title: Offering financial incentives to increase adherence to antipsychotic medication: the clinician experience.
abstract: Financial incentives for medication adherence in patients with psychotic disorders are controversial. It is not yet known whether fears expressed by clinicians are borne out in reality. We aimed to explore community mental health clinicians' experiences of the consequences of giving patients with psychotic disorders a financial incentive to take their depot medication. We implemented descriptive and thematic analyses of semistructured interviews with the clinicians of patients assigned to receive incentives within a randomized controlled trial. Fifty-nine clinicians were interviewed with regard to the effect of the incentives on 73 of the 78 patients allocated to receive incentives in the trial. Most commonly, the clinicians reported benefits for clinical management including improved adherence, contact, patient monitoring, communication, and trust (n = 52). Positive effects on symptoms, insight, or social functioning were reported for some (n = 33). Less commonly, problems for patient management were reported (n = 19) such as monetarization of the therapeutic relationship or negative consequences for the patient (n = 15) such as increased drug and alcohol use. Where requests for increased money occurred, they were rapidly resolved. It seems that, in most cases, the clinicians found that using incentives led to benefits for patient management and for patient health. However, in 33% of cases, some adverse effects were reported. It remains unclear whether certain clinical characteristics are associated with increased risk for adverse effects of financial incentives. The likelihood of benefit versus the smaller risk for adverse effects should be weighed up when deciding whether to offer incentives to individual patients.
authors.affiliation: From the *Unit of Social and Community Psychiatry, Queen Mary University of London; †Institute of Psychiatry, Psychology and Neuroscience, King's College London; and ‡Centre for Mental Health, Imperial College London, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Highton-Williamson
authors.forename: Kirsten
authors.initials: K
authors.lastname: Barnicot
authors.forename: Tarrannum
authors.initials: T
authors.lastname: Kareem
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D009042:Motivation; D010348:Patient Care Team; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D012649:Self Concept; D012919:Social Behavior; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations