Fine-dining gives patients incentive to stay on meds
Viral loads decreased for group
Sometimes the small pleasures in life can make all the difference.
At least this is what one HIV clinic discovered after starting an HIV medication adherence program that rewards patients who achieve 95 percent adherence to medication regimens and clinic appointments with a dinner out at an upscale restaurant.
"We were trying to figure out how to help our patients better adhere to their appointments and medications," says Natalie Perkins, PharmD, treatment adherence coordinator at El Rio Special Immunology Associates in Tucson, AZ.
So the clinic decided to provide a special incentive of taking out the patients who achieved the 95 percent adherence goal. The project was named Club 95, after the adherence goal.
"We said, 'We're challenging you to take at least 95 percent of your medication doses and make 95 percent of your appointments for three months," Perkins says. "Everyone who attended the initial meeting wanted to sign up and try it."
Each time a patient walked in the door they were assessed for adherence with a three-question adherence tool.1
Adherence was measured through self-reports, but the reported results were compared with viral load lab tests, as well.
The group of patients participating in the incentive program met once a month for one hour, learning more about adherence and resistance, Perkins says.
"On the third month and meeting we played HIV jeopardy and had the patients interact in a game-type setting to question their knowledge about adherence," she adds.
Of the 24 patients who entered the first incentive program, 12 were successful in adhering to at least 95 percent of their medication doses and clinic visits, Perkins says.
The 12 who succeeded attended dinner at a nice restaurant in Tucson with Perkins and another employee of El Rio Special Immunology Associates. The dinner cost about $35 per person, and the dinners were furnished with the assistance of industry support.
Of the original 24 patients in the first group, 63 percent had undetectable viral load at baseline, and 83 percent had undetectable viral load at the three month visit, Perkins says.
Also, 92 percent of the 12 people who were successful in adhering to their treatment had undetectable viral loads at the end of the study, she adds.
Of the 12 people who didn't meet their goals, four had dropped out, Perkins says.
"Of the 12, five people were quite honest about not meeting their goals when self-reporting their medication use," Perkins says.
The first experience with the restaurant incentive worked so well that the clinic decided to repeat the experience. Everyone who had participated the first time, whether they were successful or not, was invited to join the second group. There were some new patients participating, as well, Perkins says.
"There were some overlapped patients — absolutely," Perkins says. "We were happy to encourage their adherence."
The patients who were successful in the first Club 95 group were encouraged to speak at the second Club 95 group meetings, discussing their adherence strategies and the restaurant reward, she notes.
In all, 17 people participated in the second Club 95 group, and 15 of these patients were successful at achieving 95 percent adherence, Perkins says.
The second group went from 71 percent having undetectable virus at baseline to 82 percent having undetectable virus at the three-month visit, she says.
"What we were really excited to show was that in the third cohort there were 19 people who tried the incentive program," Perkins says. "And of the 19 people there were 89 percent who had undetectable viral load at baseline."
Seventeen people among the 19 patients in the group were successful, but all 19 of the patients had undetectable viral load at the three-month visit, Perkins says.
"It was exciting to see that success," Perkins says.
El Rio Special Immunology Associates has continued the incentive program, occasionally taking a month off from the Club 95 meetings to avoid patient burnout, Perkins says.
"For the next cohort, we've challenged patients to bring a new member to the meeting," she says. "We made them business cards that read, 'I'm a member of club 95. Will you join me at the next meeting?"
The program has been so successful that Perkins is doing a retrospective study of the results.
The Club 95 adherence program is inexpensive and could be used by other HIV clinics fairly easily, Perkins says.
The incentive rewards can be sponsored through grants or donations from local restaurants or other businesses, she suggests.
The staff time is minimal, requiring Perkins to spend about four hours per month on the meeting and preparation. Her coworker, a certified pharmacy technician, spends about eight hours per month on the program.
The key is to keep it active since medication adherence is an ongoing process.
"The plan is to always have it as a component of the program," Perkins says.
Reference:
- Mannheimer SM, Botsko M, Hirsschorn L, et al. The CASE Adherence Index: A novel method for measuring adherence to antiretroviral therapy. AIDS Care. 2006;18(7):853-861.
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