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Lipid Control: The Impact of Financial Incentives

Lipid Control: The Impact of Financial Incentives

Despite the well-documented benefits of statins to lower LDL cholesterol (LDL-C) and help reduce cardiovascular-related mortality, research suggests that physicians underprescribe these drugs. Other data indicate that clinicians frequently fail to intensify therapy when appropriate and that patient adherence to these medications is often subpar. The consequences of these actions can be severe among patients with cardiovascular disease, including worse outcomes, higher hospitalization and mortality rates, and increased healthcare costs. One approach to increase attention to the management of lipids is to tie physician financial incentives to clinical goals, but another strategy may be to offer incentives to patients for reaching their goals. Both of these approaches might be enhanced by applying insights from behavioral economics.   Assessing Approaches For a study published in JAMA, Kevin G. Volpp, MD, PhD, and colleagues compared the provision of financial incentives for physicians only, for patients only, or for shared incentives for both parties and looked at their effectiveness at reducing LDL-C levels among people with elevated cardiovascular risks. The interventions were tested over 12 months from 2011 to 2014 in three healthcare delivery systems in the northeastern United States. Doctors in the physician incentive group were eligible to receive up to $1,024 per enrolled patient meeting LDL-C goals. Participants in the patient incentive group were eligible for the same amount, while physicians and patients in the shared incentives group shared these incentives. A control group was also involved in the analysis and received no incentives that were tied to outcomes. That said, all patient participants received up to $355 each for participating in the trial. “Sharing financial incentives for both patients...
Surrogate Use in Diabetes: Compromising Care?

Surrogate Use in Diabetes: Compromising Care?

A recent analysis published in BMJ finds that the widespread use of surrogate endpoints in diabetes care puts the patient’s concerns on the back burner. The authors argue that easier-to-measure surrogate outcomes are often used instead of outcomes important to patients, such as death, quality of life, or functional capacity when assessing treatments.  Diabetes care is largely driven by surrogates. Concentrations of glycated haemoglobin (HbA1c) are used as a surrogate marker for outcomes that are important to patients, such as blindness or amputation. Blood pressure, lipids, albumin excretion rates, and C-reactive protein are other surrogates physicians use to predict outcomes of cardiovascular disease and to guide clinical practice. However, according to the authors, “much of the evidence for clinical interventions is based on their effect on surrogate outcomes rather than those that matter to patients, such as quality of life or avoidance of vision loss or renal failure.” Surrogates for outcomes such as glucose, lipid, and blood pressure thresholds are also used to evaluate quality of healthcare and influence reimbursements. Focus may then fall on reducing the level of the surrogate, regardless of the impact on a patient’s outlook. The authors maintain that these markers “begin to take on an existence of their own as new disease entities.” Physician’s Weekly wants to know… Do you feel there is too much focus on surrogate use? Does surrogate use treat the individual as a biological being rather than a human?   |...
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