MedicalResearch.com Interview with:
Ernst L Noordraven MSc, PhD student
Department of Psychiatry
Epidemiological and Social Psychiatric Research institute
Erasmus University Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Provision of financial incentives is a promising intervention for improving adherence in patients taking antipsychotic medication. We aimed to assess the effectiveness of this intervention for improving adherence to antipsychotic depot medication in patients with psychotic disorders, irrespective of their previous compliance.
Our 12-month randomized controlled trial showed that financial incentives improved adherence to antipsychotic depot medications in patients with psychotic disorders, regardless of their level of compliance at study entrance. Patients received either treatment as usual plus a financial reward for each depot of medication received (€30 per month if fully compliant; intervention group) or treatment as usual alone (control group). Based on the use of depot registrations from 155 patients (92%), the adjusted difference in adherence was 14·9% (95% CI 8·9–20·9%; p<0·0001) in favour of the intervention group.
Our study is also the first to demonstrate that the effects on medication adherence persist after monetary rewards are discontinued, for at least a 6-month follow-up period (adjusted difference 6·5%, 95% CI 2·0–10·9; p=0·047).
MedicalResearch.com: What should readers take away from your report?
Response: During a 12-month intervention period, the difference in adherence was 15% in favour of the intervention group. Our study supports earlier findings and is the first RCT to show that the effectiveness of this intervention is not restricted to patients with poor adherence but is generalizable to all patients with psychotic disorders, regardless their level of medication adherence. For clinical purposes this is important, because there are both practical and ethical objections to only reward those patients with poor medication adherence.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further research is needed to study the long-term effects of using financial incentives, for example in a randomized controlled trial that compares the effectiveness of a 12-month versus 24-month intervention period. These studies should also aim to improve clinical outcomes, such as psychiatric symptoms and quality of life.
MedicalResearch.com: Is there anything else you would like to add?
Response: When financial incentives are no longer offered, its positive effect on increased medication adherence decreases, but persists for at least 6 months. This seems to indicate that, in order to maintain higher levels of medication adherence over time, the use of financial incentives should be continued for patients who responded to the intervention.
No relevant disclosures.
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Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (Money for Medication): a multicentre, open-label, randomised controlled trial
The Lancet Research Article Volume 4, No. 3, p199–207, March 2017
Ernst L Noordraven, André I Wierdsma, Peter Blanken, Anthony F T Bloemendaal, Anton B P Staring, Cornelis L Mulder
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