***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Efforts to improve adherence by reducing co-payments through value-based insurance design are become more prevalent despite limited evidence of improved health outcomes . The objective of this study was to determine whether eliminating patient co-payments for blood pressure medications improves blood pressure control . STUDY DESIGN R and omized controlled trial . METHODS The Collaboration to Reduce Disparities in Hypertension ( CHORD ) was a r and omized controlled trial with 12 months ' follow-up conducted among patients from the Philadelphia and Pittsburgh Veterans Administration Medical Centers . We enrolled 479 patients with poorly controlled systolic blood pressure . Participants were r and omly assigned to : a ) receive reductions in co-payments from $ 8 to $ 0 per medication per month for each antihypertensive prescription filled , b ) a computerized behavioral intervention ( CBI ) , c ) both co-pay reduction and CBI , or d ) usual care . Our main outcome measure was change in systolic blood pressure from enrollment to 12 months post enrollment . We also measured adherence using the medication possession ratio in a subset of participants . RESULTS There were no significant interactions between the co-payment interventions and the CBI interventions . There was no relative difference in the change in medication possession ratio between baseline and 12 months ( 0.05 % and -0.90 % in control and incentive groups , respectively ; P = .74 ) or in continuous medication gaps of 30 , 60 , or 90 days . Blood pressure decreased among all participants , but to a similar degree between the financial incentive and control groups . Systolic pressure within the incentive group dropped 13.2 mm Hg versus 15.2 mm Hg for the control group ( difference = 2.0 ; 95 % CI , -2.3 to 6.3 ; P = .36 ) . The proportion of patients with blood pressure under control at 12 months was 29.5 % in the incentive group versus 33.9 in the control group ( odds ratio , 0.8 ; 95 % CI , 0.5 - 1.3 ; P = .36 ) . CONCLUSIONS Among patients with poorly controlled blood pressure , financial incentives-as implemented in this trial-that reduced patient cost sharing for blood pressure medications did not improve medication adherence or blood pressure control OBJECTIVES Value-based insurance design s are being widely used . We undertook this study to examine whether a financial incentive that lowered co-payments for blood pressure medications below $ 0 improved blood pressure control among patients with poorly controlled hypertension . STUDY DESIGN R and omized controlled trial . METHODS Participants from 3 Pennsylvania hospitals ( n = 337 ) were r and omly assigned to : a ) be paid $ 8 per medication per month for filling blood pressure prescriptions , b ) a computerized behavioral intervention ( CBI ) , c ) both payment and CBI , or d ) usual care . The primary outcome was change in blood pressure between baseline and 12 months post enrollment . We also measured adherence using the medication possession ratio in a subset of participants . RESULTS There were no significant interactions between the incentive and the CBI interventions . There were no significant changes in medication possession ratio in the treatment group . Blood pressure decreased among all participants , but to a similar degree between the financial incentive and control groups . Systolic blood pressure ( SBP ) dropped 13.7 mm Hg for the incentive group versus 10.0 mm Hg for the control group ( difference = –3.7 ; 95 % CI , –9.0 to 1.6 ; P = .17 ) . The proportion of patients with blood pressure under control 12 months post enrollment was 35.6 % of the incentive group versus 27.7 % of the control group ( odds ratio , 1.4 ; 95 % CI , 0.8 - 2.5 ; P = .19 ) . Diabetics in the incentive group had an average drop in SBP of 12.7 mm Hg between baseline and 12 months compared with 4.0 mm Hg in the control group ( P = .02 ) . Patients in the incentive group without diabetes experienced average SBP reductions of 15.0 mm Hg , compared with 16.3 mm Hg for control group nondiabetics ( P = .71 ) . CONCLUSIONS Among patients with poorly controlled blood pressure , financial incentives — as implemented in this trial — did not improve blood pressure control or adherence except among patients with diabetes BACKGROUND Adherence to medications that are prescribed after myocardial infa rct ion is poor . Eliminating out-of-pocket costs may increase adherence and improve outcomes . METHODS We enrolled patients discharged after myocardial infa rct ion and r and omly assigned their insurance-plan sponsors to full prescription coverage ( 1494 plan sponsors with 2845 patients ) or usual prescription coverage ( 1486 plan sponsors with 3010 patients ) for  all statins , beta-blockers , angiotensin-converting-enzyme inhibitors , or angiotensin-receptor blockers . The primary outcome was the first major vascular event or revascularization . Secondary outcomes were rates of medication adherence , total major vascular events or revascularization , the first major vascular event , and health expenditures . RESULTS Rates of adherence ranged from 35.9 to 49.0 % in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group ( P<0.001 for all comparisons ) . There was no significant between-group difference in the primary outcome ( 17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group ; hazard ratio , 0.93 ; 95 % confidence interval [ CI ] , 0.82 to 1.04 ; P=0.21 ) . The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group ( 21.5 vs. 23.3 ; hazard ratio , 0.89 ; 95 % CI , 0.90 to 0.99 ; P=0.03 ) , as was the rate of the first major vascular event ( 11.0 vs. 12.8 ; hazard ratio , 0.86 ; 95 % CI , 0.74 to 0.99 ; P=0.03 ) . The elimination of copayments did not increase total spending ( $ 66,008 for the full-coverage group and $ 71,778 for the usual-coverage group ; relative spending , 0.89 ; 95 % CI , 0.50 to 1.56 ; P=0.68 ) . Patient costs were reduced for drugs and other services ( relative spending , 0.74 ; 95 % CI , 0.68 to 0.80 ; P<0.001 ) . CONCLUSIONS The elimination of copayments for drugs prescribed after myocardial infa rct ion did not significantly reduce rates of the trial 's primary outcome . Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs . ( Funded by Aetna and the Commonwealth Fund ; MI FREEE Clinical Trials.gov number , NCT00566774 . ) OBJECTIVE To assess the impact of a decrease in statin copayments on medication adherence and dem and for statins . STUDY DESIGN Quasi-experimental , pre/post design . METHODS Patients in more than 700 health plans from June 2005 to May 2007 were evaluated . The intervention group ( n = 13,319 ) and matched control group ( n = 26,569 ) included patients who had at least 1 br and ed simvastatin or non-simvastatin statin purchase , respectively , before the simvastatin patent expired in June 2006 . Intervention and control patients had to have purchased at least 1 generic simvastatin and non-simvastatin statin , respectively , after patent expiration . Intervention patients were matched to control patients up to 1:2 on incident statin use ( yes/no ) and pre-patent expiration copay ( + /- $ 2 ) . Adherence was calculated with the medication possession ratio ( MPR ) . Adjusted and unadjusted changes in MPR were compared between groups . Elasticity of dem and for statins was estimated . RESULTS A small but statistically significant difference was observed between groups in the change in MPR ( intervention = 0.52 % adjusted mean increase , control = 2.02 % adjusted mean decrease ; adjusted P < .01 ) . A marginally higher percentage of intervention patients ( 10.5 % ) compared with control patients ( 10.0 % ) increased their MPR from < 80 % in the preperiod to > or = 80 % in the postperiod ( adjusted P < .01 ) . Elasticity of dem and for statins was estimated at 0.02 and -0.02 for the copayment reduction categories of $ 0 to $ 5 and > $ 15 , respectively . CONCLUSIONS Decreasing statin copayments was associated with adherence increases . However , the overall increase in medication adherence was modest and its clinical significance uncertain The Kaiser Family Foundation Survey on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy was a r and om- sample , telephone survey of adults nationwide . The national sample consisted of 2,002 adults ( 1002 men and 1000 women ) , 18 years and older , and was conducted between October 12 and November 13 , 1994 by Louis Harris and Associates , Inc. The margin of error in the national sample is plus or minus 2 percent Background Adherence to recommendations and medication is deemed to be important for effectiveness of case management interventions . Thus , reasons for non-adherence and effects on health-related quality of life ( HRQoL ) should be fully understood . The objective of this research was to identify determinants of non-adherence to medication and recommendations , and to test whether increased adherence improved HRQoL in patients after myocardial infa rct ion ( MI ) in a case management intervention . Methods Data were obtained from the intervention group of the KORINNA study , a r and omized controlled trail of a nurse-led case management intervention with targeted recommendations in the elderly after MI in Germany . Reasons for non-adherence were described . Logistic mixed effects models and OLS ( ordinary least squares ) were used to analyze the effect of recommendations on the probability of adherence and the association between adherence and HRQoL. Results One hundred and twenty-seven patients with 965 contacts were included . Frequent reasons for non-adherence to medication and recommendations were “ forgotten ” ( 22 % ; 11 % ) , “ reluctant ” ( 18 % ; 18 % ) , “ side effects ” ( 38 % ; 7 % ) , “ the problem disappeared ” ( 6 % ; 13 % ) , and “ barriers ” ( 0 % ; 13 % ) . The probability of adherence was lowest for disease and self-management ( 38 % ) and highest for visits to the doctor ( 61 % ) . Only if patients diverging from prescribed medication because of side effects were also considered as adherent , 3-year medication adherence was associated with a significant gain of 0.34 quality -adjusted life years ( QALYs ) . Conclusions Most important determinants of non-adherence to medication were side effects , and to recommendations reluctance . Recommended improvements in disease and self-management were least likely adhered . Medication adherence was associated with HRQoL.Trial registration Current Controlled Trials IS RCT N02893746 , retrospectively registered , date assigned 27/03/2009 
    Output:
    
VBIDs significantly increased adherence in all indication areas .
It is concluded that VBID implementation should be encouraged , especially for patients with heart diseases , and that full coverage was associated with higher effects .
This review may provide insight for policy-makers into how to make VBIDs more effective