The association of financial incentives for low density lipoprotein cholesterol reduction with patient activation and motivation

Abstract

There is growing interest in using financial incentives for patients to improve medication adherence, but few studies have evaluated whether financial incentives are associated with patients' activation and motivation. We analyzed survey data collected as part of a randomized clinical trial conducted from 2011 to 2014 of four financial incentive interventions to reduce low density lipoprotein cholesterol (LDL-C) among patients at risk for atherosclerotic cardiovascular disease. The main trial included 1503 patients aged 18–80 and recruited from primary care practices affiliated with three health systems. Participants were randomized into four groups: patient financial incentives, primary care physicians (PCPs) incentives, patients and PCPs shared incentives, or no incentives for LDL-C control. Patient Activation Measure (PAM) and Treatment Self Regulation Questionnaire (TSRQ) surveys were administered at baseline and 12 months. Clinical outcomes were change in LDL-C at 12 and 15 months and average medication adherence as measured by electronic pill bottle opening. Mean changes in PAM and TSRQ scores were compared between patients eligible and not eligible for incentives. Clinical outcomes were tested against baseline and change in psychosocial measures using bivariate and multivariate regression. Change in PAM score and TSRQ autonomous subscore did not differ significantly between patients eligible and not eligible for incentives. Lower baseline and greater increase in TSRQ autonomous subscore were predictive of greater 15-month decrease in LDL-C. A financial incentive intervention to improve LDL-C control was not associated with changes in patients' activation or autonomous motivation. Increases in patient autonomous motivation are predictive of long-term LDL-C control.

Impact of a Patient-Centered Behavioral Economics Intervention on Hypertension Control in a Highly Disadvantaged Population: a Randomized Trial

“…Monetary payment can induce short-term (and sometimes longer-term) health behavior changes, such as smoking cessation and healthy eating 45,46 but impact on medical conditions requiring long-term medication use is mixed [47][48][49][50][51][52] For example, use of lotteries increased short-term warfarin adherence, but the effect disappeared after the incentive was removed. 24 Sustained benefit in chronic disease care may require continued payments (particularly in populations with many competing demands and challenges), or additional interventions to promote patient attribution of behavior change to internal motivation, 26 or to influence clinician behavior.…”

The impact of uncertainty in society on the use of traditional, complementary and alternative medicine: a comparative study on visits to alternative/traditional/folk health care practitioners

“…Previous research has shown that economic measures at the national level have an effect on population health [57]. However, another study has shown that economic incentives are not always related to people’s motivation to improve their own health [58]. Thus, there may be limits to the economic measures at the national level.…”

Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure

“…Results of several studies using a lottery incentive program (“regret lottery”) approach, whereby participants are encouraged to undertake healthy behaviors through the desire to avoid regret over losing financial incentives, have been promising [ 10 , 11 ]. However, other interventions tested have been negative [ [12] , [13] , [14] ] or effective only in limited subgroups [ 15 ]. Further, with few exceptions [ 16 ], whether these incentives translate to sustainable behavior change in vulnerable populations is unclear.…”