Paying Patients to Take Their Medications Is Stupid

The New York Time reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients.  The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin – an anti blood clotting medication.

There is certainly nothing wrong with financial incentives.  Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys).   But paying patients to take their medication is different.  Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons.

Why Paying Patients to Take Their Medications is Wrong-headed

According to published research, physicians only spend 26 seconds of the average patient visit on discussing new medications with patients.  26 seconds! That’s not enough time.  Studies show that physicians often do not discuss important aspects of new medication, such as how to take the medication and how long to keep taking it.

In a previous post, I cited a study that demonstrated that poor physician-patient communication not recalcitrant patients, resulted in poor patient adherence with taking Warfarin.  As I reported, 50% of all patients in that study differed from their doctor in term of understanding how they we supposed to take the medication.  In other words, one half of the study population was taking a Warfarin incorrectly.

These finding are not new.  Numerous studies over the years have shown that many patients often don’t know the name of the medications they are taking, not to mention how to take them, or when to stop taking them.

The odds of patient medication adherence are 2.16 times higher if a physician communicates effectively with the patient.

Rather than paying patients, why not pay primary care physicians more for taking the time to: 1) explore the patient’s beliefs about medication-taking and 2) make a more compelling case for how and why patients should taking needed medications in the first place.

Sources

For Forgetful, Cash Helps the Medicine Go Down, New York Times. June 13, 2010.

Zolnierek, K., et al.  Physician Communication and Patient Adherence to Treatment. Medical Care 2009;47: 826–834.

Tarn, D., et al. How much time does it take to prescribe a new medication? Patient Education and Counseling 72 (2008) 311–319.