Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial
Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial
复制标题
DOI：
10.1136/bmj.f5847
复制
发表时间：
2013-10-07
影响因子：
105.7
通讯作者：
Burns, Tom
中科院分区：
文献类型：
--
作者：
Priebe, Stefan;Yeeles, Ksenija;Burns, Tom
目的探讨给予精神障碍患者经济奖励是否能有效提高抗精神病药物维持治疗的依从性。设计聚类随机对照试验。英国二级精神病护理中的社区精神卫生小组的设置。被诊断为精神分裂症、分裂情感性障碍或双相情感障碍的患者，他们被开了长效抗精神病药物（储备）注射，但只接受了75%或更少的处方注射。我们随机分配73个小组，共141名患者。35个干预小组的75名患者（96%随机化）和31个对照组的56名患者（89%随机化）的主要结局数据可用。干预措施干预组的参与者获得15英镑（原文如此）17；在12个月期间，每次注入储存库费用为$22)。对照组受试者接受正常治疗。主要结局指标：主要结局指标为在12个月的干预期内给予处方仓库注射剂的百分比。结果：73个小组，141名同意的患者被随机分组，131名患者（93%）的结果被评估。干预组平均基线依从性为69%，对照组为67%。在12个月的试验期间，干预组的依从性为85%，对照组为71%。调整后的效应估计为11.5%（95%置信区间为3.9% ~ 19.0%，P=0.003）。次要结局是依从性为>= 95%，干预组为28%，对照组为5%（校正优势比为8.21,95%可信区间为2.00 ~ 33.67，P=0.003）。虽然两组临床医生评定的临床改善程度差异未达到统计学意义，但干预组患者的主观生活质量评分更有利（β =0.71, 95%可信区间0.26 ~ 1.15，P=0.002）。两组住院人数和不良事件发生率均较低，且无显著差异。结论对精神障碍患者给予适度的经济激励是提高抗精神病药物维持治疗依从性的有效方法。
Objective To test whether offering financial incentives to patients with psychotic disorders is effective in improving adherence to maintenance treatment with antipsychotics.Design Cluster randomised controlled trial.Setting Community mental health teams in secondary psychiatric care in the United Kingdom.Participants Patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, who were prescribed long acting antipsychotic (depot) injections but had received 75% or less of the prescribed injections. We randomly allocated 73 teams with a total of 141 patients. Primary outcome data were available for 35 intervention teams with 75 patients (96% of randomised) and for 31 control teams with 56 patients (89% of randomised).Interventions Participants in the intervention group were offered 15 pound ((sic)17; $22) for each depot injection over a 12 month period. Participants in the control condition received treatment as usual.Main outcome measure The primary outcome was the percentage of prescribed depot injections given during the 12 month intervention period.Results 73 teams with 141 consenting patients were randomised, and outcomes were assessed for 131 patients (93%).double down arrow Average baseline adherence was 69% in the intervention group and 67% in the control group. During the 12 month trial period adherence was 85% in the intervention group and 71% in the control group. The adjusted effect estimate was 11.5% (95% confidence interval 3.9% to 19.0%, P=0.003). A secondary outcome was an adherence of >= 95%, which was achieved in 28% of the intervention group and 5% of the control group (adjusted odds ratio 8.21, 95% confidence interval 2.00 to 33.67, P=0.003). Although differences in clinician rated clinical improvement between the groups failed to reach statistical significance, patients in the intervention group had more favourable subjective quality of life ratings (beta=0.71, 95% confidence interval 0.26 to 1.15, P=0.002). The number of admissions to hospital and adverse events were low in both groups and did not show substantial differences.Conclusion Offering modest financial incentives to patients with psychotic disorders is an effective method for improving adherence to maintenance treatment with antipsychotics.