Financial Incentives for High Blood Pressure

(BENEFIT-H Trial)

No longer recruiting at 1 trial location

Overseen By Laura M Perry, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Tulane University

Must be taking: Blood pressure medication

Disqualifiers: Other blood pressure trials, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether giving money to patients sooner rather than later helps them manage their high blood pressure more effectively. Participants will be divided into two groups: one receives weekly cash rewards for checking their blood pressure (immediate financial incentives), and the other receives a single payment at the end (delayed financial incentives). The goal is to determine if frequent payments encourage better health management and improve blood pressure. The trial seeks participants diagnosed with high blood pressure, who take medication for it, and receive care from specific health centers in Louisiana. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance health management strategies.

Do I have to stop taking my current medications for this trial?

The trial does not specify if you need to stop taking your current medications. However, since participants must be taking blood pressure medication to join, it seems likely you will continue your current treatment.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that offering money can safely encourage better management of high blood pressure. Studies have found that participants generally respond well to financial rewards. Past studies have used both immediate and delayed payments to improve habits like regular medication intake and blood pressure monitoring.

Reports have not identified any major safety concerns with financial incentives. The main focus remains on their effectiveness in changing behavior, not on causing harm. Although discussions have considered possible side effects, such as changes in motivation, no serious problems have been reported.

Overall, current research indicates that financial incentives are safe. They aim to help people stay engaged in managing their health without adding physical risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for high blood pressure because they explore a new approach: financial incentives. Unlike traditional treatments focusing solely on medication and lifestyle changes, these treatments motivate patients through monetary rewards. One group receives immediate financial incentives weekly, while the other gets them at the study's end. This novel method aims to boost patient adherence to blood pressure monitoring, potentially leading to better health outcomes.

What evidence suggests that this trial's financial incentives could be effective for improving blood pressure monitoring adherence?

This trial will compare the effects of immediate versus delayed financial incentives on managing high blood pressure. Research has shown that offering money can help people manage high blood pressure in the short term. Studies have found that financial rewards, whether immediate or delayed, help patients adhere to their blood pressure check-ups. Specifically, one study discovered that a program offering money in clinics improved blood pressure control by 5.5%. However, these benefits often diminish once the rewards cease. Immediate rewards might sustain engagement longer, but both types of rewards show promise for initially managing high blood pressure. ^{1 2 6 7 8}

Who Is on the Research Team?

Marie Krousel-Wood, MD, MSPH

Principal Investigator

Tulane University

Are You a Good Fit for This Trial?

This trial is for people over 40 with high blood pressure who haven't been able to control it, even with medication. They must be patients at certain health centers in Louisiana, have a smartphone, and speak English. It's not open to those who don't meet these requirements.

Inclusion Criteria

I am 40 years old or older.

Your blood pressure is not well controlled, with a systolic blood pressure higher than 130 mm Hg or diastolic blood pressure higher than 80 mm Hg at your most recent clinic visit.

You can use a smartphone.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

3 months

Baseline

Participants attend a baseline visit to measure blood pressure, respond to a baseline survey, and receive remote patient monitoring devices and instructions

1 day

1 visit (in-person)

Treatment

Participants use remote patient monitoring devices during a two-month study period, receive weekly reports on adherence to blood pressure monitoring, and receive financial incentives based on their group allocation

8 weeks

Weekly virtual check-ins

Follow-up

Participants attend a follow-up visit at 2 months to measure their blood pressure, complete a follow-up survey, return the remote patient monitoring devices, and receive financial incentives for blood pressure monitoring (control condition only)

1 day

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Delayed financial incentives
• Immediate financial incentives

Trial Overview The study tests if giving patients money right away (weekly) versus at the end of the study encourages them more to monitor their blood pressure using provided devices. Participants are split into two groups randomly: one gets weekly cash for regular monitoring; the other gets a lump sum later.

How Is the Trial Designed?

Group I: Immediate Financial Incentives for BP monitoring Experimental Treatment 3 Interventions

* instructions for participating in a 2-month remote patient monitoring program * home blood pressure monitor and associated smartphone app, which includes a module for logging medication-taking * wrist-worn sensor and associated smartphone app * weekly adherence feedback to home blood pressure monitoring * immediate financial incentives for home blood pressure monitoring distributed weekly

Group II: Delayed Financial Incentives for BP monitoring Active Control 3 Interventions

* instructions for participating in a 2-month remote patient monitoring program * home blood pressure monitor and associated smartphone app, which includes a module for logging medication-taking * wrist-worn sensor and associated smartphone app * weekly adherence feedback to home blood pressure monitoring * delayed financial incentives for home blood pressure monitoring distributed at the end of the study

Who Is Running the Clinical Trial?

Tulane University

Lead Sponsor

Trials

129

Recruited

259,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9444259/

Effect of Financial Incentives on Hypertension Control Overall, financial incentives were effective in the short term for controlling hypertension, but no sustained effects were found in the long term.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6998348/

Financial incentives for hypertension control - PubMed Central This trial will determine whether financial incentives will improve hypertension control and generate necessary data for controlling hypertension.

3. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2718089

Efficacy of Patient Activation Interventions With or Without ... This randomized clinical trial tests the efficacy of patient activation interventions with or without financial incentives to promote ...

4. jamanetwork.com jamanetwork.com/journals/jama-health-forum/fullarticle/2814987

Association of Economic Policies With Hypertension ... One study found that a P4P program implemented in the clinic improved BP control by 5.5%. In addition, 2 studies using financial incentives in ...

5. cgdev.org cgdev.org/blog/taking-care-impacts-and-limitations-financial-incentives-health

The Impacts and Limitations of Financial Incentives in Health The report draws on research spanning 15 years and 40 countries to better understand the gap between health coverage and outcomes and points a way forward.

6. trialsjournal.biomedcentral.com trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-4051-7

Financial incentives for hypertension control: rationale ... - Trials This study will generate the necessary data for controlling hypertension via financial incentives and promoting it on a larger scale will be ...

7. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0184856

Reports of unintended consequences of financial incentives to ... We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone ...

8. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2784633

Effect of Financial Incentives for Process, Outcomes, or ... This randomized clinical trial evaluates the use of financial incentives to improve adherence to statin therapy and achieve a decrease in ...