Randomized Trial of Interventions to Improve Warfarin Adherence (WIN3)
Study Overview
Status
Intervention / Treatment
Detailed Description
Eligible subjects will be enrolled in one of the 4 arms of the RCT and followed for 6 months, with the primary outcome of out-of-range INRs. Subjects will be given a Med-eMonitor to connect to their home phone line. For all subjects, these will be used to measure daily adherence. Subjects in the incentive group will be eligible for a daily lottery prize only if, prior to the lottery being resolved, their adherence device has registered adherence to their prescribed warfarin regimen. Subjects in the MM group will have the reminder/feedback features of the Med-eMonitor turned on to provide reminders to take their warfarin as prescribed and standardized messages that will be used to provide feedback in response to their adherence. Subjects in the combined group will be exposed to both the lottery and the activated Med-eMonitor. This trial is a randomized controlled trial.
Both men and women who are at least 18 years of age and have been prescribed anticoagulation medication are eligible to participate.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- Hospital of the University of Pennsylvania Anticoagulation Management Center
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Philadelphia, Pennsylvania, United States, 19104
- Philadelphia Veteran Affairs Medical Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Key Inclusion Criteria
The study population will include all patients at the study sites who:
- are in the maintenance phase of their warfarin treatment (defined using the standard method as the period of time following 2 consecutive visits, at least 7 days apart, of stable target INR after initiation of the drug)
- whose providers indicate are expected to stay on treatment for at least 6 months
- have a target INR of 2 to 3.5
- had at least one INR out of the participant's target range within 90 days prior to enrollment (excluding the baseline visit) and/or INR at the baseline visit was below the participant's target range
- have a working analog telephone line.
Of note, patients do not have to be within their target INR range to enroll; we specifically want to include those who are below the target range at the time of study entry because they may be the patients most likely to be non-adherent.
Key Exclusion Criteria Patients will be excluded if they do not meet the above inclusion criteria,
- have an INR at screening above the target range
- are less than 18 years of age and cannot or will not give consent
- cannot read above a 6th grade reading level
- are enrolled in a clinical trial of warfarin therapy
- are unable to adequately follow study procedures
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Other: 1 Usual Care Group/Control
Participants in this study arm will be given an electronic medication monitoring system called a Med-eMonitor(MM) to use at home.
This machine will measure the participant's adherence to taking their medication.
The MM can display messages to the participant and can confirm when medication is taken correctly.
|
Financial Incentives: Study participants are entered into a daily lottery. It includes a chance to win either $10 or $100 on any given day throughout the participant's duration in the study (6 months). Participants are assigned a number and each day a computer randomly draws a winning number. Participants whose number is drawn can only collect money if they have taken the medication correctly. Med-eMonitor: The Med-eMonitor is a device used to measure medication compliance. The device has 5 drawers in which the participants' medication is placed. When a drawer opens, a message displays on the monitor, and asks the participant if he/she is taking his/her medication for the day. The device registers their answers and sends the compliance information via the participants' telephone line nightly to a central study server. |
|
Experimental: 2Med-eMonitor/Reminder
Participants in this study arm will be given an electronic medication monitoring system called a Med-eMonitor(MM) to use at home.
This machine will measure the participant's adherence to taking their medication and will be set on active mode for this group.
The MM will display messages of encouragement to participants and education on the importance of taking their warfarin medication.
The Med-eMonitor also features an alarm that will sound to remind participants to take their medication as scheduled.
|
Med-eMonitor is a device that subjects will be given that will monitor an individual's warfarin adherence.
|
|
Experimental: 3 Incentive Group/Lottery
Participants in this study arm will be given an electronic medication monitoring system called a Med-eMonitor(MM) to use at home.
This machine will measure the participant's adherence to taking their medication.
The MM can display messages to the participant.
This group will also be entered into a daily lottery in which he/she can win money.
On any given study day, participants have a 1 in 10 chance of winning $10 and 1 in 100 chance of winning $100 when taking their warfarin as prescribed.
Participants must take their dose correctly in order to be eligible for the daily lottery.
|
Financial Incentives: Study participants are entered into a daily lottery. It includes a chance to win either $10 or $100 on any given day throughout the participant's duration in the study (6 months). Participants are assigned a number and each day a computer randomly draws a winning number. Participants whose number is drawn can only collect money if they have taken the medication correctly. Med-eMonitor: The Med-eMonitor is a device used to measure medication compliance. The device has 5 drawers in which the participants' medication is placed. When a drawer opens, a message displays on the monitor, and asks the participant if he/she is taking his/her medication for the day. The device registers their answers and sends the compliance information via the participants' telephone line nightly to a central study server. |
|
Experimental: 4 Combined Group/Lottery and Reminder
Participants in this study arm will be given an electronic medication monitoring system called a Med-eMonitor(MM) to use at home.
This machine will measure the participant's adherence to taking their medication and will be set on active mode for this group.
The MM will display messages of encouragement to participants and education on the importance of taking their warfarin medication.
The Med-eMonitor also features an alarm that will sound to remind participants to take their medication as scheduled.
Participants in this group will also be entered into a daily lottery.
On any given study day, participants have a 1 in 10 chance of winning $10 and 1 in 100 chance of winning $100 when taking their warfarin medication as prescribed.
Participants must take their dose correctly in order to be eligible for the daily lottery.
|
Financial Incentives: Study participants are entered into a daily lottery. It includes a chance to win either $10 or $100 on any given day throughout the participant's duration in the study (6 months). Participants are assigned a number and each day a computer randomly draws a winning number. Participants whose number is drawn can only collect money if they have taken the medication correctly. Med-eMonitor: The Med-eMonitor is a device used to measure medication compliance. The device has 5 drawers in which the participants' medication is placed. When a drawer opens, a message displays on the monitor, and asks the participant if he/she is taking his/her medication for the day. The device registers their answers and sends the compliance information via the participants' telephone line nightly to a central study server. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Improved Warfarin Adherence/% Timeout of Target INR Range
Time Frame: six months
|
six months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Kevin Volpp, M.D., Ph.D., University of Pennsylvania
Publications and helpful links
General Publications
- Kimmel SE, Troxel AB, French B, Loewenstein G, Doshi JA, Hecht TE, Laskin M, Brensinger CM, Meussner C, Volpp K. A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial. Pharmacoepidemiol Drug Saf. 2016 Nov;25(11):1219-1227. doi: 10.1002/pds.4094. Epub 2016 Sep 4.
- Kimmel SE, Troxel AB, Loewenstein G, Brensinger CM, Jaskowiak J, Doshi JA, Laskin M, Volpp K. Randomized trial of lottery-based incentives to improve warfarin adherence. Am Heart J. 2012 Aug;164(2):268-74. doi: 10.1016/j.ahj.2012.05.005.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 809166
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