Medication Adherence: How Can We Change Patient Behavior? One Study Shows How Not To Do It

Adherence to medications prescribed after acute myocardial infarction (AMI) is low. Given that wireless technology and behavioral economic approaches have “shown promise” in improving health behaviors, researchers at the University of Pennsylvania recently conducted a study to find out whether a system of medication reminders that includes financial incentives and social support could delay subsequent vascular events in AMI patients.

Published in JAMA Internal Medicine, the study found no statistically significant differences between the two study arms in time-to-first-rehospitalization for a vascular event or death, medication adherence, or cost.

The use of electronic pill bottles that tracked when patients took medication, combined with monetary incentives and support from friends, family and engagement advisers, offered no significant improvement in medication adherence for patients that were recovering from a heart attack, as an article in FierceHealthcare notes.

“What we found was a little bit surprising and a little bit disappointing,” lead study author Kevin Volpp, MD, PhD, director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, said in an accompanying interview.

Despite the study results, the researchers still believe there is value in using technology to improve medication adherence, the article says. For example, researchers said there were indications that earlier enrollment could play a factor in the success of the interventions; because participants were identified through five different health plans, it took 40 days on average to enroll them in the program because of the delay in insurance claims, according to the article.

David Asch, MD, executive director of the University of Pennsylvania’s Center for Health Care Innovation, said one of the most important lessons of the research is the subtle distinction between various engagement strategies and how effective those are. Future research should focus on interventions that start at the time of discharge and incorporate different variations of smart pill bottles. “I think we learned enough about what went wrong in the study that may help us in designing better studies and better interventions in the future,” he said.

This study demonstrates that changing patients’ behavior is about more than just technology; a smart pill bottle is not going to suddenly convince patients to take their medicine.

One of the most significant issues to me is the 40-day average time it took to begin the program with each patient, due to delays related to insurance claims.

The best opportunity we have for changing patient behavior is at the point of care, when the patient in the hospital or the clinician’s office, and engaging with his or her health care providers. Any medication adherence program that starts 40 days after the health event in question starts out at a disadvantage; at that point, you’ve missed the window of opportunity.