Financial Reinforcers for Improving Medication Adherence: Findings from a Meta-analysis
Open accessAbstract
Background Increasingly, financial reinforcement interventions based on behavioral economic principles are being applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications.Methods Electronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in effect size and the impact of potential moderators (study design, duration of intervention, magnitude of reinforcement, and frequency of reinforcement) on effect size were examined.Results Fifteen randomized studies and 6 nonrandomized studies examined the efficacy of financial reinforcement interventions for medication adherence. Financial reinforcers were applied for adherence to medications for tuberculosis, substance abuse, human immunodeficiency virus, hepatitis, schizophrenia, and stroke prevention. Reinforcement interventions significantly improved adherence relative to control conditions with an overall effect size of 0.77 (95% confidence interval, 0.70-0.84; P<.001). Nonrandomized studies had a larger average effect size than randomized studies, but the effect size of randomized studies remained significant at 0.44 (95% confidence interval, 0.35-0.53; P<.001). Interventions that were longer in duration, provided an average reinforcement of $50 or more per week, and reinforced patients at least weekly resulted in larger effect sizes than those that were shorter, provided lower reinforcers, and reinforced patients less frequently.Conclusion These results demonstrate the efficacy of medication adherence interventions and underscore principles that should be considered in designing future adherence interventions. Financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.
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Contingency management can be used at different points of the treatment sequence, including initial engagement, attendance, and abstinence.
“It can be used at different points of the treatment se quence, including initial engagement 167 , attendance 237,239 , and ab stinence 237,239,240 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [237]
The Discussion (page unavailable) says financial reinforcers were applied during treatment initiation, and the Results describe reinforcement of medication adherence. The paper does not establish initial engagement, attendance, and abstinence as the three treatment-sequence targets in the claim; its mention of clinic attendance is contextual, and its abstinence examples appear in the References. (LLM, conf=0.78)
Experimental — accuracy not yet measuredContingency management has been successfully used to treat various SUDs.
“Contingency management has been successfully used to treat various SUDs 237 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [237]
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- Authors
- Petry, N. M., Rash, C. J., Byrne, S., Ashraf, S., & White, W. B.
- Affiliations
- University of Connecticut (US)
- Corresponding author
- Petry, Nancy M.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 125
- Issue
- 9
- Pages
- 888-896
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC3432682
- OpenAlex
- W1968992146
- Cited by
- 115
- References
- 63
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 8 · 2022: 7 · 2021: 12 · 2020: 9 · 2019: 9 · 2018: 6 · 2017: 7 · 2016: 11 · 2015: 12 · 2014: 8 · 2013: 6 · 2012: 3
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (P60AA003510, T32AA007290)
- National Institute on Drug Abuse (R01DA014618, R01DA022739, R01DA021567, R01DA018883, P50DA009241, R01DA016855, P30DA023918, R01DA027615, R01DA013444, R01DA024667)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- medication adherence, behavioral economics, adherence interventions, tuberculosis, substance abuse, HIV, hepatitis, schizophrenia, stroke prevention, intervention duration, reinforcement frequency, reinforcement magnitude
- MeSH terms
- Clinical Trials as Topic, Humans, Income, Reinforcement, Psychology, Research Design, Self Administration, United States, Randomized Controlled Trials as Topic, Drug Monitoring, Directly Observed Therapy, Medication Adherence
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