Behavioral Nudges as Patient Decision Support for Medication Adherence: The ENCOURAGE Randomized Controlled Trial.

Am Heart J

Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.

Published: February 2022

Background: Medication adherence is generally low and challenging to address because patient actions control healthcare delivery outside of medical environments. Behavioral nudging changes clinician behavior, but nudging patient decision-making requires further testing. This trial evaluated whether behavioral nudges can increase statin adherence, measured as the proportion of days covered (PDC).

Methods: In a 12-month parallel-group, unblinded, randomized controlled trial, adult patients in Intermountain Healthcare cardiology clinics were enrolled. Inclusion required an indication for statins and membership in SelectHealth insurance. Subjects were randomized 1:1 to control or nudges. Nudge content, timing, frequency, and delivery route were personalized by CareCentra using machine learning of subject motivations and abilities from psychographic assessment, demographics, social determinants, and the Intermountain Mortality Risk Score. PDC calculation used SelectHealth claims data.

Results: Among 182 subjects, age averaged 63.2±8.5 years, 25.8% were female, baseline LDL-C was 82.5±32.7 mg/dL, and 93.4% had coronary disease. Characteristics were balanced between nudge (n = 89) and control arms (n = 93). The statin PDC was greater at 12 months in the nudge group (PDC: 0.742±0.318) compared to controls (PDC: 0.639±0.358, P = 0.042). Adherent subjects (PDC ≥80%) were more concentrated in the nudge group (66.3% vs controls: 50.5%, P = 0.036) while a composite of death, myocardial infarction, stroke, and revascularization was non-significant (nudges: 6.7% vs control: 10.8%, P = 0.44).

Conclusions: Persuasive behavioral nudges driven by artificial intelligence resulted in a clinically important increase in statin adherence in general cardiology patients. This precision patient decision support utilized computerized nudge design and delivery with minimal on-going human input.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ahj.2021.11.001DOI Listing

Publication Analysis

Top Keywords

behavioral nudges
12
patient decision
8
decision support
8
medication adherence
8
randomized controlled
8
controlled trial
8
increase statin
8
statin adherence
8
nudge group
8
nudge
5

Similar Publications

Background: Online grocery shopping is a growing source of food purchases in many countries. We investigated the effect of nudging consumers towards purchases of lower sodium products using a web browser extension.

Methods: This trial was conducted among individuals with hypertension who shopped for their groceries online in Australia.

View Article and Find Full Text PDF

Intervention policies play a crucial role in promoting the green transformation of consumption patterns and reducing consumer-side carbon emissions. This topic has been extensively explored by interdisciplinary scholars. However, these studies have not substantially improved our understanding of how intervention policies effectively encourage consumers to engage in green consumption.

View Article and Find Full Text PDF

The MINDSPACE framework has made it easier to incorporate insights from behavioral science into policy, including health policy, but lacks granularity. Difficult policy problems such as adherence to psychiatric medication can benefit from judicious selection of nudges. We present a MINDSPACE Expanded Framework including 34 insights from behavioral science in the 9 MINDSPACE principles to support a more detailed integration of behavioral science into policy.

View Article and Find Full Text PDF

Challenge your customer: How businesses may trigger change in perceived barriers, capability, and consumption.

Appetite

December 2024

MAPP - Centre for Research on Customer Relations in the Food Sector, Department of Management, Aarhus University, Fuglesangsalle 4, 8210, Aarhus, Denmark. Electronic address:

The global environmental issues require that we redesign food systems. Transitioning towards more plant-based diets is crucial, but there is a gap observed between consumers' intention and behaviour. We propose that businesses in the food sector can play a role by challenging their potential customers to overcome the gap.

View Article and Find Full Text PDF

"Busting the hidden curriculum" a realist and innovative perspective to foster professional behaviors.

Front Med (Lausanne)

December 2024

Centre for Professionalism in Medicine and Health Sciences, Faculty of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.

Contemporary health professions education has long delineated the desired attributes of medical professionalism in the form of standard curricula and their role in forming professional behaviors (PBs) among aspiring doctors. However, existing research has shown the contradictory and powerful role of hidden curriculum (HC) in negatively influencing medical students' PBs through unspoken or implicit academic, cultural, or social standards and practices. These contrasting messages of formal curricula and HC lead to discordance and incongruence in future healthcare professionals developing professional identity formation.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!