University of Pennsylvania, Department of Psychiatry, Center on the Continuum of Care in the Addictions, Philadelphia, PA 19104, USA.
Drug Alcohol Depend. 2011 Apr 1;114(2-3):225-8. doi: 10.1016/j.drugalcdep.2010.09.007. Epub 2010 Nov 1.
Telephone-based monitoring is a promising approach to continuing care of substance use disorders, but patients often do not engage or participate enough to benefit. Voucher incentives can increase retention in outpatient treatment and continuing care, but may be less effective when reinforcement is delayed, as in telephone-based care. We compared treatment utilization rates among cocaine-dependent patients enrolled in telephone continuing care with and without voucher incentives to determine whether incentives increase participation in telephone-based care.
Participants were 195 cocaine-dependent patients who completed two weeks of community-based intensive outpatient treatment for substance use disorders and were randomly assigned to receive telephone continuing care with or without voucher incentives for participation as part of a larger clinical trial. The 12-month intervention included 2 in-person orientation sessions followed by up to 30 telephone sessions. Incentivized patients could receive up to $400 worth of gift cards.
Patients who received incentives were not more likely to complete their initial orientation to continuing care. Incentivized patients who completed orientation completed 67% of possible continuing care sessions, as compared to 39% among non-incentivized patients who completed orientation. Among all patients randomized to receive incentives, the average number of completed sessions was 15.5, versus 7.2 for patients who did not receive incentives, and average voucher earnings were $200.
Voucher incentives can have a large effect on telephone continuing care participation, even when reinforcement is delayed. Further research will determine whether increased participation leads to better outcome among patients who received incentives.
基于电话的监测是一种有前途的方法，可以对物质使用障碍进行持续治疗，但患者通常参与度不够，无法从中受益。代金券激励措施可以提高门诊治疗和持续治疗的保留率，但当强化延迟时，如在基于电话的护理中，效果可能会降低。我们比较了参加电话继续护理的可卡因依赖患者的治疗利用率，他们是否有代金券激励措施，以确定激励措施是否会增加他们对基于电话的护理的参与度。
参与者是 195 名可卡因依赖患者，他们完成了为期两周的社区强化门诊治疗物质使用障碍，并随机分配接受有或没有代金券激励措施的电话继续护理，作为更大临床试验的一部分。为期 12 个月的干预措施包括 2 次面对面的介绍课程，然后最多进行 30 次电话课程。有激励措施的患者最多可以获得价值 400 美元的礼品卡。
接受激励措施的患者不太可能完成他们最初的继续护理介绍。完成介绍的有激励措施的患者完成了 67%的可能的继续护理课程，而完成介绍的无激励措施的患者则完成了 39%。在所有随机接受激励措施的患者中，平均完成的课程数为 15.5 节，而未接受激励措施的患者为 7.2 节，平均代金券收入为 200 美元。
即使强化延迟，代金券激励措施也可以对电话继续护理的参与产生很大影响。进一步的研究将确定增加参与度是否会使接受激励措施的患者获得更好的结果。
