Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial

Abstract

Objective To test whether offering financial incentives to patients with psychotic disorders is effective in improving adherence to maintenance treatment with antipsychotics.Design Cluster randomised controlled trial.Setting Community mental health teams in secondary psychiatric care in the United Kingdom.Participants Patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, who were prescribed long acting antipsychotic (depot) injections but had received 75% or less of the prescribed injections. We randomly allocated 73 teams with a total of 141 patients. Primary outcome data were available for 35 intervention teams with 75 patients (96% of randomised) and for 31 control teams with 56 patients (89% of randomised).Interventions Participants in the intervention group were offered £15 (€17; $22) for each depot injection over a 12 month period. Participants in the control condition received treatment as usual.Main outcome measure The primary outcome was the percentage of prescribed depot injections given during the 12 month intervention period.Results 73 teams with 141 consenting patients were randomised, and outcomes were assessed for 131 patients (93%). Average baseline adherence was 69% in the intervention group and 67% in the control group. During the 12 month trial period adherence was 85% in the intervention group and 71% in the control group. The adjusted effect estimate was 11.5% (95% confidence interval 3.9% to 19.0%, P=0.003). A secondary outcome was an adherence of ≥95%, which was achieved in 28% of the intervention group and 5% of the control group (adjusted odds ratio 8.21, 95% confidence interval 2.00 to 33.67, P=0.003). Although differences in clinician rated clinical improvement between the groups failed to reach statistical significance, patients in the intervention group had more favourable subjective quality of life ratings (β=0.71, 95% confidence interval 0.26 to 1.15, P=0.002). The number of admissions to hospital and adverse events were low in both groups and did not show substantial differences.Conclusion Offering modest financial incentives to patients with psychotic disorders is an effective method for improving adherence to maintenance treatment with antipsychotics.Trial registration Current Controlled Trials ISRCTN77769281.

Adherence to medication is associated with non-planning impulsivity in euthymic bipolar disorder patients

“…Our findings suggest that this type of intervention could successfully be used to address adherence issues in BD patients, at least in those with high nonplanning impulsivity levels. Interestingly, a recent study (Priebe et al, 2013) reported on the effectiveness of financial incentives to improve adherence to maintenance treatment in bipolar patients. Finally, cognitive rehabilitation, which was found to display some efficacy to improve executive functioning in bipolar patients (Deckersbach et al, 2010), might enhance adherence in those with non-planning impulsivity.…”

Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial

“…adherence ≤ 75%) l examine the views and experiences of both patients and clinicians with offering financial incentives to improve adherence to LAI medication to inform the concerns raised by focus groups 47,48 and Henderson and colleagues 49 and reproduced from Highton-Williamson and colleagues.…”

“…Source: adapted from Priebe and colleagues. 47 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) licence,…”

“…Aspects of the methods have been taken from the trial protocol which is accessible in the public domain, 2 the main trial results have been taken from a paper published by Priebe and colleagues, 47 results on the cost-effectiveness have been taken from a work published by Henderson and colleagues, 49 the methods and results of the 6-and 24-month follow-up data from a manuscript in submission, the methods and results for patient experiences of the study have been paraphrased from a manuscript in submission, the methods and results for the clinicians' experiences has been taken from Highton-Williamson and colleagues. 50 The discussion and conclusions have been paraphrased from all of the above sources.…”

Paying patients with psychosis to improve adherence

“…In a linked paper (doi:10.1136/ bmj.f5847), Priebe and colleagues found that modest financial incentives significantly improved adherence in people treated with depot drugs for schizophrenia and other psychoses in the United Kingdom. 5 It is difficult to achieve adherence to antipsychotic drugs in people with psychoses for several reasons. Many do not accept that they are ill so do not believe that they need treatment.…”