Medication Adherence

Whether and why patients take their medications as prescribed, for as long as prescribed, and the factors that encourage greater compliance with drug regimens.

A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

Nov. 20, 2016

Stephen E. Kimmel, Andrea B. Troxel, Benjamin French, George Loewenstein, Jalpa A. Doshi, Todd E. H. Hecht, Mitchell Laskin, Colleen M. Brensinger, Chris Meussner, Kevin Volpp

In Pharmacoepidemiology and Drug Safety, Stephen Kimmel and colleagues, including Jalpa Doshi, Benjamin French and Kevin Volpp, investigate the comparative effectiveness of reminders alone versus daily lottery incentives in improving medication adherence. This study was a four-arm multi-center...

Rationale and design of a randomized trial of automated hovering for post myocardial infarction patients: The HeartStrong program

Sep. 22, 2016

Andrea B. Troxel, David A. Asch, Shivan J. Mehta, Laurie Norton, Devon Taylor, Tirza A. Calderon, Raymond Lim, Jingsan Zhu, Daniel M. Kolansky, Brian M. Drachman, Kevin G. Volpp

In the American Heart Journal, Andrea Troxel and colleagues, including Kevin Volpp, David Asch and Shivan Mehta, discuss the rationale and design of the HeartStrong program, a randomized controlled trial aimed at increasing medication adherence among patients with coronary artery disease. This trial features three main innovations: first, it uses behavioral economics concepts such as intermittent feedback, regret aversion and the entertainment value of a daily lottery; second, it automates procedures using new technology such as wireless pill bottles and remote feedback; and third...

Participation Rates With Opt-out Enrollment in a Remote Monitoring Intervention for Patients With Myocardial Infarction

Sep. 13, 2016

Shivan J. Mehta, Andrea B. Troxel, Noora Marcus, Christina Jameson, Devon Taylor,  David A. Asch, and Kevin G. Volpp

In JAMA Cardiology, Shivan Mehta and colleagues, including Andrea Troxel, David Asch and Kevin Volpp, evaluate whether an opt-out approach to enrollment, which has been shown to be effective in behavioral economics research, increases participation in a remote monitoring intervention among patients with myocardial infarction. This prospective cohort study compared enrollment rates in a remote monitoring intervention for medication adherence, using an opt-in vs an opt-out approach. Opt-in participants were recruited in the 60 days after discharge by sending a recruitment letter to...

A Synchronized Prescription Refill Program Improved Medication Adherence

Aug. 5, 2016

Jalpa A. Doshi, Raymond Lim, Pengxiang Li, Peinie P. Young, Victor F. Lawnicki, Joseph J. State, Andrea B. Troxel, and Kevin G. Volpp

In Health Affairs, Jalpa Doshi and colleagues, including Pengxiang Lee, Andrea Troxel and Kevin Volpp, evaluate whether renewing all medications at the same time from the same pharmacy improves adherence to medication regimens. Synchronizing medication refills is an increasingly popular strategy, but there has been little research regarding its effectiveness. The authors looked at a pilot refill synchronization program implemented by Humana, a large national insurer, and analyzed patients’ adherence before and after participation in the program, compared to a control group. The...

Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

Mar. 22, 2016

Jalpa Doshi, Junko Takeshita, Lionel Pinto, Penxiang Li, Xinyan Yu, Preethi Rao, Hema N. Viswanathan, Joel M. Gelfand

In the Journal of the American Academy of Dermatology, Jalpa Doshi and colleagues, including Penxiang Li and Preethi Rao, investigate real-world utilization patterns of biologic therapy in Medicare beneficiaries with psoriasis. Studies indicate low adherence to biologics among patients with psoriasis, yet little is known about the adherence level in the Medicare population. Using data from the Medicare Chronic Condition Data Warehouse Part A, B, and D files with 12-month follow-up after index prescription, Doshi and colleagues conducted a retrospective claims analysis on 2707...

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial

Research Brief
Jan. 15, 2016

To whom should financial incentives be targeted to achieve a desired clinical or health outcome—physicians or patients? Using insight from behavioral economics, a research team led by LDI Senior Fellows David Asch and Kevin Volpp sought to determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in promoting medication adherence and reducing cholesterol levels of patients at high risk for cardiovascular disease. Though physician and patient incentives are becoming more common, they are rarely combined, and effectiveness of these approaches is not well-established. This study offers insight into what incentive structure leads to the greatest impact on health promotion. 

Getting More Food-Allergic Young Adults To Carry Their Epinephrine: A Behavioral Economics Approach

Sep. 3, 2015

As one of the estimated 2.5% of Americans with a food allergy, deciding my next meal, snack, or even beverage is no simple task. Remembering to carry emergency epinephrine is also no walk in the park. Young adults like me are particularly vulnerable to error related to their food allergies and likely to engage in risky behavior. And despite the risk of death by anaphylaxis, few individuals with severe food allergies carry their emergency epinephrine on a daily basis.

Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic

Apr. 9, 2015

Robert J. Smith, Karin Rhodes, Breah Paciotti, Sheila Kelly, Jeanmarie Perrone, Zachary F. Meisel

In the Annals of Emergency Medicine, Robert Smith and colleagues, including Karin Rhodes and Zachary Meisel, analyze patient perspectives on pain management, use of opioids, and understanding of the risks of developing opioid dependence. The authors conducted semi-structured telephone interviews with 23 patients recently discharged from an urban academic emergency department after presenting with acute back pain. Although patients discussed many topics, themes arose around: awareness of opioid dependence and addiction, and patient-provider communication around pain management. Patients...

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