16
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Trial to Incentivise Adherence for Diabetes (TRIAD): study protocol for a randomised controlled trial

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Many people with diabetes have suboptimal glycaemic control due to not being adherent to their treatment regimen. Behavioural economic theory suggests that the lack of adherence results from the disconnect between the timing of when costs and benefits accrue. One strategy to address this discontinuity is to offer patients a near-term benefit, such as a financial reward. Whereas there is evidence that rewards can improve treatment adherence and sometimes health outcomes, further research is needed to determine whether rewards are more effective when targeting processes or intermediary health outcomes. In the Trial to Incentivise Adherence for Diabetes (TRIAD) we test whether adding financial incentives to usual care can improve HbA1c levels among people with diabetes and whether the financial incentives work better when targeting processes (adherence to blood glucose testing, medication, and daily physical activity) or the primary intermediary health outcome of self-monitored blood glucose within an acceptable range.

          Methods/design

          TRIAD is a randomised, controlled, open-label, single-centre superiority trial with three parallel arms. A total of 240 patients with suboptimally controlled diabetes (HbA1c ≥ 8%) from a polyclinic in Singapore are block-randomised (blocking factor: current vs. new glucometer users) into three arms, namely (1) usual care (UC) only, (2) UC with process incentive and (3) UC with outcome incentive, in a 2:3:3 ratio. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome (change in HbA1c level at month 6) will be measured by a laboratory that is independent from the study team. Secondary outcomes (at month 6) include the number of blood glucose testing days, glucose readings within the normal range (between 4 to 7 mmol/L), medication-adherent days, physically active days, and average incentives earned and time spent administrating the incentives.

          Discussion

          This study will provide evidence on whether financial incentives can cost-effectively improve glycaemic control. It will also provide evidence on the benefit incidence of interventions involving financial incentives. By comparing process to outcome incentives, this study will inform the design of future incentive strategies in chronic disease management and beyond.

          Trial registration

          ClinicalTrials.gov registry, ID: NCT02224417. Registered on 22 August 2014.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13063-017-2288-6) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references18

          • Record: found
          • Abstract: not found
          • Article: not found

          Golden Eggs and Hyperbolic Discounting

          D. Laibson (1997)
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            The Dishonesty of Honest People: A Theory of Self-Concept Maintenance

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis.

              The effectiveness of quality improvement (QI) strategies on diabetes care remains unclear. We aimed to assess the effects of QI strategies on glycated haemoglobin (HbA(1c)), vascular risk management, microvascular complication monitoring, and smoking cessation in patients with diabetes. We identified studies through Medline, the Cochrane Effective Practice and Organisation of Care database (from inception to July 2010), and references of included randomised clinical trials. We included trials assessing 11 predefined QI strategies or financial incentives targeting health systems, health-care professionals, or patients to improve management of adult outpatients with diabetes. Two reviewers independently abstracted data and appraised risk of bias. We reviewed 48 cluster randomised controlled trials, including 2538 clusters and 84,865 patients, and 94 patient randomised controlled trials, including 38,664 patients. In random effects meta-analysis, the QI strategies reduced HbA(1c) by a mean difference of 0·37% (95% CI 0·28-0·45; 120 trials), LDL cholesterol by 0·10 mmol/L (0·05-0.14; 47 trials), systolic blood pressure by 3·13 mm Hg (2·19-4·06, 65 trials), and diastolic blood pressure by 1·55 mm Hg (0·95-2·15, 61 trials) versus usual care. We noted larger effects when baseline concentrations were greater than 8·0% for HbA(1c), 2·59 mmol/L for LDL cholesterol, and 80 mm Hg for diastolic and 140 mm Hg for systolic blood pressure. The effectiveness of QI strategies varied depending on baseline HbA(1c) control. QI strategies increased the likelihood that patients received aspirin (11 trials; relative risk [RR] 1·33, 95% CI 1·21-1·45), antihypertensive drugs (ten trials; RR 1·17, 1·01-1·37), and screening for retinopathy (23 trials; RR 1·22, 1·13-1·32), renal function (14 trials; RR 128, 1·13-1·44), and foot abnormalities (22 trials; RR 1·27, 1·16-1·39). However, statin use (ten trials; RR 1·12, 0·99-1·28), hypertension control (18 trials; RR 1·01, 0·96-1·07), and smoking cessation (13 trials; RR 1·13, 0·99-1·29) were not significantly increased. Many trials of QI strategies showed improvements in diabetes care. Interventions targeting the system of chronic disease management along with patient-mediated QI strategies should be an important component of interventions aimed at improving diabetes management. Interventions solely targeting health-care professionals seem to be beneficial only if baseline HbA(1c) control is poor. Ontario Ministry of Health and Long-term Care and the Alberta Heritage Foundation for Medical Research (now Alberta Innovates--Health Solutions). Copyright © 2012 Elsevier Ltd. All rights reserved.
                Bookmark

                Author and article information

                Contributors
                +65 6601 2330 , marcel.bilger@duke-nus.edu.sg
                shah.mitesh@singhealth.com.sg
                tan.ngiap.chuan@singhealth.com.sg
                kayehoward_@hotmail.com
                xu.huiyan@singhealth.com.sg
                ecosse.lamoureux@seri.com.sg
                eric.finkelstein@duke-nus.edu.sg
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                17 November 2017
                17 November 2017
                2017
                : 18
                : 551
                Affiliations
                [1 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Health Services and Systems Research, Duke-NUS Medical School, ; 8 College Road, 169857 Singapore, Singapore
                [2 ]SingHealth Polyclinics, Singapore, Singapore
                [3 ]ISNI 0000 0000 9960 1711, GRID grid.419272.b, Singapore Eye Research Institute, Singapore National Eye Centre, ; Singapore, Singapore
                [4 ]ISNI 0000 0004 1936 7961, GRID grid.26009.3d, Duke Global Health Institute, Duke University, ; Durham, NC USA
                Author information
                http://orcid.org/0000-0002-2872-6597
                Article
                2288
                10.1186/s13063-017-2288-6
                5693491
                29149912
                32449abd-5049-4c0d-866f-5932ad911871
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 June 2017
                : 30 October 2017
                Funding
                Funded by: National University of Singapore Global Asia Institute
                Award ID: NIHA-2013-1-005
                Award Recipient :
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2017

                Medicine
                diabetes,medication adherence,blood glucose monitoring,physical activity,financial incentive,behaviour change

                Comments

                Comment on this article