“Nudge Theory” Proves Successful in Medication Adherence Clinical Trial
While taking medications long-term requires strong discipline and motivation, patients often cite time management – most commonly, forgetfulness – as their number one barrier to medication adherence. There are other time-related distractions that get in the way of taking medications as prescribed: lack of a medication-taking routine, complex medication regimen, no pill box or planner, or a busy schedule.
A critical component of an effective medication adherence intervention is targeted patient engagement through timed and personalized reminders and coaching, which can help patients to become active participants in the development and maintenance of their medication plan.
A recent clinical study discussed how this type of patient engagement can improve medication adherence outcomes. Intermountain Healthcare, a healthcare system headquartered in Salt Lake City, Utah, recently launched a 12-month study on the effectiveness of reminders – supported by the “nudge theory” – on patients’ adherence to statin medication.
What is the “nudge theory”?
Richard Thaler is credited with establishing the “nudge theory” and was awarded the Nobel Prize in 2017 for his contributions to the study of behavioral economics, which blends the fields of economics and psychology. Behavioral economics shows that humans do not always act rationally and sometimes need a “nudge” to make better decisions. One of the most prevalent examples of the nudge theory in healthcare is organ donation. Countries where people have to opt-in to organ donation generally see about 30% enrollment. In countries where people are automatically enrolled in organ donation but can opt-out, only about 10-15% of the population declines to become an organ donor. Naturally, the pool of organ donations is largely increased.
How can the nudge theory be used in medication adherence?
Intermountain Healthcare’s study, titled “Improvement in Medication Compliance Through the Implementation of Personalized Nudges: the ENCOURAGE Trial,” demonstrated how personalized engagement – in the forms of phone calls, emails, and texts – improved medication adherence. In total, 186 patients on statin medications were randomized into two groups: one group received standard care while the other group received “nudges” about their statin medication.
Although formal results have not yet been published, preliminary outcomes show that “patients who received nudges were more likely to take their medications and had a higher percentage of the proportion of days covered (80%), meaning that they had better adherence to their prescribed statins.” They also found that patients in the control group – those who didn’t receive any reminders - had gradual declines in proportion of days covered over the course of the study.
Other examples of medication adherence “nudges” in the real world
Health Dialog’s medication adherence programs “nudge” patients through targeted patient engagement. We recently launched a program focused on increasing medication adherence across a large Medicare Part D population. Machine-learning AI analytics (which incorporated prescription claims, condition information, social determinants of health, and other available data sets) were used to stratify the population. Nudges in the form of telephonic outreach were provided to identify barriers to adherence and establish a personalized care plan to support intrinsic motivation and help patients overcome these barriers.
In the nine-month evaluation period, over 69,000 patients were contacted for personalized coaching and 92% of those reached by phone were receptive to that coaching. Additionally, the study analysis uncovered higher medication adherence rates for the coached patient population when compared to the non-coached population:
- 7.5% higher rate of reaching 80% days covered PDC score for diabetes medications
- 7.9% higher rate of reaching 80% days covered PDC score for statins
- 7.3% higher rate of reaching 80% days covered PDC score for RASA medications