Background

Medication adherence for chronic conditions continues to be a challenge for patients. Patient incentives for medication adherence may help. Financial incentives delivered at the point of care may act as cues for medication-taking behavior.

Objectives

The purpose of this study was to investigate patient preferences for specific structures of financial medication adherence incentives that could feasibly be delivered at the point of care.

Methods

A discrete choice experiment (DCE) was performed using a national online survey. Study participants were adults who self-reported taking at least one prescription medication for one or more chronic conditions. Following an orthogonal design generated in SAS, the DCE included 32 paired-choice tasks. Data were analyzed using mixed logit models and stratified on participants’ income level.

Results

In the full cohort (n = 933), form of financial reward (such as gift-card or cash) was 1.02 times as important to participants as the probability of incentive receipt, 1.58 times as important as monetary value, and 1.93 times as important as timing of receipt. Participants were willing to give up $31.04 of an incentive's monetary value (95% CI = $27.11-$34.98) to receive the incentive 5 months sooner (1-month vs. 6-month time-lag); $60.79 (95% CI = $53.19-$68.39) for probability of receipt to increase from a 1 out of 100 chance to a 1 out of 20 chance; and $10.52 (95% CI = $6.46-$14.58) to receive an incentive in the form of a Visa® gift-card instead of grocery store voucher. These patterns of trade-offs between attributes were generally consistent among participants with lower and higher income.

Conclusions

Regardless of socioeconomic status, patient preferences for financial medication adherence incentives delivered at the point of care may be most heavily influenced by incentive form and probability of receipt. This has implications for designing medication adherence programs in terms of incentive sustainability, patient engagement, plan star ratings, and patient outcomes.

中文翻译：

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患者对药物依从性经济激励结构的偏好：离散选择实验

背景

慢性病的药物依从性仍然是患者面临的挑战。患者对药物依从性的激励可能会有所帮助。在护理点提供的经济激励可以作为服药行为的线索。

目标

本研究的目的是调查患者对特定结构的财务药物依从性激励措施的偏好，这些激励措施可以在护理点实施。

方法

使用全国在线调查进行离散选择实验（DCE）。研究参与者是自我报告为一种或多种慢性病服用至少一种处方药的成年人。在 SAS 中生成正交设计之后，DCE 包括 32 个配对选择任务。使用混合 logit 模型对数据进行分析，并对参与者的收入水平进行分层。

结果

在整个队列 (n = 933) 中，经济奖励形式（如礼品卡或现金）对参与者的重要性是获得奖励的概率的 1.02 倍，是货币价值的 1.58 倍，以及 1.93 倍作为收货时间。参与者愿意放弃 31.04 美元的奖励货币价值（95% CI = 27.11 美元-34.98 美元）以提前 5 个月获得奖励（1 个月与 6 个月的时滞）；60.79 美元（95% CI = 53.19-68.39 美元）的收货概率从 100 次中的 1 次增加到 20 次中的 1 次；和 $10.52 (95% CI = $6.46-$14.58) 以 Visa® 礼品卡而不是杂货店代金券的形式获得奖励。这些属性之间的权衡模式在收入较低和较高的参与者之间通常是一致的。

结论

无论社会经济地位如何，患者对在护理点提供的经济药物依从性激励措施的偏好可能受激励形式和接受概率的影响最大。这对于在激励可持续性、患者参与度、计划星级和患者结果方面设计药物依从性计划具有重要意义。