title: Two Randomized Controlled Pilot Trials of Social Forces to Improve Statin Adherence among Patients with Diabetes.
abstract: BACKGROUND
  Medication nonadherence is an important obstacle to cardiovascular disease management.
  
  
  OBJECTIVE
  To improve adherence through real-time feedback based on theories of how social forces influence behavior.
  
  
  METHODS
  Two randomized controlled pilot trials called PROMOTE and SUPPORT. Participants stored statin medication in wireless-enabled pill bottles that transmitted adherence data to researchers.
  
  
  METHODS
  Adults with diabetes and a history of low statin adherence based on pharmacy refills (i.e., Medication Possession Ratio [MPR] <80% in the pre-randomization screening period).
  
  
  METHODS
  In PROMOTE, each participant was randomized to 1) weekly messages in which that participant's statin adherence was compared to that of other participants (comparison), 2) weekly summaries of that participant's statin adherence (summary), or 3) control. In SUPPORT, each participant identified another person (the Medication Adherence Partner [MAP]) to receive reports about that participant's adherence, and was randomized to 1) daily reports to MAP, 2) weekly reports to MAP, 3) reports to MAP only if dose was missed, or 4) control.
  
  
  METHODS
  Adherence measured by pill bottle.
  
  
  RESULTS
  Among 45,000 health plan members contacted by mail, <1% joined the trial. Participants had low baseline MPRs (median = 60%, IQR 41-72%) but high pill-bottle adherence (90% in PROMOTE, 92% in SUPPORT) during the trial. In PROMOTE (n = 201) and SUPPORT (n = 200), no intervention demonstrated significantly better adherence vs.
  
  
  METHODS
  In a subgroup of PROMOTE participants with the lowest pre-study MPR, pill-bottle-measured adherence in the comparison arm (89%) was higher than the control (86%) and summary (76%) arms, but differences were non-significant (p = 0.10).
  
  
  CONCLUSIONS
  Interventions based on social forces did not improve medication adherence vs. control over a 3-month period. Given the low percentage of invited individuals who enrolled, the studies may have attracted participants who required little encouragement to improve adherence other than study participation.
authors.affiliation: Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. peter.reese@uphs.upenn.edu.|Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. peter.reese@uphs.upenn.edu.|Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA. peter.reese@uphs.upenn.edu.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.affiliation: Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Judd B
authors.initials: JB
authors.lastname: Kessler
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.|Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joelle
authors.initials: J
authors.lastname: Friedman
authors.affiliation: Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Mussell
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Carney
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Wenli
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Troxel
authors.affiliation: Humana, Dublin, OH, USA.
authors.forename: Peinie
authors.initials: P
authors.lastname: Young
authors.affiliation: Humana, Dublin, OH, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Lawnicki
authors.affiliation: Merck & Co, Center of Observational and Real-World Evidence, North Wales, PA, USA.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Rajpathak
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.|Wharton School, University of Pennsylvania, Philadelphia, PA, USA.|Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Volpp
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010865:Pilot Projects; D012944:Social Support
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: interventions; medication adherence; social force; social support; statins