title: Pilot Study to Test the Effectiveness of Different Financial Incentives to Improve Medication Adherence.
abstract: BACKGROUND
  Medication nonadherence affects health care costs, morbidity, and mortality. Concepts from behavioral economics can guide the development of interventions to improve medication adherence.
  
  
  OBJECTIVE
  To measure the relative effectiveness of 2 behavioral economic-based incentive structures to improve medication adherence.
  
  
  METHODS
  This randomized controlled trial compared adherence among participants taking antihypertensive or antihyperlipidemic medications randomized to usual care (UC), guaranteed pay-out (GPO) incentives, or lottery incentives. Daily adherence was measured over a 90-day period using electronic caps (Medication Event Monitoring System [MEMS]). The GPO group received $30 up-front in a virtual account, with $0.50 deducted for each missed dose. Lottery group participants were eligible for a weekly $50 drawing, but only if they had taken their medication as prescribed all week. An electronic survey assessed self-reported adherence. Statistical analysis included descriptive statistics, paired t tests, ANOVA, and Pearson's correlations.
  
  
  RESULTS
  In all, 36 participants were randomized (UC, n = 11; GPO, n = 14; lottery, n = 11). Mean percentage (±SD) of days adherent during the incentive period was highest in the lottery group (96% ± 5%), followed by the GPO group (94% ± 9%) and the UC group (94% ± 9%). There were no statistically significant differences among groups (P > 0.05). MEMS-measured adherence was not significantly correlated with a patient's self-reported adherence (P > 0.05) at baseline but was correlated at 90-day follow-up (P < 0.001).
  
  
  CONCLUSIONS
  Although no statistically significant differences in adherence were demonstrated in this small sample of highly adherent participants, larger studies in a more diverse population or with other medications might show otherwise.
authors.affiliation: Auburn University Harrison School of Pharmacy, Auburn, AL, USA Kbl0005@auburn.edu.
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Garza
authors.affiliation: Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Owensby
authors.affiliation: Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Braxton Lloyd
authors.affiliation: Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wood
authors.affiliation: Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D010865:Pilot Projects; D011897:Random Allocation; D057566:Self Report
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents
keywords: adherence; cardiovascular drugs; clinical trial design; hyperlipidemia; hypertension