Incentive Payments for Attendance at Appointments for Depression Among Low-Income African Americans

Post, Edward P.; Cruz, Mario; Harman, Jeffrey S.

doi:10.1176/appi.ps.57.3.414

Cited by 36 publications

(29 citation statements)

References 11 publications

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“…Several of the studies reviewed above included incentives for treatment attendance as well as drug abstinence, with positive results (e.g., Helmus et al, 2003; Ries et al, 2004). In addition, Carey and Carey (1990) found positive effects of contingent incentives on attendance at a day treatment for SUD in 53 people with SMI, and Post et al (2006) found that incentives ($10 per appointment) increased therapy attendance and reduced appointment rescheduling among 50 people with depression during a 12-week active intervention period. Priebe et al (2009) recently described a randomized controlled trial aimed at investigating whether financial incentives contingent upon depot antipsychotic medication adherence, compared to treatment as usual, improve clinical and psychosocial functioning among non-adherent patients with psychotic disorders.…”

Section: Future Directionsmentioning

confidence: 99%

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Tidey

2012

Preventive Medicine

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Introduction Serious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed. Methods Published reports from studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity are reviewed. Results Results of this review indicate the efficacy of incentive-based treatments for reducing tobacco and other drug use among people with SMI. Few studies have examined whether incentive-based treatments improve treatment attendance, medication use and physical activity levels in people with SMI; however, initial evidence is positive and indicates that further research in these areas is warranted. Conclusion Given the medical and psychosocial costs of tobacco and other drug use, treatment non-compliance and physical inactivity, and the efficacy of incentive-based treatments for improving these behaviors, such interventions should be further developed and integrated into behavioral health treatment programs for people with SMI.

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Section: Future Directionsmentioning

confidence: 99%

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Tidey

2012

Preventive Medicine

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“…33 tested the hypothesis that attendance at a day treatment programme could be increased by offering small incentives to patients with mental illness and substance abuse and found a modest increase in attendance over time. In 2006, Post and colleagues 34 examined the attendance of 50 low-income African Americans with depression at therapy appointments without incentives for 12 weeks, followed by tracking 12 weeks during which US$10 payments were given at regular appointments. They found patients had better adherence when payments were attached to appointments.…”

Section: Financial Incentive Researchmentioning

confidence: 99%

Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial

Priebe

Bremner

Lauber³

et al. 2016

Health Technol Assess

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BackgroundPoor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence.ObjectivesTo test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives.DesignA cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months’ follow-up. The unit of randomisation was mental health teams in the community.SettingCommunity teams in secondary mental health care.ParticipantsPatients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (interventionn = 78 and controln = 63) were included.InterventionsParticipants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual.Main outcome measuresPrimary outcome: adherence to LAI medication (the percentage of received out of those prescribed). Secondary outcomes: percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians.ResultsPrimary outcome: outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%;p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33.67;p = 0.003) and subjective quality of life (difference in means 0.71, 95% CI 0.26 to 1.15;p = 0.002). Follow-ups: after incentives stopped, adherence did not differ significantly between groups, neither during the first 6 months (adjusted difference in means –7.4%, 95% CI –17.0% to 2.1%;p = 0.175) nor during the period from month 7 to month 24 (difference in means –5.7%, 95% CI –13.1% to 1.7%;p = 0.130). Cost-effectiveness: the average costs of the financial incentives was £303. Overall costs per patient were somewhat higher in the intervention group, but the difference was not significant. Semistructured interviews: the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value. These included improvement in the therapeutic relationship. The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year.ConclusionsFinancial incentives are effective in improving adherence to LAI medication. Health-care costs (including costs of the financial incentive) are unlikely to be increased substantially by this intervention. Once the incentives stop, the advantage is not maintained. The experiences of both patients and clinicians are largely, but not exclusively, positive. Whether or not financial incentives are effective for patients with more favourable background, those on oral mediation or for shorter or longer time periods remains unknown.Trial registrationCurrent Controlled Trials ISRCTN77769281.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information.

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“…Die Hepatitis b-Impfraten unter Obdachlosen konnten durch die Gewährung von $20 pro Monat (über sechs Monate hinweg) von 23% auf 69% verbessert werden, und waren daher wesentlich effektiver als traditionelle Methoden der Information und Aufklärung [26]. Post et al zeigten, dass bei afro-amerikanischen Patienten mit Depressionen die Gewäh-rung von $10 für jeden wahrgenommenen Therapietermin die Raten von 69% auf 86% verbesserten [27].…”

Section: Evidenz: Gesundheitsverbesserungunclassified

Anreize für Eigenverantwortung: Begriffsbestimmung und Evidenzlage

Schmidt

2012

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheit

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Incentive Payments for Attendance at Appointments for Depression Among Low-Income African Americans

Abstract: Incentive payments have the potential to improve appointment adherence among low-income African Americans with depression.

Cited by 36 publications

References 11 publications

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial

Anreize für Eigenverantwortung: Begriffsbestimmung und Evidenzlage

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