Behavioral Economic Insights to Improve Medication Adherence in Adults with Chronic Conditions: A Scoping Review
Background and Objective
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.
JR made substantial contributions to the conception and design, acquisition, analysis, and interpretation of data, and was involved in drafting the final manuscript. GH and NS made substantial contributions to the conception and interpretation of data, and were involved in drafting the final manuscript. JK made substantial contributions to the conception and design, analysis, and interpretation of data, and was involved in drafting the final manuscript. All authors read and approved the final manuscript. JR is the overall guarantor.
Compliance with Ethical Standards
No funding was received for this scoping review. The funding sources for the included studies were predominantly from the National Institutes of Health and not-for-profit foundations. Five studies did not report funding sources and four studies were industry supported.
Conflict of interest
Jacqueline Roseleur, Gillian Harvey, Nigel Stocks, and Jonathan Karnon have no conflicts of interest that are directly relevant to the content of this article.
As this scoping review uses data available in the public domain, no ethics application was required.
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