Jalpa A. Doshi

A test of financial incentives to improve warfarin adherence

BackgroundSub-optimal adherence to warfarin places millions of patients at risk for stroke and bleeding complications each year. Novel methods are needed to improve adherence for warfarin. We conducted two pilot studies to determine whether a lottery-based daily financial incentive is feasible and improves warfarin adherence and anticoagulation control.MethodsVolunteers from the University of Pennsylvania Anticoagulation Management Center who had taken warfarin for at least 3 months participated in either a pilot study with a lottery with a daily expected value of

Economic Impact of Childhood and Adult Attention-Deficit/Hyperactivity Disorder in the United States

5 (N = 10) or a daily expected value of

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

3 (N = 10). All subjects received use of an Informedix Med-eMonitor™ System with a daily reminder feature. If subjects opened up their pill compartments appropriately, they were entered into a daily lottery with a 1 in 5 chance of winning

Impact of a Prescription Copayment Increase on Lipid-Lowering Medication Adherence in Veterans

10 and a 1 in 100 chance of winning

National estimates of medication use in nursing homes: findings from the 1997 medicare current beneficiary survey and the 1996 medical expenditure survey

100 (pilot 1) or a 1 in 10 chance of winning

Measurement and Rates of Persistence With and Adherence to Biologics for Rheumatoid Arthritis: A Systematic Review

10 and a 1 in 100 chance of winning

Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality.

100 (pilot 2). The primary study outcome was proportion of incorrect warfarin doses. The secondary outcome was proportion of INR measurements not within therapeutic range. Within-subject pre-post comparisons were done of INR measurements with comparisons with either historic means or within-subject comparisons of incorrect warfarin doses.ResultsIn the first pilot, the percent of out-of-range INRs decreased from 35.0% to 12.2% during the intervention, before increasing to 42% post-intervention. The mean proportion of incorrect pills taken during the intervention was 2.3% incorrect pills, compared with a historic mean of 22% incorrect pill taking in this clinic population. Among the five subjects who also had MEMS cap adherence data from warfarin use in our prior study, mean incorrect pill taking decreased from 26% pre-pilot to 2.8% in the pilot. In the second pilot, the time out of INR range decreased from 65.0% to 40.4%, with the proportion of mean incorrect pill taking dropping to 1.6%.ConclusionA daily lottery-based financial incentive demonstrated the potential for significant improvements in missed doses of warfarin and time out of INR range. Further testing should be done of this approach to determine its effectiveness and potential application to both warfarin and other chronic medications.

Randomized trial of lottery-based incentives to improve warfarin adherence

OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children in the United States and often persists into adulthood with associated symptomatology and impairments. This article comprehensively reviews studies reporting ADHD-related incremental (excess) costs for children/adolescents and adults and presents estimates of annual national incremental costs of ADHD. METHOD A systematic search for primary United States-based studies published from January 1, 1990 through June 30, 2011 on costs of children/adolescents and adults with ADHD and their family members was conducted. Only studies in which mean annual incremental costs per individual with ADHD above non-ADHD controls were reported or could be derived were included. Per-person incremental costs were adjusted to 2010 U.S. dollars and converted to annual national incremental costs of ADHD based on 2010 U.S. Census population estimates, ADHD prevalence rates, number of household members, and employment rates by age group. RESULTS Nineteen studies met the inclusion criteria. Overall national annual incremental costs of ADHD ranged from

Evaluation of nationally mandated drug use reviews to improve patient safety in nursing homes: a natural experiment.

143 to

Adherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritis

266 billion (B). Most of these costs were incurred by adults (