Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
Pinnacle Midlands Health Network, Norris Ward McKinnon House, 711 Victoria Street, Hamilton, 3240, New Zealand.
BMC Public Health. 2019 Apr 5;19(1):385. doi: 10.1186/s12889-019-6695-3.
Acute rheumatic fever in New Zealand persists and is a barometer of equity as its burden almost exclusively falls on Māori and Pacific Island populations. The primary objective of this study is to determine whether an incentive programme will result in increased secondary prophylaxis injections over a one-year period compared to a baseline period prior to the intervention.
The evaluation used a multiple baseline study to determine whether an incentive consisting of a mobile phone and monthly "top-up" (for data/calls) resulted in increased injections, increased texts/calls with nurses, reduced number of visits to get a successful injection, less medicine wasted, and increased nurse satisfaction. Participants were 77 young people (aged 14-21) on an acute rheumatic fever registry in Waikato region, New Zealand classified as either fully adherent (all injections received and no more than one late) or partially adherent based on injections at baseline.
There was a sharp increase in injections for intermittent patients post-intervention and then a slight decrease overtime, while fully adherent patients maintained their high rate of injections (p = .003). A similar pattern for nurse satisfaction emerged (p = .001). The number of calls/texts increased for all patients (p = .003). The number of visits went down for partially adherent patients and up for fully adherent patients (p = .012). The overall incremental cost-effectiveness was $989 per extra successful injection although costs increased sharply toward the end of the intervention.
Incentivising secondary prophylaxis appears to have a strong impact for partially adherent patients, particularly during the early periods following the initiation of the intervention. Enhancing communication with patients who returned to care may result in more sustainable adherence.
Retrospectively registered: Australia New Zealand Clinical Trials Registry ACTRN12618001150235 , 12 July 2018.
新西兰的急性风湿热仍在持续，它是公平的晴雨表，因为其负担几乎完全落在毛利人和太平洋岛民身上。本研究的主要目的是确定在干预前的基线期之后的一年中，激励计划是否会导致继发性预防注射增加。
该评估使用多基线研究来确定激励措施（包括手机和每月“充值”（用于数据/电话））是否会增加注射次数、增加与护士的短信/电话次数、减少获得成功注射的就诊次数、减少浪费的药物量并提高护士满意度。参与者是新西兰怀卡托地区急性风湿热登记处的 77 名年轻人（年龄在 14-21 岁之间），根据基线时的注射情况，他们被归类为完全依从者（所有注射均已接受，且最多延迟一次）或部分依从者。
干预后间歇性患者的注射量急剧增加，然后随着时间的推移略有下降，而完全依从者保持了高注射率（p=0.003）。护士满意度也出现了类似的模式（p=0.001）。所有患者的电话/短信数量均增加（p=0.003）。部分依从者的就诊次数减少，完全依从者的就诊次数增加（p=0.012）。每增加一次成功注射的增量成本效益为 989 美元，尽管成本在干预后期急剧上升。
为继发性预防提供激励措施似乎对部分依从者有很大的影响，特别是在干预开始后的早期阶段。加强与重新接受治疗的患者的沟通可能会导致更可持续的依从性。
回顾性注册：澳大利亚新西兰临床试验注册 ACTRN12618001150235 ，2018 年 7 月 12 日。
