Increasing Medication Adherence Through Physician Incentives and Messaging

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Humana, Inc
Information provided by (Responsible Party):
National Bureau of Economic Research, Inc.
ClinicalTrials.gov Identifier:
NCT01603329
First received: May 16, 2012
Last updated: February 18, 2014
Last verified: February 2014
  Purpose

The goal of this project is to increase patient adherence to medication using communications and incentives for physicians. The investigators are partnering with a health insurance company, Humana Inc, to design and implement an incentives program for physicians whose patients increase their medication adherence for oral diabetes medication, hypertension (ACEI or ARB) medication, and/or cholesterol (statins) medication. The investigators will use behavioral economics to explore the best way to communicate the incentives to the physicians.


Condition Intervention
Medication Adherence
Other: Increasing Medication Adherence through Physician Incentives and Messaging

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Increasing Medication Adherence Through Physician Incentives and Messaging

Resource links provided by NLM:


Further study details as provided by National Bureau of Economic Research, Inc.:

Primary Outcome Measures:
  • Medication Adherence [ Time Frame: Up to two years ] [ Designated as safety issue: No ]
    The investigators will see how the treatment arms affect the targeted physicians' patients medication adherence for oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication.


Secondary Outcome Measures:
  • Demographic Controls for Physicians [ Time Frame: Up to two years ] [ Designated as safety issue: No ]
    The investigators will see if our targeted physicians' demographic controls affect their patients' medication adherence rates before and after treatment.

  • Demographic Controls for Patients [ Time Frame: Up to 2 years ] [ Designated as safety issue: No ]
    The investigators will see how demographic controls for patients affect our targeted physicians' patients' medication adherence.


Estimated Enrollment: 700
Study Start Date: June 2012
Estimated Study Completion Date: March 2014
Primary Completion Date: February 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Comprehensive incentives + comprehensive communication
Physicians are given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Comp incentives + comp communication + non-white paper
Physicians are given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication, and their patient reports are printed on non-white bright colored paper.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Focused incentives + focused com for oral diabetes medication
Physicians are given financial incentives for improving patient medication adherence for oral diabetes medication.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Foc incentives + foc comm for Diabetes + non-white paper
Physicians given financial incentives for improving patient medication adherence for oral diabetes medication and patient reports are printed on bright non-white paper.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Focused incentives + focused comm for hypertension meds
Physicians are given financial incentives for improving patient medication adherence for hypertension (ACEI or ARB) medication.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Foc incentives + comm for hypertension meds + non-white paper
Physicians are given financial incentives for improving patient medication adherence for hypertension (ACEI or ARB) medication with patient reports on non-white paper.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Focused incentives + focused comm for cholesterol meds
Physicians given financial incentives for improving patient medication adherence for cholesterol (statins) medication.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Foc incentives +comm for cholesterol meds + non-white paper
Physicians given financial incentives for improving patient medication adherence for cholesterol (statins) medication and patient reports are printed on non-white paper.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Comprehensive communiation
Physicians are given communication emphasizing the importance of improving adherence to all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Comprehensive communication + non-white paper
Physicians are given communication emphasizing the importance of improving adherence to all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication and patient reports are printed on non-white paper.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence
Experimental: Control Arm
Physicians and their patient adherence is tracked, but they receive no intervention.
Other: Increasing Medication Adherence through Physician Incentives and Messaging

There are two treatments:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.

Other Name: Adherence

Detailed Description:

Traditional economics would suggest that the best way to maximize adherence would be to give physicians financial incentives to improve adherence to all relevant drugs, and that communications to physicians should emphasize all of the relevant drugs. Behavioral economics suggests theory suggests that if you emphasize everything, then you are effectively emphasizing nothing. Behavioral econonmics would suggest to maximize adherence one should give physicians financial incentives for improving adherence for a small number of relevant drugs, and communications to physicians should emphasize a small number of the relevant drugs. This allows physicians to focus their energy and reduces the probability that they will give up because they're overwhelmed, or in other words, avoid the phenomenon called metric fatigue.

Humana has already implemented an incentives program for physicians, and the investigators will work with them to design a program that just focuses on medication adherence. Physicians targeted for this pilot could also be enrolled in another Humana incentives program, but this incentives program will act independently of the other.

There are two treatment dimensions the investigators will test via random assignment at the practice level:

  1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
  2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

In a previous study to increase uptake of colonoscopies among employees at a partner firm, the investigators found that using a post it note to catch the attention of the employee statistically significantly increased colonoscopy uptake over a control group. The investigators will also employ an eye catching method in the proposed pilot. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. They will be encouraged to include the patient sheet in their chart as a reminder to discuss medication adherence with their patient the next time they see them. For half of our arms, the investigators will make the patient sheets a bright, non-white, color, in order to futher draw the physicians' attention to that specific paper in their chart.

Our experimental arms will be:

  1. Comprehensive incentives + comprehensive communication
  2. Comprehensive incentives + comprehensive communication + printed on bright non-white paper
  3. Focused incentives + focused communication (one for all three drug classes)
  4. Focused incentives + focused communication + printed on bright non-white paper (one for all three drug classes)
  5. Comprehensive communiation
  6. Comprehensive communication + printed on bright non-white paper
  7. Control arm: no communication + no incentives

The investigators hypothesize that physicians who receive focused incentives and focused communications will have more patients with increased medication adherence than physicians who receive comprehensive incentives and comprehensive communications. The investigators also hypothsize that physicians who receive patient sheets using bright, non-white paper will have more patients with increased medication adherence than physicians who receive plain white patient sheets.

  Eligibility

Ages Eligible for Study:   65 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Physician in the Humana network
  • Treats Humana Medicare Advantage Members
  • Has Humana Medicare Advantage members who are taking at least one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and/or cholesterol (statins) medication, and who are less than 80% adherent.

Exclusion Criteria:

  • Practices with more than 10 physicians
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01603329

Locations
United States, Kentucky
Humana, Inc
Louisville, Kentucky, United States, 40202
Sponsors and Collaborators
National Bureau of Economic Research, Inc.
Humana, Inc
Investigators
Principal Investigator: David I Laibson, Ph.D. National Bureau of Economic Research, Harvard University
  More Information

No publications provided

Responsible Party: National Bureau of Economic Research, Inc.
ClinicalTrials.gov Identifier: NCT01603329     History of Changes
Other Study ID Numbers: 007
Study First Received: May 16, 2012
Last Updated: February 18, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by National Bureau of Economic Research, Inc.:
medication adherence
diabetes
hypertension
cholesterol
statins

ClinicalTrials.gov processed this record on October 16, 2014