Background Financial reinforcement interventions based on behavioral economic principles are being increasingly applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications. Methods Electronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in effect size and the impact of potential moderators (study design, duration of intervention, magnitude of reinforcement, and frequency of reinforcement) on effect size were examined. Results Fifteen randomized studies and 6 non-randomized studies examined the efficacy of financial reinforcement interventions for medication adherence. Financial reinforcers were applied for adherence to medications for tuberculosis, substance abuse, HIV, hepatitis, schizophrenia, and stroke prevention. Reinforcement interventions significantly improved adherence relative to control conditions with an overall effect size of 0.77 (95% CI = 0.70–0.84), p < .001. Non-randomized studies had a larger average effect size than randomized studies, but the effect size of randomized studies remained significant at 0.44 (95% CI = 0.35–0.53), p < .001. Interventions that were longer in duration, provided average reinforcement of ≥$50/week, and reinforced patients at least weekly resulted in larger effect sizes than those that were shorter, provided lower reinforcers, and reinforced patients less frequently. Conclusions These results demonstrate the efficacy of medication adherence interventions and underscore principles that should be considered in designing future adherence interventions. Importantly, financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.

Background: Bronchiectasis is a condition of increasing incidence and prevalence in the United States, defined by the presence of bronchial dilatation on chest-computed tomography. Most patients suffer from chronic daily cough and sputum production. Patients suffering from this disease often have a poor healthrelated quality of life (HRQoL), with increased morbidity and mortality, and increased health care burden.Little is known about trends in HRQoL among patients with bronchiectasis, therefore, we examined these trends over 2 years using a bronchiectasis-specific HRQoL instrument. Methods: We present data obtained from administering the Quality of Life-Bronchiectasis (QOL-B) questionnaires at three time points: (I) baseline at the time of first visit to the University of Connecticut Center for Bronchiectasis Care; (II) 1 year follow-up; and (III) a 2-year follow-up. Responses from the 36-item questionnaire evaluate eight scales (Physical Functioning, Role Functioning, Vitality, Emotional Functioning, Social Functioning, Treatment Burden, Health Perceptions, and Respiratory Symptoms);scores are standardized on a 0-100 point scale with higher scores indicating better HRQoL.Results: Twenty-six patients provided baseline QOL-B data, with seven lost to follow-up, leaving nineteen patients in the longitudinal study. Statistically significant improvement between the initial visit and the oneyear follow-up visit was shown in three of the eight domains: Physical Functioning, Role Functioning, and Health Perceptions. At 2 years, these improved HRQoL scores were generally maintained.Conclusions: This study demonstrates patients with bronchiectasis can demonstrate improved HRQoL after treatment at a specialized care center and these improvements are maintained for most patients 2 years after the initial visit.