New Incentive Approaches to Adherence. Stephen Kimmel, MD, MSCE Andrea Troxel, ScD Center for Clinical Epidemiology and Biostatistics. The Importance of Clinical Trials to Study Adherence Interventions. Observational studies prone to bias Patient selection Temporal trends
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Stephen Kimmel, MD, MSCE
Andrea Troxel, ScD
Center for Clinical Epidemiology and Biostatistics
Source: Doshi, Zhu, Kimmel, Volpp et al. Circulation
Source: Chernew ME, et al. Health Affairs 2008;27(1):103-12.
Source: Volpp, Troxel, Kimmel , Doshi et al. 2010
40% of patients were
Either missed or extra dose
Odds Ratio (CI)
% Missed Pills
Reference group: No missed pills
Kimmel et al. Arch Intern Med. 2007;167:229-235.
Percent of Days Non-Adherent
Month After Beginning Warfarin Use
Volpp, Loewenstein, Troxel, Doshi & Kimmel, BMC Health Services Research, 2008
P-value for interaction=0.0016
At least one INR out of range within 90 days and/or INR below range at baseline visit