Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Study protocol

Money for medication: a randomized controlled study on the effectiveness of financial incentives to improve medication adherence in patients with psychotic disorders

Authors: Ernst L Noordraven, Charlotte H Audier, Anton BP Staring, Andre I Wierdsma, Peter Blanken, Bas EA van der Hoorn, Leona Hakkaart-van Roijen, Cornelis L Mulder

Published in: BMC Psychiatry | Issue 1/2014

Login to get access

Abstract

Background

Non-adherence with antipsychotic medication is a frequently occurring problem, particularly among patients with psychotic disorders. Prior research has generally shown encouraging results for interventions based on ‘Contingency Management’ (CM), in which desirable behaviour is encouraged by providing rewards contingent upon the behaviour. However, little is known about the application of CM on medication adherence in patients with psychotic disorders. An earlier pilot-study by our study group showed promising results in reducing admission days and increasing adherence. The current study is a randomized controlled trial concerning the effectiveness of a CM procedure called ‘Money for Medication’ (M4M), aimed at improving adherence with antipsychotic depot medication in psychotic disorder patients.

Methods/Design

Outpatients (n =168) with a psychotic disorder will be randomly assigned to either the experimental group (n =84), receiving a financial reward for each accepted antipsychotic medication depot, or the control group (n =84), receiving treatment as usual without financial rewards. Patients are included regardless of their previous adherence. The intervention has a duration of twelve months. During the subsequent six months follow-up, the effects of discontinuing the intervention on depot acceptance will be assessed.
The primary goal of this study is to assess the effectiveness of providing financial incentives for improving adherence with antipsychotic depot medication (during and after the intervention). The primary outcome measure is the percentage of accepted depots in comparison to prescription. Secondary, we will consider alternative measures of medication acceptance, i.e. the longest period of uninterrupted depot acceptance and the time expired before depot is taken. Additionally, the effectiveness of the experimental intervention will be assessed in terms of psychosocial functioning, substance use, medication side-effects, quality of life, motivation, cost-utility and patients’ and clinicians’ attitudes towards M4M.

Discussion

This RCT assesses the effectiveness and side-effects of financial incentives in improving adherence with antipsychotic depot medication in patients with psychotic disorders. This study is designed to assess whether M4M is an effective intervention to improve patients’ acceptance of their antipsychotic depot medication and to examine how this intervention contributes to patients’ functioning and wellbeing.
Appendix
Available only for authorised users
Literature
1.
Valenstein M, Ganoczy D, McCarthy JF, Myra Kim H, Lee TA, Blow FC: Antipsychotic adherence over time among patients receiving treatment for schizophrenia: a retrospective review. J Clin Psychiatry. 2006, 67: 1542-1550. 10.4088/JCP.v67n1008.CrossRefPubMed
2.
Gilmer TP, Ph D, Dolder CR, Pharm D, Lacro JP, Folsom DP, Lindamer L, Garcia P, Ed D, Jeste DV: Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia. Am J Psychiatry. 2004, 161: 692-699. 10.1176/appi.ajp.161.4.692.CrossRefPubMed
3.
Velligan DI, Diamond PM, Mintz J, Maples N, Li X, Zeber J, Ereshefsky L, Lam Y-WF, Castillo D, Miller AL: The use of individually tailored environmental supports to improve medication adherence and outcomes in schizophrenia. Schizophr Bull. 2008, 34: 483-493. 10.1093/schbul/sbm111.CrossRefPubMed
4.
Llorca P-M: Partial compliance in schizophrenia and the impact on patient outcomes. Psychiatry Res. 2008, 161: 235-247. 10.1016/j.psychres.2007.07.012.CrossRefPubMed
5.
Haro JM, Suarez D, Novick D, Brown J, Usall J, Naber D: Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: observational versus randomized studies results. Eur Neuropsychopharmacol. 2007, 17: 235-244. 10.1016/j.euroneuro.2006.09.005.CrossRefPubMed
6.
Weiden PJ, Olfson M: Cost of relapse in schizophrenia. Schizophr Bull. 1995, 21: 419-429. 10.1093/schbul/21.3.419.CrossRefPubMed
7.
Marder SR: Overview of partial compliance. J Clin Psychiatry. 2003, 64: 3-9.PubMed
8.
Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T: Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care. 2002, 40: 630-639. 10.1097/00005650-200208000-00002.CrossRefPubMed
9.
Weiden PJ, Kozma C, Grogg A, Locklear J: Partial compliance and risk of rehospitalization among California medicaid patients with schizophrenia. Psychiatr Serv. 2004, 55: 886-891. 10.1176/appi.ps.55.8.886.CrossRefPubMed
10.
Hor K, Taylor M: Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010, 24 (4 Suppl): 81-90. 10.1177/1359786810385490.CrossRefPubMedPubMedCentral
11.
Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ: Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005, 187: 9-20. 10.1192/bjp.187.1.9.CrossRefPubMed
12.
Ascher-Svanum H, Nyhuis AW, Faries DE, Ball DE, Kinon BJ: Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia. BMC Psychiatry. 2010, 10: 11-10.1186/1471-244X-10-11.CrossRefPubMedPubMedCentral
13.
Giuffrida A, Torgerson DJ: Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997, 315: 703-707. 10.1136/bmj.315.7110.703.CrossRefPubMedPubMedCentral
14.
Valenstein M, Blow FC, Copeland L a, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T: Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophr Bull. 2004, 30: 255-264. 10.1093/oxfordjournals.schbul.a007076.CrossRefPubMed
15.
Higashi K, Medic G, Littlewood KJ, Diez T, Granström O, De Hert M: Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol. 2013, 70: 1-46.
16.
Westermeyer J: Comorbid schizophrenia and substance abuse: a review of epidemiology and course. Am J Addict. 2006, 15: 345-355. 10.1080/10550490600860114.CrossRefPubMed
17.
Ascher-Svanum H, Faries DE, Zhu B, Ernst FR, Swartz MS, Swanson JW: Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry. 2006, 67: 453-460. 10.4088/JCP.v67n0317.CrossRefPubMed
18.
Olfson M, Mechanic D, Hansell S, Boyer C a, Walkup J, Weiden PJ: Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatr Serv Washingt DC. 2000, 47: 853-858.
19.
Acosta FJ, Bosch E, Sarmiento G, Juanes N, Caballero-Hidalgo A, Mayans T: Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables. Schizophr Res. 2009, 107: 213-217. 10.1016/j.schres.2008.09.007.CrossRefPubMed
20.
Liraud F, Verdoux H: Association between temperamental characteristics and medication adherence in subjects presenting with psychotic or mood disorders. Psychiatry Res. 2001, 102: 91-95. 10.1016/S0165-1781(01)00240-2.CrossRefPubMed
21.
Löffler W, Kilian R, Toumi M, Angermeyer MC: Schizophrenic Patients’ subjective reasons for compliance and noncompliance with neuroleptic treatment. Pharmacopsychiatry. 2003, 36: 105-112. 10.1055/s-2003-39985.CrossRefPubMed
22.
Janssen B, Gaebel W, Haerter M, Komaharadi F, Lindel B, Weinmann S: Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders. Psychopharmacology (Berl). 2006, 187: 229-236. 10.1007/s00213-006-0413-4.CrossRef
23.
Lacro JP, Pharm D, Dunn LB, Dolder CR, Leckband SG, Ph R, Jeste DV: Prevalence of and risk factors for medication nonadherence in patients with schizphrenia: a comprehensive review of recent literature. J Clin. 2002, 63: 893-910.
24.
Hudson TJ, Owen RR, Thrush CR, Han X, Pyne JM, Thapa P, Sullivan G: A pilot study of barriers to medication adherence in schizophrenia. J Clin Psychiatry. 2004, 65: 211-216. 10.4088/JCP.v65n0211.CrossRefPubMed
25.
Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP: The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry. 2009, 70: 1-46.PubMed
26.
Staring ABP, Mulder CL, Der Van Gaag M, Selten J, Loonen AJM, Hengeveld MW: Understanding and improving treatment adherence in patients with psychotic disorders: a review and a proposed intervention. Curr Psychiatry Rev. 2006, 2: 487-494. 10.2174/157340006778699738.CrossRef
27.
Staring ABP, Van der Gaag M, Mulder CL: Schizophrenia and antipsychotic medication - Better adherence, better outcomes?. Schizophr Res. 2013, 151: 296-297. 10.1016/j.schres.2013.10.035.CrossRefPubMed
28.
Haynes RB, McDonald HP, Garg AX: Helping patients follow prescribed treatment: clinical applications. JAMA. 2002, 288: 2880-2883. 10.1001/jama.288.22.2880.CrossRefPubMed
29.
Novick D, Haro JM, Suarez D, Perez V, Dittmann RW, Haddad PM: Predictors and clinical consequences of non-adherence with antipsychotic medication in the outpatient treatment of schizophrenia. Psychiatry Res. 2010, 176: 109-113. 10.1016/j.psychres.2009.05.004.CrossRefPubMed
30.
Osterberg L, Blaschke T: Adherence to medication. N Eng J Med. 2005, 353: 487-497. 10.1056/NEJMra050100.CrossRef
31.
Prendergast M, Podus D, Finney J, Greenwell L, Roll J: Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 2006, 101: 1546-1560. 10.1111/j.1360-0443.2006.01581.x.CrossRefPubMed
32.
Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST: A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006, 101: 192-203. 10.1111/j.1360-0443.2006.01311.x.CrossRefPubMed
33.
Priebe S, Burton A, Ashby D, Ashcroft R, Burns T, David A, Eldridge S, Firn M, Knapp M, McCabe R: Financial incentives to improve adherence to anti-psychotic maintenance medication in non-adherent patients - a cluster randomised controlled trial (FIAT). BMC Psychiatry. 2009, 9: 61-10.1186/1471-244X-9-61.CrossRefPubMedPubMedCentral
34.
Claassen D, Fakhoury W, Ford R, Priebe S: Money for medication: financial incentives to improve medication adherence in assertive outreach. Psychiatr Bull. 2007, 31: 4-7. 10.1192/pb.31.1.4.CrossRef
35.
Staring AB, Mulder CL, Priebe S: Financial incentives to improve adherence to medication in five patients with schizophrenia in the Netherlands. Psychopharmacol Bull. 2010, 43: 1-6.
36.
Priebe S, Yeeles K, Bremner S, Lauber C, Eldridge S, Ashby D, David AS, O’Connell N, Forrest A, Burns T: Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ. 2013, 345: f5847-10.1136/bmj.f5847.CrossRef
37.
Van Veldhuizen JR: FACT: a Dutch version of ACT. Community Ment Health J. 2007, 43: 421-433. 10.1007/s10597-007-9089-4.CrossRefPubMed
38.
Sclar DA, Pharm B, Chin A, Skaer TL, Okamoto MP, Nakahiro RK, Gill MA: Effect of health education in promoting prescription refill compliance among patients with hypertension. Clin Ther. 1991, 13: 489-495.PubMed
39.
Perkins DO: Adherence to antipsychotic medications. J Clin Psychiatry. 1999, 60 (suppl 21): 25-30.PubMed
40.
Weiden PJ, Rapkin B, Mott T, Zygmunt A, Goldman D, Horvitz-lennon M, Frances A: Rating of medication influences (ROMI) scale in schizophrenia. Schizophr Bull. 1994, 20: 297-310. 10.1093/schbul/20.2.297.CrossRefPubMed
41.
Kay SR, Qpjer LA: The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophr Bull. 1987, 13: 261-272. 10.1093/schbul/13.2.261.CrossRefPubMed
42.
Knegtering H, Bruggeman R: Meetinstrumenten bij psychotische stoornissen. Tijdschr Psychiatr. 2004, 46: 675-679.
43.
Van den Oord EJCG, Rujescu D, Robles JR, Giegling I, Birrell C, Bukszár J, Murrelle L, Möller H-J, Middleton L, Muglia P: Factor structure and external validity of the PANSS revisited. Schizophr Res. 2006, 82: 213-223. 10.1016/j.schres.2005.09.002.CrossRefPubMed
44.
Wolthaus JE, Dingemans PM, Schene AH, Linszen DH, Knegtering H, Holthausen EA, Cahn W, Hijman R: Component structure of the positive and negative syndrome scale (PANSS) in patients with recent-onset schizophrenia and spectrum disorders. Psychopharmacology (Berl). 2000, 150: 399-403. 10.1007/s002130000459.CrossRef
45.
Mulder CL, Staring ABP, Loos J, Buwalda VJA, Kuijpers S, Systema S, Wierdsma AI: De Health of the Nation Outcome Scales (honos) als instrument voor ‘routine outcome assessment. Tijdschr Psychiatr. 2004, 6: 273-284.
46.
Bebbington P, Brugha T, Hill T, Marsden L, Window S: Health of the Nation Outcome Scales (Ho NOS). Br J Psychiatry. 1999, 174: 389-394. 10.1192/bjp.174.5.389.CrossRefPubMed
47.
Dickman SJ: Functional and dysfunctional impulsivity : personality and cognitive correlates. J Pers Soc Psychol. 1990, 58: 95-102. 10.1037/0022-3514.58.1.95.CrossRefPubMed
48.
Claes L, Vertommen H, Braspenning N: Psychometric properties of the Dickman Impulsivity Inventory. Pers Individ Dif. 2000, 29: 27-35. 10.1016/S0191-8869(99)00172-5.CrossRef
49.
Pedrero Pérez EJ: Evaluación de la impulsividad funcional y disfuncional en adictos a sustancias mediante el Inventario de Dickman. Psicothema. 2009, 21: 585-591.PubMed
50.
Kokkevi A, Hartgers C: EuropASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. Eur Addict Res. 1995, 1: 208-210. 10.1159/000259089.CrossRef
51.
Wittchen H-U: Reliability and validity studies of the WHO Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatric Res. 1994, 28: 57-84. 10.1016/0022-3956(94)90036-1.CrossRef
52.
Andrews G, Peters L: The psychometric properties of the composite international diagnostic interview. Soc Psychiatry Psychiatr Epidemiol. 1998, 33: 80-88. 10.1007/s001270050026.CrossRefPubMed
53.
Priebe S, Huxley P, Knight S, Evans S: Application and results of the Manchester short assessment of quality of life (Mansa). Int J Soc Psychiatry. 1999, 45: 7-12. 10.1177/002076409904500102.CrossRefPubMed
54.
Björkmann T, Svensson B: Quality of life in people with severe mental illness. Reliability and validity of the Manchester Short Assessment of Quality of Life (MANSA). Nord J Psychiatry. 2005, 59: 302-306. 10.1080/08039480500213733.CrossRef
55.
Weiden PJ, Miller AL: Which side effects really matter? Screening for common and distressing side effects of antipsychotic medications. J Psychiatr Pract. 2001, 7 (January): 41-47. 10.1097/00131746-200101000-00005.CrossRefPubMed
56.
van Hakkaart RL: Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). iMTA. 2002, 5: 5-45.
57.
König H-H, Roick C, Matthias A: Validity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders. Eur Psychiatry. 2007, 22: 177-187. 10.1016/j.eurpsy.2006.08.004.CrossRefPubMed
58.
Van der Zanden BP, Dijkgraaf MGW, Blanken P, de Borgie CA JM, van Ree JM, van den Brink W: Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population. Drug Alcohol Depend. 2006, 82: 111-118. 10.1016/j.drugalcdep.2005.08.012.CrossRefPubMed
59.
Jochems EC, Mulder CL, Duivenvoorden HJ, van der Feltz-Cornelis CM, van Dam A: Measures of motivation for psychiatric treatment based on self-determination theory: psychometric properties in Dutch psychiatric outpatients. Assessment. 2014, 21: 1-17. 10.1177/1073191113517928.CrossRef
60.
Remington G, Kwon J, Collins A, Laporte D, Mann S, Christensen B: The use of electronic monitoring (MEMS) to evaluate antipsychotic compliance in outpatients with schizophrenia. Schizophr Res. 2007, 90: 229-237. 10.1016/j.schres.2006.11.015.CrossRefPubMed
61.
Cohen J: Statistical Power Analysis for the Behavioral Sciences. 1988, Lawrence Erlbaum, Hillsdale, NJ, 2
62.
Festinger DS, Marlowe DB, Dugosh KL, Croft JR, Arabia PL: Higher magnitude cash payments improve research follow-up rates without increasing drug use or perceived coercion. Drug Alcohol Depend. 2008, 96: 128-135. 10.1016/j.drugalcdep.2008.02.007.CrossRefPubMedPubMedCentral
63.
Higgins ST, Heil SH, Dantona R, Donham R, Matthews M, Badger GJ: Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients. Addiction. 2007, 102: 271-281. 10.1111/j.1360-0443.2006.01664.x.CrossRefPubMed
64.
Ciudad A, Haro JM, Alonso J, Bousoño M, Suárez D, Novick D, Gilaberte I: The Schizophrenia Outpatient Health Outcomes (SOHO) study: 3-year results of antipsychotic treatment discontinuation and related clinical factors in Spain. Eur Psychiatry. 2008, 23: 1-7. 10.1016/j.eurpsy.2007.09.008.CrossRefPubMed
65.
Zhu B, Ph D, Ascher-svanum H, Faries D, Montgomery W, Pharm B, Marder SR: Time to discontinuation of depot and oral first-generation antipsychotics in the usual care of schizophrenia. Psychiatr Serv. 2008, 59: 315-317. 10.1176/appi.ps.59.3.315.CrossRefPubMed
66.
67.
Priebe S, Sinclair J, Burton A, Marougka S, Larsen J, Firn M, Ashcroft R: Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study. J Med Ethics. 2010, 36: 463-468. 10.1136/jme.2009.035071.CrossRefPubMedPubMedCentral
Metadata
Title
Money for medication: a randomized controlled study on the effectiveness of financial incentives to improve medication adherence in patients with psychotic disorders
Authors
Ernst L Noordraven
Charlotte H Audier
Anton BP Staring
Andre I Wierdsma
Peter Blanken
Bas EA van der Hoorn
Leona Hakkaart-van Roijen
Cornelis L Mulder
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0343-3

Other articles of this Issue 1/2014

BMC Psychiatry 1/2014 Go to the issue

Research article

Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project

Research article

Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

Erratum

Erratum to: changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

Research article

The strengths based approach as a service delivery model for severe mental illness: a meta-analysis of clinical trials

Research article

Helpful self-management strategies to cope with enduring depression from the patients’ point of view: a concept map study

Study protocol

Design of an international multicentre RCT on group schema therapy for borderline personality disorder