Noordraven Ernst L, Schermer Maartje H N, Blanken Peter, Mulder Cornelis L, Wierdsma André I
Dual Diagnosis Center (CDP) Palier, Parnassia Psychiatric Institute, 2552 KS, The Hague, The Netherlands.
Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, 3015CE, Rotterdam, The Netherlands.
BMC Psychiatry. 2017 Aug 29;17(1):313. doi: 10.1186/s12888-017-1485-x.
A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in this trial.
Three mental healthcare institutions in secondary psychiatric care in the Netherlands participated in this study. Patients (n = 169), 18-65 years, diagnosed with schizophrenia, schizoaffective disorder or another psychotic disorder who had been prescribed antipsychotic depot medication, were randomly assigned to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (intervention group) or treatment as usual alone (control group). Structured questionnaires were administered after the 12-month intervention period. Data were available for 133 patients (69 control and 64 intervention) and for 97 clinicians.
Patients (88%) and clinicians (81%) indicated that financial incentives were a good approach to improve medication adherence. Ethical concerns were categorized according to the four-principles approach (autonomy, beneficence, non-maleficence, and justice). Patients and clinicians alike mentioned various advantages of M4M in clinical practice, such as increased medication adherence and improved illness insight; but also disadvantages such as reduced intrinsic motivation, loss of autonomy and feelings of dependence.
Overall, patients evaluated financial incentives as an effective method of improving medication adherence and were willing to accept this reward during clinical treatment. Clinicians were also positive about the use of this intervention in daily practice. Ethical concerns are discussed in terms of patient autonomy, beneficence, non-maleficence and justice. We conclude that this intervention is ethically acceptable under certain conditions, and that further research is necessary to clarify issues of benefit, motivation and the preferred size and duration of the incentive.
Nederlands Trial Register, number NTR2350 .
开展了一项名为“药物换金钱”（M4M）的随机对照试验，该试验为服用抗精神病长效针剂的患者提供经济激励。本研究评估了参与该试验的患者和临床医生的态度及伦理考量。
荷兰三家二级精神科护理机构参与了本研究。年龄在18至65岁、被诊断为精神分裂症、分裂情感性障碍或其他精神病性障碍且已被开具抗精神病长效针剂的患者（n = 169）被随机分配，分别接受为期12个月的常规治疗加每接受一针长效针剂给予经济奖励（干预组）或仅接受常规治疗（对照组）。在12个月的干预期结束后进行结构化问卷调查。获取了133名患者（69名对照组和64名干预组）以及97名临床医生的数据。
患者（88%）和临床医生（81%）表示经济激励是提高药物依从性的好方法。伦理问题根据四原则法（自主性、 beneficence、不伤害和公正）进行分类。患者和临床医生都提到了M4M在临床实践中的各种优点，如药物依从性增加和疾病洞察力改善；但也提到了缺点，如内在动机降低、自主性丧失和依赖感。
总体而言，患者将经济激励评估为提高药物依从性的有效方法，并愿意在临床治疗期间接受这种奖励。临床医生对在日常实践中使用这种干预措施也持积极态度。从患者自主性、 beneficence、不伤害和公正方面讨论了伦理问题。我们得出结论，在某些条件下这种干预在伦理上是可接受的，并且有必要进行进一步研究以阐明益处、动机以及激励的最佳规模和持续时间等问题。
荷兰试验注册中心，编号NTR2350 。
