Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (Money for Medication): a multicentre, open-label, randomised controlled trial
Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (Money for Medication): a multicentre, open-label, randomised controlled trial
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DOI：
10.1016/s2215-0366(17)30045-7
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发表时间：
2017-03-01
影响因子：
64.3
通讯作者：
Mulder, Cornelis L.
中科院分区：
文献类型：
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作者：
Noordraven, Ernst L.;Wierdsma, Andre I.;Mulder, Cornelis L.
背景 提供经济激励是提高服用抗精神病药物患者依从性的一种有前途的干预措施。我们的目的是评估这种干预措施对于提高精神障碍患者抗精神病药物长效药物依从性的有效性，无论他们以前的依从性如何。方法我们在荷兰二级精神病护理服务的三个精神卫生保健机构中进行了这项多中心、开放标签、随机对照试验。符合条件的患者年龄在 18-65 岁，已被诊断患有精神分裂症或其他精神障碍，已服用抗精神病长效药物或有开始使用长效药物的指征，并且正在参加门诊治疗。患者被随机分配（1:1），通过计算机生成的随机分组，分组大小为 4，接受 12 个月的照常治疗，加上每个收到的药物库的经济奖励（（原文如此）如果完全合规，每月 30 粒；干预组）或照常单独治疗（对照组）。随机分组按治疗部位和可疑预后因素进行分层：性别、共病物质使用障碍（不存在与存在）以及基线前 4 个月内抗精神病药物的依从性 (= 50%)。患者、临床医生、访谈者和研究助理在分组之前而不是之后不知道分组分配情况。主要结果是药物拥有率（MPR），定义为在 12 个月的干预期内收到的抗精神病药物储存库数量除以所开抗精神病药物储存库总数。患者接受了 6 个月的随访，在此期间，服用抗精神病药物并没有给予金钱奖励。我们按意向治疗进行了分析。该试验已在荷兰试验登记处注册，编号 NTR2350。 结果 2010 年 5 月 21 日至 2014 年 10 月 15 日期间，我们将 169 名患者随机分配至干预组 (n=84) 或对照组 (n=85)。 155 名 (92%) 患者的主要结果数据可用。基线时，干预组的平均 MPR 为 76.0% (SD 28.2%)，而对照组为 77.9% (28.5%)。 12 个月时，干预组的平均 MPR (94.3% [SD 11.3%]) 高于对照组 (80.3% [19.1%])，调整后的差异为 14.9% (95% CI 8.9-20.9%；p
Background Provision of financial incentives is a promising intervention for improving adherence in patients taking antipsychotic medication. We aimed to assess the effectiveness of this intervention for improving adherence to antipsychotic depot medication in patients with psychotic disorders, irrespective of their previous compliance.Methods We did this multicentre, open-label, randomised controlled trial at three mental health-care institutions in secondary psychiatric care services in the Netherlands. Eligible patients were aged 18-65 years, had been diagnosed with schizophrenia or another psychotic disorder, had been prescribed antipsychotic depot medication or had an indication to start using depot medication, and were participating in outpatient treatment. Patients were randomly assigned (1: 1), via computer-generated randomisation with a block size of four, to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received ((sic)30 per month if fully compliant; intervention group) or treatment as usual alone (control group). Randomisation was stratified by treatment site and suspected prognostic factors: sex, comorbid substance-use disorder (absent vs present), and compliance with antipsychotic medication in the 4 months before baseline (= 50%). Patients, clinicians, interviewers, and research assistants were masked to group allocation before, but not after, group assignment. The primary outcome was the Medication Possession Ratio (MPR), defined as the number of depots of antipsychotic medication received divided by the total number of depots of antipsychotic medication prescribed during the 12 month intervention period. Patients were followed up for 6 months, during which time no monetary rewards were offered for taking antipsychotic medication. We did analysis by intention to treat. This trial is registered with the Nederlands Trial Register, number NTR2350.Findings Between May 21, 2010, and Oct 15, 2014, we randomly assigned 169 patients to the intervention group (n=84) or the control group (n=85). Primary outcome data were available for 155 (92%) patients. At baseline, the mean MPR was 76.0% (SD 28.2%) in the intervention group versus 77.9% (28.5%) in the control group. At 12 months, the mean MPR was higher in the intervention group (94.3% [SD 11.3%]) than in the control group (80.3% [19.1%]), with an adjusted difference of 14.9% (95% CI 8.9-20.9%; p