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Financial incentives to improve adherence to anti-psychotic maintenance medication in non-adherent patients a cluster randomised controlled trial - FIAT Study

Centre for Psychiatry

Funding Body: National Institute for Health Research (Ref: HTA 07/60/43)
Project Investigator: Stefan Priebe

Overview

Whilst financial incentives have effectively been used to improve adherence to a range of treatments, it had not been assessed whether financial incentives can improve adherence to anti-psychotic medication in patients with psychotic disorders.
FIAT is a multi-centre randomised controlled trial examining the effectiveness and cost-effectiveness of financial incentives on adherence to anti-psychotic maintenance medication in patients with severe mental illness [1]

Activities & Outputs

The acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness was initially investigated through a focus group study [2].
Participants with adherence to prescribed depot medication lower than 75% were recruited from community mental health teams (CMHTs) and assertive outreach teams (AOTs) in England and Wales.
Teams were randomly allocated to either the intervention condition in which participating patients received financial incentives of £15 for each depot medication taken, or the control condition, in which patients continued with treatment as usual and did not received anything. The type, frequency or changes to depot medication were unaffected by the intervention.
The main outcome of the trial was the adherence to depot medication [3].

We found that providing financial incentives had significant effect on adherence rates: whilst in the control group adherence remained unchanged (baseline adherence 67%, adherence at the end of intervention 71%), in the intervention group the adherence increased from 69% to 85% that is by more than a half of the possible improvement. This is an effect greater than any other intervention aimed at adherence to treatment improvement, such as compliance therapy, family therapy, or psychoeducation, has shown so far.
The study has also investigated whether improved adherence is associated with changes in clinical outcomes [3].
The number of hospitalizations and untoward events were low in both groups limiting the power of the study to detect any differences. Clinicians’ ratings of clinical improvement were higher in the intervention group, although the effect was not statistically significant. Importantly, patients in the intervention group rated their subjective quality of life significantly higher than patients in the control group.

Currently, FIAT is in its final stages exploring patients’, as well as clinicians’, opinions and experiences with the financial incentives in the follow-up stage. In addition, whether and how adherence and other outcomes changed after the financial incentives had stopped will be examined.

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