OARSI Keynote: Understanding human behavior improves patient outcomes
LIVERPOOL, England — Understanding the incentives that drive human behavior may be useful in helping patients with osteoarthritis improve health-related habits, according to keynote speaker David Asch, MD.
When patients fail to exercise or adhere to medications, it is not a knowledge or education deficit, but a behavioral deficit, according to Asch, who is professor of medicine, medical ethics and health policy, health care management, and operations, information and decisions, and executive director at the Center for Health Care Innovation at the University of Pennsylvania. “People know about the dangers of smoking or that vaccination is safe because they’ve been educated about these things,” he said. “But patient education, clearly, can be limited.”
For Asch, rationality poorly describes behavior changes. “Many of us operate under the impression that we accept information, rationally process it and change behavior,” he said. “But the mind is a highly resistant pathway.”
For this reason, Asch believes that the science of motivation has evolved. “It has moved from information to financial rewards,” he said. “If you increase rewards, you can improve behavior. Behavioral economics is the next step.”
Asch said that behavioral economics recognizes that people are irrational, but in predictable ways. “Decisions are affected by emotions, bias and social context,” he said. “This predictability gives us the opportunity to be forewarned about decision errors that people make.”
One of these biases is a type of myopia, where individuals choose an immediate reward, like a cigarette or a piece of chocolate cake, over a distant reward, like the good health benefits that will come from avoiding those temptations, according to Asch. “We need to find ways to accelerate rewards that patients receive for adhering to the things that will benefit them,” he said. “This is applicable in OA, which is a disease that requires daily engagement for a sustained period. Medication adherence and exercise are daily challenges.”
Using financial incentives
Experts are developing lottery-based rewards, where a financial incentive is tied to medication adherence. However, simply offering money for a behavior may not always be the best approach, according to Asch. “We are far more motivated to avoid a $100 loss than we are to achieve a $100 gain,” he said. “It doesn’t make economic sense, but it makes behavioral sense.”
Further understanding human behavior can also benefit clinicians, according to Asch. He noted a study about prescribing patterns conducted at the University of Pennsylvania. When the default prescription on electronic medical forms was the generic drug as opposed to the name-brand drug, clinicians dramatically reduced the number of name-brand drugs they prescribed, thereby saving money without impacting patient outcomes.
Asch added that social motivation can be more effective than financial motivation. “We care what others think about us,” he said. “If you’re a rheumatologist prescribing medications or a patient with OA taking your medication every day, no one sees what you do. If we can find ways to make these activities visible, we can find ways to change behaviors.”
Asch acknowledged that many of the approaches he discussed do not seem to make sense on paper, but seeing them played out in real life demonstrates their effectiveness. “Once you accept that people are irrational, it gives you better opportunities to help them,” he said. – by Rob Volansky
Asch D. Motivating healthy eating in the modern era. Presented at: OARSI 2018 World Congress on Osteoarthritis; April 26-29; Liverpool, England.
Disclosure: Asch reports being part owner of Val Health.