Pavlickova Hana, Bremner Stephen A, Priebe Stefan
Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, United Kingdom E13 8SP
J Clin Psychiatry. 2015 Aug;76(8):e1029-34. doi: 10.4088/JCP.14m09669.
A recent cluster-randomized controlled trial found that offering financial incentives improves adherence to long-acting injectable antipsychotics (LAIs). The present study investigates whether the impact of incentives diminishes over time and whether the improvement in adherence is linked to the amount of incentives offered.
Seventy-three teams with 141 patients with psychotic disorders (using ICD-10) were randomized to the intervention or control group. Over 1 year, patients in the intervention group received £15 (US $23) for each LAI, while control patients received treatment as usual. Adherence levels, ie, the percentage of prescribed LAIs that were received, were calculated for quarterly intervals. The amount of incentives offered was calculated from the treatment cycle at baseline. Multilevel models were used to examine the time course of the effect of incentives and the effect of the amount of incentives offered on adherence.
Adherence increased in both the intervention and the control group over time by an average of 4.2% per quarterly interval (95% CI, 2.8%-5.6%; P < .001). Despite this general increase, adherence in the intervention group remained improved compared to the control group by between 11% and 14% per quarterly interval. There was no interaction effect between time and treatment group. Further, a higher total amount of incentives was associated with poorer adherence (βbootstrapped = -0.11; 95% CIbootstrapped, -0.20 to -0.01; P = .023).
A substantial effect of financial incentives on adherence to LAIs occurs within the first 3 months of the intervention and is sustained over 1 year. A higher total amount of incentives does not increase the effect.
ISRCTN.com identifier: ISRCTN77769281 and UKCRN.org identifier: 7033.
最近一项整群随机对照试验发现，提供经济激励措施可提高长效注射用抗精神病药物（LAIs）的依从性。本研究调查了激励措施的影响是否会随时间减弱，以及依从性的提高是否与所提供的激励金额有关。
将73个团队的141名患有精神障碍（使用国际疾病分类第10版）的患者随机分为干预组或对照组。在1年的时间里，干预组的患者每次接受长效注射药物可获得15英镑（23美元），而对照组患者则接受常规治疗。每季度计算一次依从水平，即接受的规定长效注射药物的百分比。从基线时的治疗周期计算所提供的激励金额。使用多水平模型来研究激励措施效果的时间进程以及所提供的激励金额对依从性的影响。
随着时间的推移，干预组和对照组的依从性均有所提高，每季度平均提高4.2%（95%可信区间，2.8%-5.6%；P<.001）。尽管有这种总体提高，但干预组的依从性与对照组相比，每季度仍提高11%至14%。时间和治疗组之间没有交互作用。此外，更高的激励总额与更差的依从性相关（自抽样β=-0.11；95%自抽样可信区间，-0.20至-0.01；P=.023）。
经济激励措施对长效注射用抗精神病药物依从性的显著影响在干预的前3个月内出现，并持续1年。更高的激励总额并不会增加这种效果。
ISRCTN.com标识符：ISRCTN77769281和UKCRN.org标识符：7033。
