Financial incentives to improve adherence to anti-psychotic maintenance medication in non-adherent patients - a cluster randomised controlled trial (FIAT)

Priebe, Stefan; Burton, Alexandra; Ashby, Deborah; Ashcroft, Richard; Burns, Tom; David, Anthony S.; Eldridge, Sandra; Firn, Mike; Knapp, Martín

doi:10.1186/1471-244x-9-61

Cited by 29 publications

(24 citation statements)

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“…In addition, Carey and Carey (1990) found positive effects of contingent incentives on attendance at a day treatment for SUD in 53 people with SMI, and Post et al (2006) found that incentives ($10 per appointment) increased therapy attendance and reduced appointment rescheduling among 50 people with depression during a 12-week active intervention period. Priebe et al (2009) recently described a randomized controlled trial aimed at investigating whether financial incentives contingent upon depot antipsychotic medication adherence, compared to treatment as usual, improve clinical and psychosocial functioning among non-adherent patients with psychotic disorders. Given the positive findings reviewed above, and the high psychosocial and financial costs of poor adherence, it is surprising that that adherence-contingent incentives are not routinely used, at least with chronically non-compliant individuals.…”

Section: Future Directionsmentioning

confidence: 99%

“…Given the positive findings reviewed above, and the high psychosocial and financial costs of poor adherence, it is surprising that that adherence-contingent incentives are not routinely used, at least with chronically non-compliant individuals. Negative attitudes by treatment providers may be a major reason for the poor uptake of these incentives; ironically, they are regarded by many treatment providers as being too effective, thus potentially undermining patient autonomy (Claassen 2007; Claassen et al 2007; Priebe et al, 2009; Burton et al, 2010). …”

Section: Future Directionsmentioning

confidence: 99%

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Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Tidey

2012

Preventive Medicine

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Introduction Serious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed. Methods Published reports from studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity are reviewed. Results Results of this review indicate the efficacy of incentive-based treatments for reducing tobacco and other drug use among people with SMI. Few studies have examined whether incentive-based treatments improve treatment attendance, medication use and physical activity levels in people with SMI; however, initial evidence is positive and indicates that further research in these areas is warranted. Conclusion Given the medical and psychosocial costs of tobacco and other drug use, treatment non-compliance and physical inactivity, and the efficacy of incentive-based treatments for improving these behaviors, such interventions should be further developed and integrated into behavioral health treatment programs for people with SMI.

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Section: Future Directionsmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Tidey

2012

Preventive Medicine

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“…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.…”

Section: Justification For the Current Studymentioning

confidence: 99%

“…The trial protocol is accessible in the public domain. 48 The study tested the hypothesis that offering financial incentives to patients who agree to their treatment but who have difficulties adhering sufficiently to it (i.e. have adherence ≤ 75%) would lead to improvements in their adherence.…”

Section: Designmentioning

confidence: 99%

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

Priebe

Bremner

Lauber³

et al. 2016

Health Technol Assess

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BackgroundPoor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence.ObjectivesTo test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives.DesignA cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months’ follow-up. The unit of randomisation was mental health teams in the community.SettingCommunity teams in secondary mental health care.ParticipantsPatients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (interventionn = 78 and controln = 63) were included.InterventionsParticipants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual.Main outcome measuresPrimary outcome: adherence to LAI medication (the percentage of received out of those prescribed). Secondary outcomes: percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians.ResultsPrimary outcome: outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%;p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33.67;p = 0.003) and subjective quality of life (difference in means 0.71, 95% CI 0.26 to 1.15;p = 0.002). Follow-ups: after incentives stopped, adherence did not differ significantly between groups, neither during the first 6 months (adjusted difference in means –7.4%, 95% CI –17.0% to 2.1%;p = 0.175) nor during the period from month 7 to month 24 (difference in means –5.7%, 95% CI –13.1% to 1.7%;p = 0.130). Cost-effectiveness: the average costs of the financial incentives was £303. Overall costs per patient were somewhat higher in the intervention group, but the difference was not significant. Semistructured interviews: the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value. These included improvement in the therapeutic relationship. The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year.ConclusionsFinancial incentives are effective in improving adherence to LAI medication. Health-care costs (including costs of the financial incentive) are unlikely to be increased substantially by this intervention. Once the incentives stop, the advantage is not maintained. The experiences of both patients and clinicians are largely, but not exclusively, positive. Whether or not financial incentives are effective for patients with more favourable background, those on oral mediation or for shorter or longer time periods remains unknown.Trial registrationCurrent Controlled Trials ISRCTN77769281.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information.

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Designing Interventions

2012

A Practical Guide to Cluster Randomised Trials in Health Services Research

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Financial incentives to improve adherence to anti-psychotic maintenance medication in non-adherent patients - a cluster randomised controlled trial (FIAT)

Cited by 29 publications

References 24 publications

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

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

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