Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, USA.
Am J Med. 2012 Sep;125(9):888-96. doi: 10.1016/j.amjmed.2012.01.003. Epub 2012 Jul 14.
Increasingly, financial reinforcement interventions based on behavioral economic principles are being applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications.
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.
Fifteen randomized studies and 6 nonrandomized studies examined the efficacy of financial reinforcement interventions for medication adherence. Financial reinforcers were applied for adherence to medications for tuberculosis, substance abuse, human immunodeficiency virus, hepatitis, schizophrenia, and stroke prevention. Reinforcement interventions significantly improved adherence relative to control conditions with an overall effect size of 0.77 (95% confidence interval, 0.70-0.84; P<.001). Nonrandomized studies had a larger average effect size than randomized studies, but the effect size of randomized studies remained significant at 0.44 (95% confidence interval, 0.35-0.53; P<.001). Interventions that were longer in duration, provided an average reinforcement of $50 or more per 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.
These results demonstrate the efficacy of medication adherence interventions and underscore principles that should be considered in designing future adherence interventions. Financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.
越来越多的基于行为经济学原理的财务强化干预措施正在被应用于医疗保健领域，本研究考察了使用财务强化物来提高药物依从性的效果。
检索了电子数据库和相关参考文献的书目，并对确定的试验进行了荟萃分析。考察了效应量的变异性以及潜在调节因素（研究设计、干预持续时间、强化程度和强化频率）对效应量的影响。
15 项随机研究和 6 项非随机研究考察了财务强化干预措施对药物依从性的疗效。财务强化物被应用于肺结核、药物滥用、人类免疫缺陷病毒、肝炎、精神分裂症和中风预防等药物的依从性。与对照条件相比，强化干预显著提高了药物依从性，总体效应量为 0.77（95%置信区间，0.70-0.84；P<.001）。非随机研究的平均效应量大于随机研究，但随机研究的效应量仍为 0.44（95%置信区间，0.35-0.53；P<.001）。持续时间较长、每周提供 50 美元或更多平均强化物、每周至少强化一次的干预措施比持续时间较短、提供较低强化物、强化频率较低的干预措施效果更大。
这些结果表明药物依从性干预措施的有效性，并强调了在设计未来依从性干预措施时应考虑的原则。财务强化干预措施有可能提高药物依从性，并可能为患者和社会带来益处。
