The usual approach to improving health-related behaviors involves education and, in some cases, financial incentives; a better approach involves using “behavioral economics” to help patients identify and overcome psychological barriers to behavioral change, according to Dr. David Asch.
During his keynote presentation titled “Using Behavioral Economics to Improve Individual and Population Health” on Thursday morning at the 2015 AGA Technology Summit, Dr. Asch will describe the concept of behavioral economics and discuss ongoing research demonstrating its value in the health care setting.
“In health care, so many of the outcomes that people achieve are highly determined by their own behaviors,” Dr. Asch, an internist at the University of Pennsylvania, Philadelphia , said in an interview.
This is true regarding diet, exercise, and medication adherence, he added, naming just a few examples.
“Human behavior is really the final common pathway toward a lot of the outcomes we care about in health and health care, and until recently there hasn’t been a lot of insight into how to improve people’s health behavior and to advance their own goals,” he said.
One thing that’s known, however, is that being armed with the knowledge that a certain behavior will derail one’s efforts doesn’t necessarily prevent that behavior. A person may know that it’s safer to use a seat belt, but may avoid using one anyway. A dieter may know that piece of chocolate cake is fattening, but will eat it anyway.
That’s why education – though important – is not typically enough on its own to change behaviors, Dr. Asch said, explaining that the premise of the educational approach is that if you tell dieters that chocolate cake is fattening, they won’t eat it, and therefore they won’t get fat.
It’s clear what a weak argument that is, he said.
Similarly, economic incentives – paying patients to take their medication or quit smoking, or, conversely, charging penalties if they don’t – may have some benefit, but these incentives are expensive and off-putting, and their effectiveness is limited, he noted.
Behavioral economics, on the other hand, has much more to do with psychology than with economics, he said, adding that “the basic principle is that all of us are irrational. We do all sorts of things that are irrational, meaning they’re not consistent with our own best interests.”
The key insight of behavioral economics, however, isn’t that people are irrational – it is that they are irrational in highly predictable ways, Dr. Asch said, explaining that people tend to make the same types of mistakes as other people, which allows for the development of solutions with widespread applicability.
“We can harness these same errors that trip us up and use them to create interventions that improve our health,” he said.
At the summit, which is sponsored by the AGA’s Center for GI Innovation and Technology, Dr. Asch will share his recent research showing how health can be improved by “taking advantage of these psychological foibles.”
One study he will discuss is looking at how behavioral economics can promote medication adherence.
“We have a large study in the field right now for patients who have been discharged from the hospital following a heart attack,” he said explaining that such patients are typically discharged on three or four different types of medications, and despite the seriousness of the condition, adherence is only about 40%.
The study uses a multipronged approach that “game-ifies” medication adherence by monitoring pill use via special pill bottles with a computer chip in the cap. A daily lottery is conducted in which patients are randomly selected for monetary prizes if they have been adherent (the data are transmitted through a cell phone signal), resulting in a doubling of compliance rates, he said.
The approach incorporates powerful psychological forces such as regret, which patients will experience if their number is drawn in the lottery and they lose out on the money because of lack of medication adherence, for example. It also enlists the help of a volunteer support person – such as an adult child of the patient – who is notified if a patient misses 2 days of medication in a row. The latter “turns an unwitnessed event into a witnessed event,” providing further impetus for compliance, Dr. Asch said, explaining that no one wants a witness to their failure.
The study is ongoing, and while it remains to be seen whether the behavioral economics approach reduces admissions and proves cost effective, it’s clear that it works to promote adherence, he said.