Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104-6021, USA.
Clin Trials. 2012 Dec;9(6):689-95. doi: 10.1177/1740774512453520. Epub 2012 Jul 30.
Adherence to medications for chronic conditions is often very low, limiting the benefit to patients, even when the medications are effective and have favorable side effect profiles.
This article reviews some of the prior work on treatment adherence, introduces novel concepts from behavioral economics that can be used to design interventions to improve adherence, and proposes new approaches for clinical trials.
Relevant experience of the authors and insights from the literature were combined to identify key issues and propose methodological improvements. Specific examples regarding adherence to warfarin are provided.
Several new approaches to trial design can be effectively applied in the context of medication adherence. These include tailored intervention strategies and sequential multiple assignment randomized trial (SMART) designs.
While we have proposed to use these new approaches for ongoing studies of adherence in behavioral health, practical experience with their application is still somewhat limited.
Behavioral economics offer a variety of concepts that, when used in the design of interventions to improve adherence, may be more successful than traditional approaches. New clinical trial designs can also be adopted to improve the efficiency of studies that assess these approaches.
慢性病药物治疗的依从性通常非常低，即使药物有效且副作用小，也会限制其对患者的获益。
本文回顾了一些关于治疗依从性的前期工作，介绍了行为经济学中可以用于设计干预措施以提高依从性的新观念，并为临床试验提出了新方法。
作者结合相关经验和文献见解，确定了关键问题并提出了方法学改进。文中还提供了关于华法林依从性的具体示例。
在药物依从性的背景下，可以有效地应用几种新的试验设计方法。其中包括量身定制的干预策略和序贯多项分配随机试验（SMART）设计。
虽然我们已提议在行为健康领域中正在进行的依从性研究中使用这些新方法，但对其应用的实际经验仍然有限。
行为经济学提供了多种概念，将这些概念用于设计改善依从性的干预措施时，可能比传统方法更成功。还可以采用新的临床试验设计来提高评估这些方法的研究效率。
