- Published in The American Journal of Pharmacy Benefits -

An Intermittent Reinforcement Platform to Increase Adherence to Medications

Author(s): Murat V. Kalayoglu, MD, PhD; Michael Reppucci, RPH; Terrence F. Blaschke, MD; Luis N. Marenco, MD; and Michael S. Singer, MD, PhD

Am Journal of Pharmacy BenefitsNonadherence to daily health behaviors is an enormous burden to the US healthcare system. Current interventions to improve medication adherence often are costly, intrusive, and overall minimally effective. Most are passive: they act on the patient (through outgoing contact and strategies) rather than motivate active engagement in therapy.

Objective: To test the efficacy of an automated intermittent reinforcement platform to drive patient utilization and improve medication adherence rates.

Study Design: Four-month prospective cohort pilot program (1-month enrollment phase).

Methods: Specially labeled bottles were dispensed to 50 unique individuals who were continuing statin therapy. Enrollment occurred voluntarily by phoning a toll-free number and entering an assigned code. The system learned from user behavior and automatically tailored reward points to reinforce desired behavior. Educational messages were delivered at peak acceptance points and refill needs were predicted and facilitated automatically. Adherence was measured directly through deidentified refill data as well as indirectly through call frequency.

Results: Adherence increased and remained at high levels with the intervention over the course of the program. Adherence as measured by refill rate improved from 72.7% to 97.9%, a 34.6% relative increase (P = .0016). Average medication adherence for participants, as measured indirectly by call frequency, was 87.62% over the course of the study. Participant feedback was uniformly positive, and a correlation was found between call frequency and prescription refills. Conclusion: Motivating patients with an automated, intermittent reinforcement platform is a highly effective way to increase medication adherence and limit costs.

(Am J Pharm Benefits. 2009;1(2):91-94


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