Does incentivizing prescription medication make us more likely to take our medication?

My previous blog posts have focused on negative impacts of the opioid epidemic and the increase in opioid related deaths. Statistics like those have, no doubt, had an impact on who takes what prescriptions when. The article I read this week focused on a sort of opposite trend; the negative effects of not taking prescribed medication.

**Side note: Prescriptions can be a huge pain. Recently I have been prescribed 4 different pills to take, and swallow following my tonsillectomy. I have also been told that swallowing will be very difficult after this procedure. I’m hoping this blog post will make me more motivated to take these pills.

In the article, recently posted on Upshot, the author a review done by the New England Journal of Medicine, they estimated cost of noncompliance-related hospital visits in America is $100 billion. Not only that, but the deaths due to noncompliance with medication is estimated around 100,000 per year. That is a lot of people not taking their medication.

Further research in this article indicated that steps taken to increase compliance have been largely ineffective. One study even tried to incentivize taking prescription medication, and failed!

The study was conducted over 12 months, and was composed of 1509 individuals out of 7,179 contacted. All of the patients were between 18-80 years old, who had all suffered a myocardial infarction (heart attack), and were prescribed at least two of four pre-determined medications. They established a 2:1 ratio between treatment grouped patients, those who received the intervention and those who received “typical” treatment. The intervention was given through three steps per person:

  1. Entering cardiovascular patients (with prescriptions for their condition) into lotteries where they could win $5 or $50 every day for a year.
  2. Giving participants an electronic pill bottle, that allowed their caretakers to be notified when the patient had not taken their medication.
  3. Finally, there was a staff member who would remind the patients the importance of adhering to their medication.

Despite all of these incentives, people still elected to not take their medication. As a result, the lengths of time from first hospitalization to second were about the same. Their findings are summarized below:

“In this randomized clinical trial of 1509 patients following acute myocardial infarction, there were no statistically significant differences between study arms in time to first re-hospitalization for a vascular event or death, medication adherence, or cost.”

This is a super interesting trend to me. Why, even after all the incentives and promptings given, are people still unwilling to take their medications? How are we still having an opioid crisis if these rates of noncompliance are so high? Are these trends consistent in other disorders (besides heart conditions) as well?

It would also be interesting to see the rates of noncompliance in individuals with non-life threatening conditions. I would guess that the rates would be even higher, because there is less incentive to take the pills.



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