Financial incentives to improve adherence to anti-psychotic maintenance medication in non-adherent patients - a cluster randomised controlled trial (FIAT).
BACKGROUND
Various interventions have been tested to achieve adherence to anti-psychotic maintenance medication in non-adherent patients with psychotic disorders, and there is no consistent evidence for the effectiveness of any established intervention. The effectiveness of financial incentives in improving adherence to a range of treatments has been demonstrated; no randomised controlled trial however has tested the use of financial incentives to achieve medication adherence for patients with psychotic disorders living in the community.


METHODS
In a cluster randomised controlled trial, 34 mental health teams caring for difficult to engage patients in the community will be randomly allocated to either the intervention group, where patients will be offered a financial incentive for each anti-psychotic depot medication they receive over a 12 month period, or the control group, where all patients will receive treatment as usual. We will recruit 136 patients with psychotic disorders who use these services and who have problems adhering to antipsychotic depot medication, although all conventional methods to achieve adherence have been tried. The primary outcome will be adherence levels, and secondary outcomes are global clinical improvement, number of voluntary and involuntary hospital admissions, number of attempted and completed suicides, incidents of physical violence, number of police arrests, number of days spent in work/training/education, subjective quality of life and satisfaction with medication. We will also establish the cost effectiveness of offering financial incentives.


CONCLUSIONS
The study aims to provide new evidence on the effectiveness and cost effectiveness of offering financial incentives to patients with psychotic disorders to adhere to antipsychotic maintenance medication. If financial incentives improve adherence and lead to better health and social outcomes, they may be recommended as one option to improve the treatment of non-adherent patients with psychotic disorders.


BACKGROUND
Current controlled trials ISRCTN77769281.
Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, UK. s.priebe@qmul.ac.uk
Stefan
S
Priebe
Alexandra
A
Burton
Deborah
D
Ashby
Richard
R
Ashcroft
Tom
T
Burns
Anthony
A
David
Sandra
S
Eldridge
Mike
M
Firn
Martin
M
Knapp
Rose
R
McCabe
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations / Q000191:economics; D003697:Delphi Technique; D005249:Fees and Charges / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D011788:Quality of Life; D012201:Reward; D013406:Suicide, Attempted / Q000517:prevention & control; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations