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

Tidey, Jennifer W.

doi:10.1016/j.ypmed.2011.11.010

Cited by 27 publications

(20 citation statements)

References 81 publications

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“…This corresponds with some research that suggests that larger PFIs were more effective at changing health behaviour than small amounts (Lumley et al, 2009;Lynagh et al, 2011b;Sigmon and Patrick, 2012). The current study also adds another perspective on the utility of financial incentives for smoking cessation in disadvantaged groups which previous reviews have suggested is an efficacious and effective method of promoting smoking cessation amongst socially disadvantaged groups including low income pregnant women (Higgins et al, 2012;Lumley et al, 2009), illicit drug users (Sigmon and Patrick, 2012), and people with mental illness (Tidey, 2012). Further research regarding the acceptability, effectiveness and associated possible positive and negative effects of PFIs with disadvantaged groups is warranted.…”

Section: Discussionsupporting

confidence: 86%

“…They found that incentives were effective at encouraging cessation in four of five trials with opioid-maintained patients and that effect was moderated by incentive magnitude-the higher the incentive amount the more likely a positive outcome. Tidey (2012) found similar evidence for the effectiveness of PFIs for people with serious mental illness.…”

mentioning

confidence: 62%

“…Higgins et al (2012) update this review and come to the same conclusion that PFIs show considerable promise for the short-term cessation of smoking among socioeconomically disadvantaged pregnant women. Two recent reviews have examined the effectiveness of financial incentives for two different socially disadvantaged groups (Sigmon and Patrick, 2012;Tidey, 2012). Sigmon and Patrick (2012) examined the evidence for the efficacy of PFIs for "special populations" one of which was substance abusers.…”

mentioning

confidence: 99%

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Money as motivation to quit: A survey of a non-random Australian sample of socially disadvantaged smokers' views of the acceptability of cash incentives

Bonevski

Bryant

Lynagh

et al. 2012

Preventive Medicine

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Section: Discussionsupporting

confidence: 86%

mentioning

confidence: 62%

mentioning

confidence: 99%

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Money as motivation to quit: A survey of a non-random Australian sample of socially disadvantaged smokers' views of the acceptability of cash incentives

Bonevski

Bryant

Lynagh

et al. 2012

Preventive Medicine

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“…67 Contingency reinforcement for reduced cotinine but not for group attendance was associated with reduction in urine cotinine and expired carbon monoxide in one study in smokers with schizophrenia. 68 Some evidence suggests NRT combined with monetary reinforcement for lower expired CO concentration is superior to placebo + contingency reinforcement for smoking reduction among smokers with schizophrenia while contingencies are in place.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Tobacco Use Disorders in Smokers with Serious Mental Illness

Evins

Cather

Laffer

2015

Harvard Review of Psychiatry

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Addiction to tobacco-derived nicotine remains highly prevalent in the US, with 18% using daily, but 53% of those with serious mental illness smoke regularly. While smokers with serious mental illness have been excluded from most large nicotine dependence treatment studies, a growing evidence base is emerging to guide clinicians in how to assist their patients with psychiatric illness to quit smoking. The aim of this review is to present the evidence on safety and efficacy of smoking cessation interventions for those with serious mental illness. Smokers with schizophrenia spectrum disorders should receive varenicline or bupropion with or without nicotine replacement therapy (NRT) in combination with behavioral treatment. Preliminary evidence suggests that varenicline in combination with behavioral support is efficacious and well tolerated for smoking cessation for those with bipolar disorder and major depressive disorder. More work is needed to establish treatment guidelines for smokers with major depressive disorder and bipolar disorder. Controlled trials to date have not found evidence for worsening of psychiatric symptoms or increased rate of psychiatric adverse events in this population with available pharmacotherapeutic cessation aids. Converging evidence indicates that a majority of smokers with serious mental illness want to quit smoking and that available pharmacotherapeutic cessation aids combined with behavioral support are both effective for and well tolerated by these smokers. Most people with serious mental illness see their psychiatrist more regularly than their primary care physician, and many receive care exclusively in a psychiatric treatment setting. Psychiatrists thus have an important role to play in the recognition and treatment of tobacco use disorders in people with serious mental illness.

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“…Tidey 36 conducted a review of studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity. They concluded that 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 behaviours, incentive-based treatments should be further developed and integrated into behavioural treatment programmes for people with serious mental illness.…”

Section: Carey and Careymentioning

confidence: 99%

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

Cited by 27 publications

References 81 publications

Money as motivation to quit: A survey of a non-random Australian sample of socially disadvantaged smokers' views of the acceptability of cash incentives

Money as motivation to quit: A survey of a non-random Australian sample of socially disadvantaged smokers' views of the acceptability of cash incentives

Treatment of Tobacco Use Disorders in Smokers 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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