Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study: Figure 1

Abstract

BackgroundOffering financial incentives to achieve medication adherence in patients with severe mental illness is controversial.AimsTo explore the views of different stakeholders on the ethical acceptability of the practice.MethodFocus group study consisting of 25 groups with different stakeholders.ResultsEleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) ‘problems requiring clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion.ConclusionsThe use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies.

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

“…[94][95][96][97] However, this was not a strong finding in the current work. The systematic review was not able to draw generalisable conclusions concerning effectiveness, but did find some instances in which financial incentives were effective at encouraging uptake.…”

“…Findings from both stakeholder groups provide strong support for previous research, where a variety of stakeholders across a range of clinical and public health settings have described health-promoting financial incentives as coercive, divisive and akin to bribery. 49,50,91,[93][94][95][96] However, unlike previous work in other settings, in which stakeholders have challenged the potential effectiveness of health promoting financial incentives in general (sometimes as a way of avoiding discussion of acceptability altogether), [93][94][95][96] there was, overall, an acceptance that financial incentives could be effective in encouraging the uptake of preschool vaccinations for some parents. A more detailed understanding of what aspects of acceptability of health-promoting financial incentives are common across all settings and which are context-specific -as well as what determines context-specific differenceswould be helpful.…”

Engagement processes in model programs for community reentry from prison for people with serious mental illness

“…Behavioral strategies include reminder letters or phone calls to increase attendance at appointments, providing praise or tangible rewards when attendance or participation goals are met, and even providing financial incentives for attending treatment or taking medication (Priebe et al, 2010). Initiatives to remove access barriers by providing transportation, allowing scheduling flexibility, or arranging child care could likewise be seen as behavioral or task oriented in nature.…”

The effect of the patient protection and Affordable Care Act on the Medicare Part D coverage gap as reflected in diabetes medication adherence.

“…An analysis conducted in England attributed medication non-adherence to be a contributing factor in at least 25 percent of suicides and homicides by people with mental illness (Priebe et al, 2010). It also is estimated that a lack of adherence to regimens for heart disease is responsible for 125,000 deaths annually (McCarthy, 1998).…”

“…Some reasons a person might choose to be non-adherent to therapy include a decision to avoid potential serious side effects or on the basis that the patient disagrees with the treatment or even the diagnosis itself (Priebe et al, 2010). There are potential benefits to non-adherence because it can sometimes reduce the cost of treatment and adverse effects, especially if the treatment is inappropriate (Giuffrida & Torgerson, 1997).…”