Cash rewards encourage antipsychotic injection adherence

By Eleanor McDermid, Senior medwireNews Reporter

Offering “modest” financial incentives to patients receiving maintenance antipsychotic treatment by depot injection can encourage them to adhere to the regimen, shows a randomized trial.

The UK-based trial recruited outpatients with schizophrenia, schizoaffective disorder, or bipolar disorder who had not received at least 75% of their prescribed antipsychotic injections. The 131 patients who completed the trial were cared for by 73 mental health teams, and the teams were randomly assigned to award financial incentives or to continue as normal.

Patients in the intervention group received £ 15 (€ 18; US$ 24) for each injection given, and over the 12-month study period their adherence rose significantly from 69% to 85%.

“Given the ceiling effect of 100% adherence, this shift represents more than half of the potentially possible maximum improvement,” write Stefan Priebe (Queen Mary University of London, UK) and co-workers in BMJ.

By contrast, adherence in the control group increased only slightly, from 67% to 71%.

“Thus it remained largely unchanged, which might be expected in people with severe psychotic disorders and poor adherence,” says the team.

In the intervention group, 28% of patients achieved near complete adherence (at least 95% of injections), compared with just 5% of the control group.

The improved adherence did not have a significant effect on patients’ clinical status, however. Although physicians rated 58% of patients in the intervention group as improved on the clinical improvement component of the clinical global impression scale, compared with 41% of the control group, this did not achieve statistical significance.

Despite this, subjective quality of life improved significantly on the DIALOG scale among patients in the intervention group, with scores increasing from 4.4 to 5.2, whereas the average score in the control group remained at 4.9.

“Consistent treatment may have helped patients to organise their lives better, cope with problems, and engage in satisfying activities,” suggest Priebe et al.

They note that the financial incentive did not ensure adherence in all patients. “However, we can conclude that offering a modest financial incentive is the most effective method shown so far of improving treatment adherence in this patient group,” writes the team. “It should be considered if poor treatment adherence poses a risk to patients’ health and social outcomes and if other methods to achieve adherence have failed.”

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