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

anon79999497 · September 30, 2016, 11:46am

CONCLUSIONS: Financial 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.

ncbi.nlm.nih.gov

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

S Priebe, SA Bremner, C Lauber, C Henderson and T Burns, Health technology assessment (Winchester, England), Sep 2016

Poor 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.To 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.A 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.Community teams in secondary mental health care.Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included.Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual.adherence to LAI medication (the percentage of received out of those prescribed).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.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.Financial 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.Current Controlled Trials ISRCTN77769281.This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information.

So basically when financial incentives are stopped adherence levels drop.

anon77239798 · September 30, 2016, 11:49am

If I was paid to take my medicine… Hmmmm. Interesting thought.

anon79999497 · September 30, 2016, 12:11pm

My view is that if the medication is as bad as some people make out(as opposed to not being that effective) then no amount of cash incentive would persuade you to have it/take it.
If you are willing to take for financial gain then your reasons for not taking in the first place would be rather flimsy.

I can just imagine the scenario. " These drugs are evil, they’re designed to kill me", “We’ll offer you £15” " Ok, you’ve sold me on the deal"

anon77239798 · September 30, 2016, 12:12pm

Since Brexit, are you back to pounds? Or still using the Euro?

anon88813813 · September 30, 2016, 12:14pm

The uk has never used the euro. It has always kept itself separate from the single currency.

anon77239798 · September 30, 2016, 12:15pm

I didn’t realize that

anon77239798 · September 30, 2016, 12:42pm

Then the study should say if the subjects we paid in which currency! Oh my that would cause confusion!

anon79999497 · September 30, 2016, 1:49pm

@NiceHat It said £15 ie British currency.

anon77239798 · September 30, 2016, 1:53pm

I know, but that’s also about $15 American, that’s a burger and a glass or 2 of beer is all. I wouldn’t give myself akathesia over a burger and a brew.

It’s less if paid in foreign currency, as I’d have to exchange the pounds for dollars.

anon79999497 · September 30, 2016, 2:04pm

15.00 GBP = 19.478254 USD

http://www.x-rates.com/calculator/?from=GBP&to=USD&amount=15

anon77239798 · September 30, 2016, 6:52pm

$6.50 American for me locally for a burger and fries, at happy hour I get a glass of beer for $2. So 15 pounds is closer to 2 meals of burgers and cheap brews.

I still would pass on a shot of akethesia.

anon11056724 · September 30, 2016, 10:14pm

How 'bout they just develop a new drug that doesn’t have the unbareable side effects and we’ll all take it for free.

anon77239798 · September 30, 2016, 10:23pm

That would be a cure

anon79999497 · September 30, 2016, 10:24pm

Unfortunately all medication has side effects, including non psychiatric meds. The aim should be for meds where the therapeutic benefits clearly outweigh the severity of the side effects.

JH85 · September 30, 2016, 10:33pm

It’s only for injectables. Isn’t their a new one that you only take 3-4 time per annum?

anon11056724 · September 30, 2016, 10:34pm

Maybe so, but atypicals and typicals are extremely unpleasant. I think it’s referred to as a quality of life issue and right now on meds my quality of life could be a lot better if they had one that didn’t have these unpleasant side effects. You can’t blame someone for not wanting to take their antipsychotics. I’ll leave it at that because we all need them but I feel strongly about this subject.
And you’re right all meds have side effects, I don’t even like taking my mood stabilizer it has some unpleasantness associated with it too.