Clinical research studyFinancial Reinforcers for Improving Medication Adherence: Findings from a Meta-analysis
Section snippets
Identification of Studies
PubMed and PsychInfo databases were searched through April 2011 for matches in titles, abstracts and descriptors, for the terms: medication and (compliance or adhere*) and (incentive* or cash* or money or token* or payment*). Reference lists of retrieved articles also were examined.
Study Inclusion and Exclusion Criteria
Article titles and abstracts were screened independently. If either suggested that the article might be appropriate, the article was retrieved. Financially based reinforcers for medication adherence were defined as
Results
Electronic searches identified 621 articles containing the keywords. After review of the titles and abstracts, 46 articles were retrieved as potentially meeting the study inclusion criteria, and 32 additional articles were found through references contained in source articles. Of the 78 retrieved articles, 18 were excluded because they were reviews, 10 discussed ethical issues about payments, 8 did not provide financial reinforcers to patients, 8 did not reinforce medication ingestion, 5
Discussion
Financial reinforcement interventions are beneficial for improving medication adherence with an overall mean effect size of 0.77. An additional 60 studies would need to have been conducted, and to have found nonsignificant effects, to reverse the conclusion drawn. All 4 moderators evaluated significantly impact effect sizes. Compared with nonrandomized studies, randomized studies had a smaller, but statistically significant, effect size in the moderate range. Consistent with behavioral economic
Conclusions
Despite demonstrated successes, providing patients with financial reinforcers is highly controversial.14 An ongoing study using these approaches with patients under psychiatric care in the United Kingdom60 has been met with considerable skepticism. Decisions about which patients receive financial reinforcers require careful consideration to balance concerns about equitability, possibilities of unintended behaviors, and costs and benefits of treatment. Results from this meta-analysis indicate
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Funding: The research and preparation of this report were supported by National Institutes of Health Grants P30-DA023918, R01-DA024667, R01-DA027615, R01-DA022739, R01-DA13444, R01-DA018883, R01-DA016855, R01-DA14618, P50-DA09241, P60-AA03510, and T32-AA07290.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.