Shared physician and patient financial incentives associated with most LDL improvement

Financial incentives to improve lipid control worked best when they were shared between physicians and patients, a recent trial found.

The multicenter trial included 348 primary care physicians and 1,503 adult patients who had a 10-year Framingham Risk Score of 20% or greater, coronary artery disease equivalents and LDL cholesterol levels of 120 mg/dL or greater, or a 10-year risk of 10% to 20% and LDL of 140 mg/dL or greater. The trial ran from 2011 to 2014, with each patient participating for a year, in 3 U.S. primary care practices.

Participants were randomized to 1 of 4 groups: a control group, a group where physicians could receive up to $1,024 per patient meeting LDL goals, a group where patients could win up to $1,024 in daily lotteries for medication adherence, or a group where the incentives were shared between physicians and patients. Results were published in the Journal of the American Medical Association on Nov. 10.

All groups, including controls, improved mean LDL after 12 months in the program, but only the shared incentive group showed significantly greater improvement than controls. Mean reduction in LDL was 33.6 mg/dL in the shared group compared to 27.9 mg/dL in the physician incentive group, 25.1 mg/dL in the patient incentive group, and 25.1 mg/dL in controls. The percentage of patients achieving their LDL goal also supported the effectiveness of the shared group: 49% in the shared group, 40% in the physician and patient incentive groups, and 36% among controls.

The difference between the shared group and controls was statistically significant, but modest, and further investigation is required to determine whether the shared incentive approach provides good value, the study authors concluded. It makes sense that a shared approach would work best, since achieving lipid goals requires both that physicians prescribe medication and patients adhere to it, they noted.

It's also important to note that the control patients were paid study participants using electronic pill bottles to monitor adherence, which “should temper conclusions about the ineffectiveness of the physician and patient incentives if either were used alone,” the researchers said. On the other hand, only 6% of eligible patients enrolled in the study, so the results of any of the interventions might not be representative of all patients with similar cardiovascular risk factors, the authors said.