Incentives research must balance carrots and sticks

This issue covers topics such as offering incentives to help patients change their lifestyles, treating depression and its extensive influence on overall health, and new modalities for treating allergies.

Change is hard, and maintaining change can be even harder. It's well known that even the most motivated patient can have a difficult time sticking to a healthy eating plan for weight loss or staying away from cigarettes. Recently, multiple studies have focused in on the potential use of financial incentives to help change both physician and patient behavior in regards to, respectively, provision of guideline-recommended care and maintenance of behavior modification. The hope is that changes initially made for short-term financial gain will eventually become second nature, improving long-term outcomes and potentially cutting health care costs. But the effectiveness of incentives can vary according to their design and the populations they target, and ethical issues must be considered, too. In our story, Charlotte Huff talks to experts about what types of carrots and sticks have been shown to be most effective, as well as their potential limitations in leading to sustained improvements.

Depression is a perennial problem in primary care, and ACP recently released a guideline on treatment that recommends cognitive-behavioral therapy or second-generation antidepressants for major depressive disorder, based on clinician judgment and patient preference. Both types of therapy were found to be similarly effective and to have similar rates of discontinuation. Our story examines the recommendation in the context of primary care and provides some guidance on best practices in screening for and subsequently treating depressed patients, stressing the importance of shared decision making and discussions of pros and cons. The article also addresses the issue of adherence and how to effectively explain to patients that sometimes the first treatment they try for depression may not work immediately, or at all.

May is Asthma and Allergy Awareness Month, and our story focuses in on diagnosing and treating environmental allergens. While referral to an allergist can be necessary for severe cases, much can be done by removing or limiting environmental triggers and by trying over-the-counter medications. Please also meet ACP's new President, Nitin S. Damle, MD, FACP, and read his first President's Message column, which outlines his and the College's priorities.

This month, ACP will hold Internal Medicine Meeting 2016 from May 5 to 7 in Washington, D.C., and the July/August issue of ACP Internist will feature a wrapup of our coverage. If you go the meeting, please share your thoughts and opinions on your experiences.


Jennifer Kearney-Strouse