School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Patient. 2019 Dec;12(6):571-592. doi: 10.1007/s40271-019-00377-8.
Medication adherence is poor in patients with chronic conditions. Behavioral economic interventions may reduce biases that are associated with poor adherence. The objective of this review is to map the available evidence on behavioral economic interventions to improve medication adherence in adults with chronic conditions in high-income settings.
We conducted a scoping review and reported the study using the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Review checklist. We searched PubMed, EMBASE, SCOPUS, PsycINFO, EconLit, and CINAHL from database inception to 29 August, 2018 for peer-reviewed studies and included a search of the gray literature. Data on study characteristics, study design, and study outcomes were extracted by one reviewer. Twenty-five percent of the studies were verified by a second reviewer.
Thirty-four studies, targeting diabetes mellitus, human immunodeficiency virus, and cardiovascular and renal diseases met our inclusion criteria. All but two studies were from the USA. The majority of interventions used financial incentives, often in conjunction with other behavioral economic concepts. Non-financial interventions included framing, social influences, reinforcement, and feedback. The effectiveness of interventions was mixed.
Behavioral economic informed interventions show promise in terms of improving medication adherence. However, there is no single simple intervention. This review highlighted the importance of targeting non-adherent patients, understanding their reasons for non-adherence, providing reminders and feedback to patients and physicians, and measuring clinical outcomes in addition to medication adherence. Further research in settings that differ from the US health system is needed.
慢性病患者的药物依从性较差。行为经济学干预措施可能会减少与药物依从性差相关的偏见。本研究旨在系统地回顾和绘制在高收入环境中改善慢性病成人药物依从性的行为经济学干预措施的现有证据。
我们进行了范围界定审查，并使用 Joanna Briggs 研究所审查员手册和 PRISMA 扩展清单报告了该研究。我们从数据库建立到 2018 年 8 月 29 日，在 PubMed、EMBASE、SCOPUS、PsycINFO、EconLit 和 CINAHL 上搜索了同行评议研究，并包括对灰色文献的搜索。一位评审员提取了研究特征、研究设计和研究结果的数据。有 25%的研究由第二位评审员进行了验证。
有 34 项研究符合纳入标准，这些研究的目标是糖尿病、人类免疫缺陷病毒以及心血管和肾脏疾病。除了两项研究之外，所有研究均来自美国。大多数干预措施都使用了经济激励措施，通常与其他行为经济学概念结合使用。非经济干预措施包括框架、社会影响、强化和反馈。干预措施的效果不一。
受行为经济学启发的干预措施在改善药物依从性方面显示出了前景。然而，并没有单一简单的干预措施。本综述强调了针对非依从性患者、了解其不依从的原因、为患者和医生提供提醒和反馈以及除药物依从性之外还测量临床结果的重要性。需要在与美国卫生系统不同的环境中进行进一步的研究。
