Asthma UK Centre of Applied Research, National Heart and Lung Institute, Imperial College London, London, UK.
Asthma UK Centre of Applied Research, Centre for Population Health Sciences, The University of Edinburgh Centre for Population Health Sciences, Edinburgh, UK.
BMJ Open. 2023 Jul 30;13(7):e070761. doi: 10.1136/bmjopen-2022-070761.
The objectives of this systematic review are to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma management behaviours, determine overall effectiveness of financial incentives, identify design characteristics of effective interventions and assess the impact on longer-term outcomes in the context of asthma.
Systematic review with narrative synthesis.
Electronic databases (MEDLINE, Embase, Global Health, PsycINFO, CINAHL, PubMed and Web of Science) and grey literature sources (NHS Digital, CORE, ProQuest, Clinical Trials Register and EU Clinical Trials Register) were searched in November 2021 and updated March 2023.
Eligible articles assessed financial incentives to improve asthma management behaviours (attendance at appointments, medication adherence, tobacco smoke/allergen exposure, inhaler technique and asthma education) for patients with asthma or parents/guardians of children with asthma. Eligible study design included randomised controlled, controlled or quasi-randomised trials and retrospective/prospective cohort, case-controlled or pilot/feasibility studies.
A narrative synthesis was conducted; eligible studies were grouped by asthma management behaviours and financial incentive framework domains.
We identified 4268 articles; 8 met the inclusion criteria. The studies were from the USA (n=7) and the UK (n=1). Asthma management behaviours included attendance at appointments (n=4), reduction in smoke exposure (n=1) and medication adherence (n=3). Five studies demonstrated positive behaviour change, four of which were significant (attendance at appointments (n=3) showed significant differences between intervention and control: 73% and 49% in one study, 46.3% and 28.9% in another, and 35.7% and 18.9%, respectively; medication adherence (n=1) showed significant change from 80% during intervention to 33% post intervention). These four significant studies used 'positive gain', 'certain', 'fixed' financial incentives of smaller magnitude, given for 'all' instances of behaviour.
There is some evidence that patient-directed financial incentives improve asthma management behaviours. However, in view of the wide heterogeneity in study design and measured outcomes, determining overall effectiveness was challenging.
CRD42021266679.
本系统评价的目的是确定评估患者导向型财务激励干预措施以改善哮喘管理行为的有效性的研究，确定财务激励的总体效果，确定有效干预措施的设计特点，并评估其对哮喘背景下长期结局的影响。
系统评价与叙述性综合。
2021 年 11 月检索电子数据库（MEDLINE、Embase、全球健康、PsycINFO、CINAHL、PubMed 和 Web of Science）和灰色文献来源（NHS Digital、CORE、ProQuest、临床试验登记处和欧盟临床试验登记处），并于 2023 年 3 月更新。
符合条件的文章评估了为哮喘患者或哮喘儿童的父母/监护人提供的财务激励措施，以改善哮喘管理行为（就诊、药物依从性、烟草烟雾/过敏原暴露、吸入器技术和哮喘教育）。合格的研究设计包括随机对照、对照或准随机试验以及回顾性/前瞻性队列、病例对照或试点/可行性研究。
进行了叙述性综合；符合条件的研究按哮喘管理行为和财务激励框架领域分组。
我们确定了 4268 篇文章；符合纳入标准的有 8 篇。这些研究来自美国（n=7）和英国（n=1）。哮喘管理行为包括就诊（n=4）、减少烟雾暴露（n=1）和药物依从性（n=3）。五项研究显示出积极的行为改变，其中四项具有统计学意义（就诊显示干预与对照组之间的差异有统计学意义：一项研究中分别为 73%和 49%，另一项研究中分别为 46.3%和 28.9%，还有一项研究中分别为 35.7%和 18.9%；药物依从性（n=1）显示出从干预期间的 80%到干预后 33%的显著变化）。这四项具有统计学意义的研究使用了“正向收益”、“确定”、“固定”的财务激励措施，激励幅度较小，针对“所有”行为发生的情况。
有一些证据表明，患者导向的财务激励措施可以改善哮喘管理行为。然而，鉴于研究设计和测量结果的广泛异质性，确定总体效果具有挑战性。
PROSPERO 注册号：CRD42021266679。
