- Could financial incentives drive better patient engagement and care outcomes?
Probably no, says one recent study published in the July issue of the Journal of the American Medical Association.
The study, led by researchers at Columbia University’s Mailman School of Public Health, Emory University, and the University of Miami, investigated the way in which financial incentives may encourage patients to engage with their own healthcare and meet certain benchmarks.
Ultimately, the researchers sought to test if these strategies could increase viral suppression in patients managing both HIV and substance abuse.
According to the team, research indicates that substance abuse has a negative impact on HIV treatment, making it a critical component of their study.
After enrolling 800 patients who are HIV positive, the researchers split them into three cohorts, testing three different courses of treatment.
The first involved 11 sessions of case management and care coordination, helping to boost overall patient care between various different providers.
The second involved both the care coordination approach and financial incentives for better patient engagement. This meant patients could receive up to $1,160 in incentive payments for meeting certain benchmarks in targeted behaviors to reduce substance abuse, increased engagement in HIV care, and improving HIV outcomes.
The final cohort involved regular HIV care at each of the 11 different hospitals participating in the study.
After the 12-month test period, only 35 percent of patients had any significant amount of viral suppression, and the results showed no significant differences between patients across any of the three cohorts.
These results suggest that neither improved care coordination nor financial incentives for patient engagement help improve HIV care.
The researchers offered several explanations for the study’s results. First, many participants faced a lack of substance abuse treatment options.
“It is possible that the lack of substance use disorders treatment options affected study results,” the research team explained. “In the study interventions, patient navigators sought to engage participants using substances with available treatment services. Several study sites did not reside in jurisdictions that offered harm reduction services.”
The study may have also yielded these results because of the types of drugs most of the participants used. According to the researchers, certain types of drugs inhibit viral suppression more than others.
“The majority of the study participants used stimulants, a group that was less likely to become virally suppressed compared with those who only used opiates, alcohol, or both,” the research team said.
The study also showed many issues with how healthcare organizations face HIV and substance abuse treatment, saying that they often do not go far enough to engage patients. As noted above, several regions have too limited of substance abuse treatment resources, making it difficult for patients to seek help.
Likewise, patient engagement efforts may not be strong enough for patients who manage other comorbidities, like socioeconomic disadvantage.
“The study results raise the question of whether intensive, individual-level interventions are sufficiently broad and robust enough to improve HIV outcomes among populations currently not benefitting from treatment,” the researchers posited.
“Most participants were low-income persons of color who may experience negative sociocultural factors such as poverty, racism, unstable housing, HIV-related stigma, and high rates of incarceration. Systemic and structural barriers to care may be difficult to overcome with an individual-level behavioral intervention, even an intensive one.”
Ultimately, they suggested, several HIV positive patients will need stronger patient engagement strategies in order to yield positive change in their health.
“Substance use is a significant factor in poor HIV clinical outcomes, and it is essential that we continue to address this issue and overcome barriers to engaging patients in substance use treatment if we expect to control the HIV epidemic,” said study author Wendy Armstrong, MD, in a public statement. “This includes confronting the co-morbidities associated with considerable social disadvantage that often accompany this disease.”