title: The use of incentives to reinforce medication adherence.
abstract: OBJECTIVE
  Poor medication adherence is a longstanding problem, and is especially pertinent for individuals with chronic conditions or diseases. Adherence to medications can improve patient outcomes and greatly reduce the cost of care. The purpose of the present review is to describe the literature on the use of incentives as applied to the problem of medication adherence.
  
  
  METHODS
  We conducted a systematic review of peer-reviewed empirical evaluations of incentives provided to patients contingent upon medication adherence.
  
  
  RESULTS
  This review suggests that incentive-based medication adherence interventions can be very effective, but there are few controlled studies. The studies on incentive-based medication adherence interventions most commonly feature patients taking medication for drug or alcohol dependence, HIV, or latent tuberculosis. Across studies that reported percent adherence comparisons, incentives increased adherence by a mean of 20 percentage points, but effects varied widely. Cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention. Post-intervention evaluations were rare, but tended to find that adherence effects diminish after the interventions are discontinued.
  
  
  CONCLUSIONS
  Incentive-based medication adherence interventions are promising but understudied. A significant challenge for research in this area is the development of sustainable and cost-effective long-term interventions.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore MD 21224, USA. defulio@jhmi.edu
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFulio
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
mesh_terms: D000437:Alcoholism / Q000188:drug therapy; D005069:Evaluation Studies as Topic; D015658:HIV Infections / Q000188:drug therapy; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics* / Q000379:methods / Q000592:standards*; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy; D055118:Medication Adherence; D009042:Motivation; D012201:Reward; D019966:Substance-Related Disorders / Q000188:drug therapy; D014481:United States