Priebe Stefan, Burton Alexandra, Ashby Deborah, Ashcroft Richard, Burns Tom, David Anthony, Eldridge Sandra, Firn Mike, Knapp Martin, McCabe Rose
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.
BMC Psychiatry. 2009 Sep 28;9:61. doi: 10.1186/1471-244X-9-61.
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/DESIGN: 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.
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.
Current controlled trials ISRCTN77769281.
已对多种干预措施进行了测试，以促使患有精神疾病的非依从性患者坚持服用抗精神病维持药物，但尚无一致证据表明任何既定干预措施的有效性。经济激励措施在提高对一系列治疗的依从性方面的有效性已得到证实；然而，尚无随机对照试验测试过使用经济激励措施来促使社区中患有精神疾病的患者坚持服药。
方法/设计：在一项整群随机对照试验中，34个负责照顾社区中难以参与治疗的患者的精神卫生团队将被随机分配到干预组或对照组。在干预组中，患者每接受一剂抗精神病长效针剂药物，将获得经济激励；在对照组中，所有患者将接受常规治疗。我们将招募136名使用这些服务且在坚持服用抗精神病长效针剂药物方面存在问题的精神疾病患者，尽管已尝试了所有常规的促进依从性的方法。主要结局将是依从水平，次要结局包括整体临床改善情况、自愿和非自愿住院次数、自杀未遂和自杀完成次数、身体暴力事件、警方逮捕次数、工作/培训/教育天数、主观生活质量以及对药物治疗的满意度。我们还将确定提供经济激励措施的成本效益。
该研究旨在提供新的证据，证明对患有精神疾病的患者提供经济激励以促使其坚持服用抗精神病维持药物的有效性和成本效益。如果经济激励措施能提高依从性并带来更好的健康和社会结局，那么它们可能会被推荐作为改善非依从性精神疾病患者治疗的一种选择。
当前受控试验ISRCTN77769281。
