Kullgren Jeffrey T, Hafez Dina, Fedewa Allison, Heisler Michele
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI, USA.
Department of Internal Medicine, University of Michigan Medical School, 3101 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
Curr Diab Rep. 2017 Sep;17(9):73. doi: 10.1007/s11892-017-0894-z.
The purpose of this paper was to review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM.
We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggested such approaches have the potential to improve patient behaviors and such approaches should be tested more broadly.
本文旨在综述行为经济学干预措施(经济激励、选择架构调整或承诺机制)在预防高危患者2型糖尿病(T2DM)或改善T2DM患者自我管理方面的研究。
我们发现15项研究采用了不同的研究设计和结果,以测试临床、工作场所或健康计划环境中的行为经济学干预措施。在四项关注T2DM预防的研究中,两项发现经济激励增加了体重减轻和空腹血糖测试的完成率,两项选择架构调整在鼓励完成T2DM筛查测试方面效果不一。在11项关注改善T2DM自我管理的研究中,六项经济激励测试中有四项显示推荐护理过程中的参与度增加或生物测量指标改善,五项选择架构调整测试中有三项发现自我管理行为有所改善。尽管很少有研究测试行为经济学干预措施对T2DM的预防或治疗作用,但已有的研究表明这些方法有可能改善患者行为,应更广泛地进行测试。