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A Brief Metric Framework for Patient Adherence to Doctor's Advice Based on Behavioral Economics.

ABSTRACT: Purpose:This study tried to establish a metric framework of patient adherence to doctor's advice based on the expected utility and prospect theories, and it explained why the key to patient adherence to doctor's advice is patients' perceptions. Methods:Our framework is primarily based on two mature theories: expected utility theory and prospect theory. We started with a basic assumption: the doctor is rational and cares for patient's health utility. We analyzed the expected utility of therapy with a definite diagnosis. Then, we considered the impacts of the accuracy of diagnostic techniques. After that, we explored the patient's response to the doctors' advices based on behavioral economics. In addition, we launched a discrete choice experiment to test our main point: perception is the key to patients' adherence. A total of 200 undergraduate students participated in the discrete choice experiment. Results:Three main factors might impact a rational clinical decision: the therapeutic and side effects of the treatment, patient's true disease risk, and diagnostic accuracy. However, another factor, patient's individual percepion, was crucial for patient's adherence since it may bias the patient's estimations regarding the above three factors. As a result, doctors and patients would have a cognitive gap in the estimation of the disease and the treatment. Conclusion:The results indicate that without the necessary information, better clinical techniques may not help to improve patient adherence, which support our theoretical reasoning forcefully. Therefore, improving patient adherence should be more of a process of empathy and communication rather than a promotion of medical technology.

SUBMITTER: Lin S

PROVIDER: S-EPMC7049270 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A Brief Metric Framework for Patient Adherence to Doctor's Advice Based on Behavioral Economics.

Lin Senlin S Ma Yingyan Y Zou Haidong H

Patient preference and adherence 20200225

<h4>Purpose</h4>This study tried to establish a metric framework of patient adherence to doctor's advice based on the expected utility and prospect theories, and it explained why the key to patient adherence to doctor's advice is patients' perceptions.<h4>Methods</h4>Our framework is primarily based on two mature theories: expected utility theory and prospect theory. We started with a basic assumption: the doctor is rational and cares for patient's health utility. We analyzed the expected utilit ...[more]

PMID: 32158201

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Project description:BackgroundDespite several years of guidance on infant feeding, there has been only a slight change in consumer compliance. Therefore, this study aimed to analyse parents feeding practices, explore physicians' advice about infant feeding and subsequent parent's adherence to advice.MethodsA multicentric cross-sectional qualitative and descriptive self-report online study was conducted in volunteers to participate in the study.ResultsFifty-four physicians (paediatricians and general practitioners) and 600 parents of infants were recruited. Of the infants, 20.2% presented at inclusion with at least one type of functional gastrointestinal disorder. The breastfeeding prevalence was quite low (37.3%). The main initial deviance from guidelines said they observed in infant feeding was the early use of cow's milk. More than two-thirds of infants older than 8 months were drinking cow's milk. The introduction of solid foods was globally in line with recommendations. Most physicians gave advice about the different aspects of infant feeding but were seeking more information, as did the parents. A discrepancy between the physicians' statements and the parents' perceptions was observed. However the majority (95.4%) of parents reported that they followed totally or partially the advice received, especially by abandoning subsequently the use of cow's milk in favour of a formula. The main reason for not adhering to the advice was that they did not consider it suitable for their infant and they preferred to rely on their feelings or recommendations from familiars.ConclusionsThis survey provides good insights into parents' infant feeding practices together with the advice given by their doctor. The gap between practices and current guidelines is notable only for breast-feeding and use of formula. Despite several guidelines professionals and parents seek nutrition information. It highlights the need to deliver consistent, relevant, and less confusing messages about infant feeding.

Project description:BackgroundMany HIV-positive patients do not appropriately adhere to their antiretroviral medication (ART). This leads to higher viral loads and greater probability of HIV transmission. Present bias-a tendency to give in to short-term temptations at the expense of long-term outcomes-is a potential driver of low adherence. In this study we test a novel intervention rooted in behavioral economics that is designed to overcome present bias and increase ART adherence.Methods/designWe will enroll 330 HIV-positive patients at Mildmay Hospital in Kampala, Uganda, into a 2-year randomized controlled trial. Participants will be randomized to one of three groups. The first intervention group (T1, n = 110) will be eligible for small lottery prizes based on timely clinic visits and demonstration of viral suppression. Group 2 (T2, n = 110) will be eligible for the same lottery prizes conditional on high adherence measured by a medication event management system (MEMS) cap. The control group (n = 110) will receive the usual standard of care. Adherence will be measured continuously throughout the intervention period and for 12 months post-intervention to evaluate effect persistence. Surveys will be conducted at baseline and then every 6 months. Viral loads will be measured annually. Primary outcomes are whether the viral load is detectable and MEMS-measured adherence. Secondary outcomes are the log-transformed viral load as a continuous measure and a binary measure for whether the person took at least 90% of their ART pills.DiscussionOur study is one of the first to investigate the effectiveness of lottery incentives for improving ART adherence, and in addition, it compares the relative efficacy of using electronically measured adherence versus viral load to determine lottery eligibility. MEMS caps are relatively costly, whereas viral load testing is now part of routine clinical care in Uganda. BEST will test whether directly incentivizing viral suppression (which can be implemented using readily available clinic data) is as effective as incentivizing electronically measured adherence. Cost-effectiveness analyses of the two implementation modes will also be performed.Trial registrationClinicalTrials.gov, NCT03494777. Registered on 11 April 2018.

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A Brief Metric Framework for Patient Adherence to Doctor's Advice Based on Behavioral Economics.

Publications

A Brief Metric Framework for Patient Adherence to Doctor's Advice Based on Behavioral Economics.

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