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Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.

ABSTRACT: BACKGROUND:Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence. OBJECTIVE:To test the impact of a pill bottle used to monitor adherence, deliver a daily alarm, and generate weekly medication adherence feedback reports on statin adherence. DESIGN:Three-month, three-arm randomized clinical trial (ClinicalTrials.gov identifier: NCT02480530). PARTICIPANTS:One hundred and twenty-six veterans with known coronary artery disease and poor adherence (medication possession ratio <80 %). INTERVENTION:Patients were randomized to one of three groups: (1) a control group (n = 36) that received a pill-monitoring device with no alarms or feedback; (2) an individual feedback group (n = 36) that received a daily alarm and a weekly medication adherence feedback report; and (3) a partner feedback group (n = 54) that received an alarm and a weekly feedback report that was shared with a friend, family member, or a peer. The intervention continued for 3 months, and participants were followed for an additional 3 months after the intervention period. MAIN MEASURES:Adherence as measured by pill bottle. Secondary outcomes included change in LDL (mg/dl), patient activation, and social support. KEY RESULTS:During the 3-month intervention period, medication adherence was higher in both feedback arms than in the control arm (individual feedback group 89 %, partner feedback group 86 %, control group 67 %; p?

SUBMITTER: Reddy A

PROVIDER: S-EPMC5330995 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.

Reddy Ashok A Huseman Tiffany L TL Canamucio Anne A Marcus Steven C SC Asch David A DA Volpp Kevin K Long Judith A JA

Journal of general internal medicine 20160909 3

<h4>Background</h4>Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence.<h4>Objective</h4>To test the impact of a pill bottle used to monitor adherence, deliver a daily alarm, and generate weekly medication adherence feedback reports on statin adherence.<h4>Design</h4>Three-month, three-arm randomized clinical trial (ClinicalTrials.gov identifier: NCT02480530).<h4>Participants</h4>One hundred and twenty-six veterans wi ...[more]

PMID: 27612487

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Project description:ImportanceFinancial incentives can improve medication adherence and cardiovascular disease risk, but the optimal design to promote sustained adherence after incentives are discontinued is unknown.ObjectiveTo 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.Design, setting, and participantsThis 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.InterventionsThe 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.Main outcomes and measuresThe primary outcome was change in LDL-C level from baseline to 12 months.ResultsAmong 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).Conclusions and relevanceCompared 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.Trial registrationClinicalTrials.gov Identifier: NCT01798784.

Dataset Information

Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.

Publications

Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.

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