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A Brief Metric Framework for Patient Adherence to Doctor’s Advice Based on Behavioral Economics

Authors Lin S, Ma Y, Zou H

Received 19 August 2019

Accepted for publication 19 January 2020

Published 25 February 2020 Volume 2020:14 Pages 371—381


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu

Senlin Lin, 1, 2,* Yingyan Ma, 1, 2,* Haidong Zou 1, 2

1Department of Eye Disease Prevention, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200010, People’s Republic of China; 2Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Haidong Zou
Department of Eye Disease Prevention, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai 200010, People’s Republic of China
Tel +86 133 1198 6528

Purpose: This study tried to establish a metric framework of patient adherence to doctor’s advice based on the expected utility and prospect theories, and it explained why the key to patient adherence to doctor’s advice is patients’ perceptions.
Methods: Our framework is primarily based on two mature theories: expected utility theory and prospect theory. We started with a basic assumption: the doctor is rational and cares for patient’s health utility. We analyzed the expected utility of therapy with a definite diagnosis. Then, we considered the impacts of the accuracy of diagnostic techniques. After that, we explored the patient’s response to the doctors’ advices based on behavioral economics. In addition, we launched a discrete choice experiment to test our main point: perception is the key to patients’ adherence. A total of 200 undergraduate students participated in the discrete choice experiment.
Results: Three main factors might impact a rational clinical decision: the therapeutic and side effects of the treatment, patient’s true disease risk, and diagnostic accuracy. However, another factor, patient’s individual percepion, was crucial for patient’s adherence since it may bias the patient’s estimations regarding the above three factors. As a result, doctors and patients would have a cognitive gap in the estimation of the disease and the treatment.
Conclusion: The results indicate that without the necessary information, better clinical techniques may not help to improve patient adherence, which support our theoretical reasoning forcefully. Therefore, improving patient adherence should be more of a process of empathy and communication rather than a promotion of medical technology.

Keywords: patient adherence, behavioral economics, discrete choice experiment

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