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Shared Incentives with Physicians, Patients Work Best to Improve Lipids

PHILADELPHIA – Who needs to be incentivized to improve lipids in primary care practice – the physicians or the patients?

A new study, published recently in the Journal of the American Medical Association, suggests the answer is both.

The report, from University of Pennsylvania researchers and colleagues finds that shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a modest reduction of low-density lipoprotein cholesterol (LDL-C) levels after 12 months

Background information in the articles notes that taking statins to lower cholesterol reduces the risk of heart attack by about 30%, but the use of the drugs is limited for a variety of reasons, including under-prescribing or physicians’ failure to intensify treatment when indicated, as well as poor medication adherence among patients.

The study, which involved 1,503 patients, sought to determine if financial incentives to physicians or patients are helpful in remedying the situation. To do so, 340 primary care physicians in three healthcare delivery systems in the Northeast were randomly assigned to one of four groups: control, physician incentives, patient incentives, or shared physician-patient incentives.

In the control group, neither physicians nor patients received incentives tied to outcomes, although patients received up to $355 each for trial participation. Meanwhile, physicians in the physician incentives group were eligible to receive up to $1,024 per enrolled patient meeting LDL-C goals, while patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. In the final group, those incentives were shared by physicians and patients.

After 12 months, the average reduction in LDL-C levels for patients was 25.1 mg/dL for patients in the control group; 25.1 mg/dL for patients in the patient incentives group; 27.9 mg/dL for patients in the physician incentives group and 33.6 mg/dL for patients in the shared physician-patient incentives group. The last was the only statistically significant decline, according to the results.

"Reducing LDL requires two basic actions," said senior author Kevin G.M. Volpp, MD, PhD. "First, physicians have to prescribe the appropriate medication. Second, patients have to consistently take the medication. Previous studies focused on incentivizing one group or the other have produced only moderate improvements for patients, but when we look at it as a two-way street where patients and physicians each bear responsibility, the findings then become consistent with what we might intuitively expect."