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Open Access Study protocol

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

Stefan Priebe1*, Alexandra Burton1, Deborah Ashby2, Richard Ashcroft3, Tom Burns4, Anthony David5, Sandra Eldridge6, Mike Firn7, Martin Knapp8 and Rose McCabe1

Author Affiliations

1 Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK

2 Division of Epidemiology, Public Health and Primary Care, Department of Epidemiology and Public Health, Imperial College London, Norfolk Place, St Mary's Campus, London, W2 1PG, UK

3 School of Law, Queen Mary University of London, Mile End, London, E1 4NS, UK

4 Department of Psychiatry, University of Oxford, University Department of Psychiatry, Warneford Hospital, Headington, Oxford, OX3 7JX, UK

5 Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College London, Denmark Hill, London, SE5 8AF, UK

6 Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Abernethy Building, 2 Newark Street, London, E1 2AT, UK

7 South West London & St George's Mental Health NHS Trust, Springfield University Hospital, 61 Glenburnie Road London, SW17 7DJ, UK

8 Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK

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BMC Psychiatry 2009, 9:61  doi:10.1186/1471-244X-9-61

Published: 28 September 2009

Abstract

Background

Various interventions have been tested to achieve adherence to anti-psychotic maintenance medication in non-adherent patients with psychotic disorders, and there is no consistent evidence for the effectiveness of any established intervention. The effectiveness of financial incentives in improving adherence to a range of treatments has been demonstrated; no randomised controlled trial however has tested the use of financial incentives to achieve medication adherence for patients with psychotic disorders living in the community.

Methods/Design

In a cluster randomised controlled trial, 34 mental health teams caring for difficult to engage patients in the community will be randomly allocated to either the intervention group, where patients will be offered a financial incentive for each anti-psychotic depot medication they receive over a 12 month period, or the control group, where all patients will receive treatment as usual. We will recruit 136 patients with psychotic disorders who use these services and who have problems adhering to antipsychotic depot medication, although all conventional methods to achieve adherence have been tried. The primary outcome will be adherence levels, and secondary outcomes are global clinical improvement, number of voluntary and involuntary hospital admissions, number of attempted and completed suicides, incidents of physical violence, number of police arrests, number of days spent in work/training/education, subjective quality of life and satisfaction with medication. We will also establish the cost effectiveness of offering financial incentives.

Discussion

The study aims to provide new evidence on the effectiveness and cost effectiveness of offering financial incentives to patients with psychotic disorders to adhere to antipsychotic maintenance medication. If financial incentives improve adherence and lead to better health and social outcomes, they may be recommended as one option to improve the treatment of non-adherent patients with psychotic disorders.

Trial Registration

Current controlled trials ISRCTN77769281.