mg/dL（95% CI，31.3-41.7 mg/dL）在抽奖加存款合同组中（每个激励组与对照组相比调整后的 P > .99）。与对照组相比，不同的经济激励措施提高了他汀类药物的依从性，但没有改善 LDL-C 水平。这一结果表明，在旨在改善健康行为的试验中，直接测量健康结果（而不是简单地遵守）的重要性。 ClinicalTrials.gov 标识符：NCT01798784
Can daily financial incentives for medication adherence induce lasting habits for statin adherence and sustained reductions in low-density lipoprotein cholesterol (LDL-C) levels even after financial incentives are discontinued? In a randomized clinical trial of individuals at elevated risk of cardiovascular disease and with suboptimal cholesterol levels and imperfect adherence, participants in the intervention groups received financial incentives for statin adherence for 6 months. Measured adherence was better among individuals receiving financial incentives, but the change in LDL-C level from baseline to 12 months, the primary outcome, did not differ between intervention and control groups. Measured improvements in adherence after financial incentives did not translate into improved LDL-C levels. This randomized clinical trial examines whether 6-month interventions involving different financial incentives to encourage statin adherence reduce low-density lipoprotein cholesterol levels from baseline to 12 months. Financial incentives can improve medication adherence and cardiovascular disease risk, but the optimal design to promote sustained adherence after incentives are discontinued is unknown. To determine whether 6-month interventions involving different financial incentives to encourage statin adherence reduce low-density lipoprotein cholesterol (LDL-C) levels from baseline to 12 months. This 4-group, randomized clinical trial was conducted from August 2013 to July 2018 among several large US insurer or employer populations and the University of Pennsylvania Health System. The study population included adults with elevated risk of cardiovascular disease, suboptimal LDL-C control, and evidence of imperfect adherence to statin medication. Data analysis was performed from July 2017 to June 2019. The interventions lasted 6 months during which all participants received daily medication reminders and an electronic pill bottle. Statin adherence was measured by opening the bottle. For participants randomized to the 3 intervention groups, adherence was rewarded with financial incentives. The sweepstakes group involved incentives for daily adherence. In the deadline sweepstakes group, incentives were reduced if participants were adherent only after a reminder. The sweepstakes plus deposit contract group split incentives between daily adherence and a monthly deposit reduced for each day of nonadherence. The primary outcome was change in LDL-C level from baseline to 12 months. Among 805 participants randomized (199 in the simple daily sweepstakes group, 204 in the deadline sweepstakes group, 201 in the sweepstakes plus deposit contract group, and 201 in the control group), the mean (SD) age was 58.5 (10.3) years; 519 participants (64.5%) were women, 514 (63.9%) had diabetes, and 273 (33.9%) had cardiovascular disease. The mean (SD) baseline LDL-C level was 143.2 (42.5) mg/dL. Measured adherence at 6 months (defined as the proportion of 180 days with electronic pill bottle opening) in the control group (0.69; 95% CI, 0.66-0.72) was lower than that in the simple sweepstakes group (0.84; 95% CI, 0.81-0.87), the deadline sweepstakes group (0.86; 95% CI, 0.83-0.89), and the sweepstakes plus deposit contract group (0.87; 95% CI, 0.84-0.90) (P < .001 for each incentive group vs control). LDL-C levels were measured for 636 participants at 12 months. Mean LDL-C level reductions from baseline to 12 months were 33.6 mg/dL (95% CI, 28.4-38.8 mg/dL) in the control group, 32.4 mg/dL (95% CI, 27.3-37.6 mg/dL) in the sweepstakes group, 33.2 mg/dL (95% CI, 28.1-38.3 mg/dL) in the deadline sweepstakes group, and 36.5 mg/dL (95% CI, 31.3-41.7 mg/dL) in the sweepstakes plus deposit contract group (adjusted P > .99 for each incentive group vs control). Compared with the control group, different financial incentives improved measured statin adherence but not LDL-C levels. This result points to the importance of directly measuring health outcomes, rather than simply adherence, in trials aimed at improving health behaviors. ClinicalTrials.gov Identifier: NCT01798784
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影响因子：
2.8
作者：
Volpp KG;Loewenstein G;Troxel AB;Doshi J;Price M;Laskin M;Kimmel SE
通讯作者：
Kimmel SE
影响因子：
5.9
作者：
Shah, Nilay D.;Dunlay, Shannon M.;Ting, Henry H.;Montori, Victor M.;Thomas, Randal J.;Wagie, Amy E.;Roger, Veronique L.
通讯作者：
Roger, Veronique L.
影响因子：
168.9
作者：
Mihaylova, B.;Emberson, J.;Blackwell, L.;Keech, A.;Simes, J.;Barnes, E. H.;Voysey, M.;Gray, A.;Collins, R.;Baigent, C.;de Lemos, J.;Braunwald, E.;Blazing, M.;Murphy, S.;Downs, J. R.;Gotto, A.;Clearfield, M.;Holdaas, H.;Gordon, D.;Davis, B.;Koren, M.;Dahlof, B.;Poulter, N.;Sever, P.;Knopp, R. H.;Fellstrom, B.;Holdaas, H.;Jardine, A.;Schmieder, R.;Zannad, F.;Goldbourt, U.;Kaplinsky, E.;Colhoun, H. M.;Betteridge, D. J.;Durrington, P. N.;Hitman, G. A.;Fuller, J.;Neil, A.;Wanner, C.;Krane, V.;Sacks, F.;Moye, L.;Pfeffer, M.;Hawkins, C. M.;Braunwald, E.;Kjekshus, J.;Wedel, H.;Wikstrand, J.;Barter, P.;Keech, A.;Tavazzi, L.;Maggioni, A.;Marchioli, R.;Tognoni, G.;Franzosi, M. G.;Maggioni, A.;Bloomfield, H.;Robins, S.;Collins, R.;Armitage, J.;Keech, A.;Parish, S.;Peto, R.;Sleight, P.;Pedersen, T. R.;Ridker, P. M.;Holman, R.;Meade, T.;Simes, J.;Keech, A.;MacMahon, S.;Marschner, I.;Tonkin, A.;Shaw, J.;Serruys, P. W.;Nakamura, H.;Knatterud, G.;Furberg, C.;Byington, R.;Macfarlane, P.;Cobbe, S.;Ford, I.;Murphy, M.;Blauw, G. J.;Packard, C.;Shepherd, J.;Kjekshus, J.;Pedersen, T.;Wilhelmsen, L.;Braunwald, E.;Cannon, C.;Murphy, S.;Collins, R.;Armitage, J.;Bowman, L.;Parish, S.;Peto, R.;Sleight, P.;Baigent, C.;Landray, M.;Collins, R.;La Rosa, J.;Rossouw, J.;Probstfield, J.;Shepherd, J.;Cobbe, S.;Macfarlane, P.;Ford, I.
通讯作者：
Ford, I.
DOI：
10.1001/jama.296.21.joc60162
发表时间：
2006-12-06
影响因子：
120.7
作者：
Lee, Jeannie K.;Grace, Karen A.;Taylor, Allen J.
通讯作者：
Taylor, Allen J.
影响因子：
24
作者：
Colantonio, Lisandro D.;Huang, Lei;Rosenson, Robert S.
通讯作者：
Rosenson, Robert S.