A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

Background Previous research has suggested that daily lottery incentives could improve medication adherence. Such daily incentives include implicit reminders. However, the comparative effectiveness of reminders alone versus daily incentives has not been tested. Methods A total of 270 patients on war...

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Published in:Pharmacoepidemiology and drug safety Vol. 25; no. 11; pp. 1219 - 1227
Main Authors: Kimmel, Stephen E., Troxel, Andrea B., French, Benjamin, Loewenstein, George, Doshi, Jalpa A., Hecht, Todd E. H., Laskin, Mitchell, Brensinger, Colleen M., Meussner, Chris, Volpp, Kevin
Format: Journal Article
Language:English
Published: England Blackwell Publishing Ltd 01-11-2016
Wiley Subscription Services, Inc
Subjects:
Aged
Anticoagulants
Anticoagulants - administration & dosage
behavioral
Compliance
Drug therapy
economics
Female
Humans
incentives
International Normalized Ratio
Male
Medication Adherence
Middle Aged
Motivation
pharmacoepidemiology
Reminder Systems
trials
Warfarin - administration & dosage
anticoagulants
economics
incentives
trials
behavioral
pharmacoepidemiology
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Summary:Background Previous research has suggested that daily lottery incentives could improve medication adherence. Such daily incentives include implicit reminders. However, the comparative effectiveness of reminders alone versus daily incentives has not been tested. Methods A total of 270 patients on warfarin were enrolled in a four‐arm, multi‐center, randomized controlled trial comparing a daily lottery‐based incentive, a daily reminder, and a combination of the two against a control group (usual care). Results Participants in the reminder group had the lowest percentage of time out of target international normalized ratio (INR) range, the primary outcome, with an adjusted odds of an out‐of‐range INR 36% lower than among those in the control group, 95%CI [7%, 55%]. No other group had a statistically significant improvement in anticoagulation control relative to the control group or to each other. The only group that had significant improvement in incorrect adherence was the lottery group (incorrect adherence: 12.1% compared with 23.7% in the control group, difference of −7.4% 95%CI [−14%, −0.3%]). However, there was no relationship between changes in adherence and anticoagulation control in the lottery group. Conclusions Automated reminders led to the largest improvements in anticoagulation control, although without impacting measured adherence. Lottery‐based reminders improved measured adherence but did not lead to improved anticoagulation control. Copyright © 2016 John Wiley & Sons, Ltd.
Bibliography:Institutes of Health, National Heart Lung Blood Institute (NHLBI) - No. R01-HL-090929
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ArticleID:PDS4094
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-News-2
ObjectType-Feature-3
content type line 23
ObjectType-Feature-2
ISSN:1053-8569
1099-1557
DOI:10.1002/pds.4094