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A behavioral economics-based telehealth intervention to improve aspirin adherence following hospitalization for acute coronary syndrome
Riegel, Barbara Stephens-Shields, Alisa Jaskowiak-Barr, Anne Daus, Marguerite Kimmel, Stephen E.
Riegel, Barbara
Stephens-Shields, Alisa
Jaskowiak-Barr, Anne
Daus, Marguerite
Kimmel, Stephen E.
Abstract
Purpose
A significant number of patients with acute coronary syndrome (ACS) are nonadherent to aspirin after hospital discharge, with an associated increased risk of subsequent cardiovascular events. The purpose of this pilot study was to test the efficacy of a telehealth intervention based on behavioral economics to improve aspirin adherence following hospitalization for ACS.
Methods
We enrolled 130 participants (c¯X = 58 ± 10.7 years of age, 38% female, 45% black) from two hospitals. Patients were eligible if they owned a smartphone and were admitted to the hospital for ACS, prescribed aspirin at discharge, and responsible for administering their own medications. Consenting participants were randomized to the intervention or usual care group. The intervention group was eligible to receive up to $50 per month if they took their medicine daily, with $2 per day deducted if a dose was missed. All participants received an electronic monitoring (EM) pill bottle containing a 90‐day supply of aspirin, which was used to measure adherence calculated as the proportion of prescribed drug taken using the EM device. Based on the skewness in the adherence distribution, quantile regression was used to evaluate the effect of the intervention on median adherence over time.
Results
After 90 days, adherence fell in the control group but remained high in the intervention group (median adherence 81% vs 90%, P = .18). Rehospitalization was higher in the control group (24% vs 13%, P = .17).
Conclusion
A loss aversion behavioral economics‐based telehealth intervention is a promising approach to improving aspirin adherence following hospitalization for ACS.
Keywords
behavioral economics, loss aversion, medication adherence, myocardial infarction, pharmacoepidemiology, randomized controlled trial, technology, unstable angina
Date
2020
Type
Journal article
Journal
Pharmacoepidemiology and Drug Safety
Book
Volume
29
Issue
5
Page Range
513-517
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
DOI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled