Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T05:59:44.855Z Has data issue: false hasContentIssue false
  • English
  • Français

Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance

Published online by Cambridge University Press:  27 February 2019

JON M. JACHIMOWICZ Open the ORCID record for JON M. JACHIMOWICZ [Opens in a new window] ,
JOE J. GLADSTONE ,
DAN BERRY ,
CHARLOTTE L. KIRKDALE ,
TRACEY THORNLEY  and
ADAM D. GALINSKY
JON M. JACHIMOWICZ*
Affiliation:
Columbia University, New York, NY, USA
JOE J. GLADSTONE*
Affiliation:
University College London, London, UK
DAN BERRY
Affiliation:
UK Government Department of Health and Social Care, London, UK
CHARLOTTE L. KIRKDALE
Affiliation:
Boots UK, Nottingham, UK
TRACEY THORNLEY
Affiliation:
Boots UK, Nottingham, UK and University of Nottingham, Nottingham, UK
ADAM D. GALINSKY
Affiliation:
Columbia University, New York, NY, USA
*
*Correspondence to: Jon M. Jachimowicz, Columbia University, 116th St & 3022 Broadway, New York, NY10027, USA. Email: [email protected]
Joe J. Gladstone, University College London, Level 38, 1 Canada Square, Rm NE3, Canary Wharf, London, E14 5AB, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Poor compliance of prescription medication is an ongoing public health crisis. Nearly half of patients do not take their medication as prescribed, harming their own health while also increasing public health care costs. Despite these detrimental consequences, prior research has struggled to establish cost-effective and scalable interventions to improve adherence rates. We suggest that one reason for the limited success of prior interventions is that they make the personal health costs of non-adherence insufficiently prominent, while a higher saliency of these costs may motivate patients to adhere more. In the current research, we test whether an intervention that makes the personal health costs of non-compliance more salient for patients will increase their medication adherence. To do so, we conducted a randomized controlled trial with 16,191 patients across 278 UK pharmacies over a 9-month time period and manipulated the perceived consequences of medication non-adherence. We find that patients who received a treatment highlighting the personal health costs of non-compliance were significantly more likely to adhere to their medication than three comparison groups (odds ratio = 1.84, 95% confidence interval = 1.37–2.47). Shifting patients’ focus to the personal health costs of non-compliance may thus offer a potentially cost-effective and scalable approach to improving medication adherence.

Type
Article
Information
Behavioural Public Policy , Volume 5 , Issue 3 , July 2021 , pp. 396 - 416
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

‡

Denotes equal first authorship

References

Albarracín, D. and Kumkale, G. T. (2003), ‘Affect as information in persuasion: A model of affect identification and discounting’, Journal of Personality and Social Psychology, 84(3): 453–469.CrossRefGoogle Scholar
Apter, A. J., Reisine, S. T., Affleck, G., Barrows, E. and ZuWallack, R. L. (1998), ‘Adherence with twice-daily dosing of inhaled steroids: Socioeconomic and health-belief differences’, American Journal of Respiratory and Critical Care Medicine, 157(6 PART I): 1810–1817.CrossRefGoogle ScholarPubMed
Barclay, T. R., Hinkin, C. H., Castellon, S. A., Mason, K. I., Reinhard, M. J., Marion, S. D. and Durvasula, R. S. (2007), ‘Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status’, Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 26(1): 40–9.CrossRefGoogle ScholarPubMed
Barth, K. R., Cook, R. L., Downs, J. S., Switzer, G. E. and Fischhoff, B. (2002), ‘Social stigma and negative consequences: factors that influence college students’ decisions to seek testing for sexually transmitted infections’, Journal of American College Health, 50(4): 153–159.CrossRefGoogle ScholarPubMed
Beshears, J., Choi, J. J. and Madrian, B. C. (2011), ‘Self Control and Liquidity: How to Design a Commitment Contract’, Working Paper, 1–54.Google Scholar
Choudhry, N. K., Avorn, J., Glynn, R. J., Antman, E. M., Schneeweiss, S., Toscano, M. and Shrank, W. H. (2011), ‘Full Coverage for Preventive Medications after Myocardial Infarction’, New England Journal of Medicine, 365(22): 2088–2097.CrossRefGoogle ScholarPubMed
Elliott, R. A., Boyd, M. J., Salema, N.-E., Davies, J., Barber, N., Mehta, R. L., and Craig, C. (2016), ‘Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service’, BMJ Quality & Safety, 25: 747–758.CrossRefGoogle ScholarPubMed
Fisher, R. J. (1993), ‘Social Desirability Bias and the Validity of Indirect Questioning’, Journal of Consumer Research, 20(2): 303–315.CrossRefGoogle Scholar
Frazier, P. A., Davis-Ali, S. H., Dahl, K. E., P.A., F., S.H., D.-A. and K.E., D. (1994), ‘Correlates of noncompliance among renal transplant recipients’, Clinical Transplantation, 8(6): 550–557. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L24361561%5Cnhttp://sfx.metabib.ch/sfx_locater?sid=EMBASE&issn=09020063&id=doi:&atitle=Correlates+of+noncompliance+among+renal+transplant+recipients&stitle=CLIN.+TRANSPLANT.&title=ClGoogle ScholarPubMed
Golman, R., Hagmann, D., and Loewenstein, G. (2017), ‘Information Avoidance’, Journal of Economic Literature, 55(1): 96–135.CrossRefGoogle Scholar
Grant, R. W., Devita, N. G., Singer, D. E. and Meigs, J. B. (2003), ‘Polypharmacy and medication adherence in patients with type 2 diabetes’, Diabetes Care, 26(5): 1408–1412.CrossRefGoogle ScholarPubMed
Gray, T. A., Fenerty, C., Harper, R., Spencer, A. F., Campbell, M., Henson, D. B. and Waterman, H. (2012), ‘Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: An exploratory randomised controlled trial’, Eye, 26(3): 407–417.CrossRefGoogle Scholar
Gulliver, A., Griffiths, K. M. and Christensen, H. (2010), ‘Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review’, BMC Psychiatry, 113.Google Scholar
Hallsworth, M. (2017), ‘Rethinking public health using behavioural science’, Nature Human Behaviour, 1(9): 612–612.CrossRefGoogle ScholarPubMed
Hardin, G. (1968), ‘The tragedy of the commons’, Nature, 162: 1243–1248.Google ScholarPubMed
Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P. and Yao, X. (2008), ‘Interventions for enhancing medication adherence (Review)’, Cochrane Database of Systematic Review, 2.Google Scholar
Haynes, R. B., Taylor, D. W., Sackett, D. L., Gibson, E. S., Bernholz, C. D. and Mukherjee, J. (1980), ‘Can simple clinical measurements detect patient noncompliance?’, Hypertension, 2(6): 757–764.CrossRefGoogle ScholarPubMed
Haynes, R., Taylor, D. and Sackett, D. (1979), Compliance in Health Care, Baltimore, MD: Johns Hopkins University Press.Google Scholar
Hertz, R., Unger, A. and Lustik, M. (2005), ‘Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance’, Clinical Therapeutics, 27(7): 1064–1073.CrossRefGoogle ScholarPubMed
Hinkin, C. H., Hardy, D. J., Mason, K., Castellon, S.a, Durvasula, R. S., Lam, M. N. and Stefaniak, M. (2004), ‘Medication Adherence in HIV-infected adults: effect of patient age, cognitive status and substance abuse’, Aids, 18: 19–25.CrossRefGoogle ScholarPubMed
Hungin, A. P., Rubin, G. and O'Flanagan, H. (1999), ‘Factors influencing compliance in long-term proton pump inhibitor therapy in general practice’, British Journal of General Practice, 49(0960-1643): 463–464.Google ScholarPubMed
Kahneman, D., Knetsch, J. L. and Thaler, R. H. (1991), ‘Anomalies: The Endowment Effect, Loss Aversion, and Status Quo Bias’, Journal of Economic Perspectives, 5(1): 193–206.CrossRefGoogle Scholar
Kahneman, D. and Tversky, A. (1979), ‘Prospect Theory: An Analysis of Decision under Risk’, Econometrica, 47(2): 263–292.CrossRefGoogle Scholar
Karlsson, N., Loewenstein, G. and Seppi, D. (2009), ‘The ostrich effect: Selective attention to information’, Journal of Risk and Uncertainty, 38(2): 95–115.CrossRefGoogle Scholar
Kettle, K. L. and Häubl, G. (2011), ‘The Signature Effect: Signing Influences Consumption-Related Behavior by Priming Self-Identity’, Journal of Consumer Research, 38(3): 474–489.CrossRefGoogle Scholar
Knapton, S. (2015), ‘NHS drugs to be stamped ‘Funded by the Taxpayer’ to reduce waste’, The Telegraph.Google Scholar
Krousel-Wood, M., Hyre, A., Muntner, P. and Morisky, D. (2005), ‘Methods to improve medication adherence in patients with hypertension: current status and future directions’, Curr Opin Cardiol, 20: 296–300.CrossRefGoogle ScholarPubMed
Kyngas, H. and Lahdenpera, T. (1999), ‘Compliance of patients with hypertension and associated factors’, Journal of Advanced Nursing, 29(4): 832–839.CrossRefGoogle ScholarPubMed
Lertmaharit, S., Kamol-Ratankul, P., Sawert, H., Jittimanee, S. and Wangmanee, S. (2005), ‘Factors associated with compliance among tuberculosis patients in Thailand’, Journal of the Medical Association of Thailand, 88.Google ScholarPubMed
Lim, T. O., Ngah, B. A., Rahman, R. A., Suppiah, A., Ismail, F., Chako, P. and Na, H. H. (1992), ‘The mentakab hypertension study project. Part V - Drug compliance in hypertensive patients’, Singapore Medical Journal, 33(1): 63–66.Google ScholarPubMed
Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A. and Pescosolido, B. A. (1999), ‘Public conceptions of mental illness: Labels, causes, dangerousness, and social distance’, American Journal of Public Health, 89(9): 1328–1333.CrossRefGoogle ScholarPubMed
Matz, S. C., Gladstone, J. J. and Stillwell, D. (2017), ‘In a world of big data, small effects can still matter: A reply to Boyce, Daly, Hounkpatin, and Wood (2017)’, Psychological Science, 28: 547–550.CrossRefGoogle Scholar
Milkman, K. L., Beshears, J., Choi, J. J., Laibson, D. and Madrian, B. C. (2011), ‘Using implementation intentions prompts to enhance influenza vaccination rates’, Proceedings of the National Academy of Sciences of the United States of America, 108(26): 10415–20.CrossRefGoogle ScholarPubMed
Morgan, O. and Baker, A. (2006), ‘Measuring deprivation in England and Wales using 2001 Carstairs scores’, Health Statistics Quarterly / Office for National Statistics, (31): 28–33.Google Scholar
Morisky, D. E., Green, L. W. and Levine, D. M. (1986), ‘Concurrent and predictive validity of a self-reported measure of medication adherence’, Medical Care, 24(1): 67–74.CrossRefGoogle ScholarPubMed
Nichols, A. L. and Maner, J. K. (2008), ‘The good-subject effect: investigating participant demand characteristics’, The Journal of General Psychology, 135(2): 151–165.CrossRefGoogle ScholarPubMed
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A. and Haynes, R. B. (2014), ‘Interventions for enhancing medication adherence’, The Cochrane Database of Systematic Reviews, 11(11): CD000011.Google Scholar
Osterberg, L. and Blaschke, T. (2005), ‘Adherence to medication’, New England Journal of Medicine, 353(5): 487–497.CrossRefGoogle ScholarPubMed
Petty, R. E. and Cacioppo, J. T. (2012), The elaboration likelihood model of persuasion, Springer Science & Business Media.Google Scholar
Petty, R. E., Cacioppo, J. T. and Goldman, R. (1981), ‘Personal involvement as a determinant of argument-based persuasion’, Journal of Personality and Social Psychology, 41(5): 847–855.CrossRefGoogle Scholar
Pope, D. G. and Schweitzer, M. E. (2011), ‘Is tiger woods loss averse? Persistent bias in the face of experience, competition, and high stakes’, American Economic Review, 101(1): 129–157.CrossRefGoogle Scholar
Randall, D. M. and Fernandes, M. F. (1991), ‘The social desirability response bias in ethics research’, Journal of Business Ethics, 10(11): 805–817.CrossRefGoogle Scholar
Rogers, T., Milkman, K. L., John, L. K. and Norton, M. I. (2015), ‘Beyond good intentions: Prompting people to make plans improves follow-through on important tasks’, Behavioral Science and Policy, 1(2): 33–41.CrossRefGoogle Scholar
Rogers, T., Milkman, K. L. and Volpp, K. G. (2014), ‘Commitment devices: using initiatives to change behavior’, JAMA, 311(20): 2065–2066.CrossRefGoogle ScholarPubMed
Scannell, L. and Gifford, R. (2013), ‘Personally Relevant Climate Change: The Role of Place Attachment and Local Versus Global Message Framing in Engagement’, Environment and Behavior, 45(1): 60–85.CrossRefGoogle Scholar
Senior, V., Marteau, T. M. and Weinman, J. (2004), ‘Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: The role of illness perceptions’, Cardiovascular Drugs and Therapy, 18(6): 475–481.CrossRefGoogle ScholarPubMed
Shea, S., Misra, D., Ehrlich, M. H., Field, L. and Francis, C. K. (1992), ‘Correlates of nonadherence to hypertension treatment in an inner-city minority population’, American Journal of Public Health, 82(12): 1607–1612.CrossRefGoogle Scholar
Shi, L., Liu, J., Fonseca, V., Walker, P., Kalsekar, A. and Pawaskar, M. (2010), ‘Correlation between adherence rates measured by MEMS and self-reported questionnaires: a meta-analysis’, Health and Quality of Life Uutcomes, 8(99): 1–7.Google ScholarPubMed
Shu, L. L., Mazar, N., Gino, F., Ariely, D. and Bazerman, M. H. (2012), ‘Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end’, Proceedings of the National Academy of Sciences of the United States of America, 109(38): 15197–200.CrossRefGoogle Scholar
Sinaiko, A. D. and Rosenthal, M. B. (2011), ‘Increased Price Transparency in Health Care — Challenges and Potential Effects’, New England Journal of Medicine, 364(10): 891–894.CrossRefGoogle ScholarPubMed
Solomon, D. H., Iversen, M. D., Avorn, J., Gleeson, T., Brookhart, M. A., Patrick, A. R. and Katz, J. N. (2012), ‘Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial’, Archives of Internal Medicine, 172(6): 477–83.CrossRefGoogle ScholarPubMed
Sorrentino, R. M., Bobocel, D. R., Gitta, M. Z. and Olson, J. M. (1988), ‘Uncertainty orientation and persuasion: Individual differences in the effects of personal relevance on social judgments’, Journal of Personality and Social Psychology, 55(3): 357–371.CrossRefGoogle Scholar
Steiner, J. F. and Prochazka, A. V. (1997), ‘The assessment of refill compliance using pharmacy records: Methods, validity, and applications’, Journal of Clinical Epidemiology, 50(1): 105–116.CrossRefGoogle ScholarPubMed
Viller, F., Guillemin, F., Briancon, S., Moum, T., Suurmeijer, T. and van den Heuvel, W. (1999), ‘Compliance to drug treatment of patients with rheumatoid arthritis: a 3 year longitudinal study’, Journal of Rheumatology, 26(10): 2114–22.Google ScholarPubMed
Viswanathan, M., Golin, C., Jones, C., Ashok, M., Blalock, S., Wines, R. and Lohr, K. (2012), ‘Interventions to improve adherence to self-administered medications for chronic diseases in the United States: A systematic review’, Annals of Internal Medicine, 157(11): 785–795.CrossRefGoogle ScholarPubMed
Vlasnik, J. J., Aliotta, S. L. and DeLor, B. (2005), ‘Medication adherence: Factors influencing compliance with prescribed medication plans’, Case Manager, 16(2): 47–51.CrossRefGoogle ScholarPubMed
Volpp, K. G., Troxel, A. B., Mehta, S. J., Norton, L., Zhu, J., Lim, R. and Asch, D. A. (2017), ‘Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction: The HeartStrong Randomized Clinical Trial’, JAMA Internal Medicine, 19104: 1–9.Google Scholar
Waltz, E. (2016), ‘Drugs go wireless’, Nature Biotechnology, 34(1): 15–18.CrossRefGoogle ScholarPubMed
Supplementary material: File

Jachimowicz et al. supplementary material

Figure S1 and Table S1

Download Jachimowicz et al. supplementary material(File)
File 89.7 KB