441 research outputs found
Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: Patients' and clinicians' perspectives after a 12-month randomized controlled trial
Background: A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in this trial. Methods: Three mental healthcare institutions in secondary psychiatric care in the Netherlands participated in this study. Patients (n = 169), 18-65 years, diagnosed with schizophrenia, schizoaffective disorder or another psychotic disorder who had been prescribed antipsychotic depot medication, were randomly assigned to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (intervention group) or treatment as usual alone (control group). Structured questionnaires were administered after the 12-month intervention period. Data were available for 133 patients (69 control and 64 intervention) and for 97 clinicians. Results: Patients (88%) and clinicians (81%) indicated that financial incentives were a good approach to improve medication adherence. Ethical concerns were categorized according to the four-principles approach (autonomy, beneficence, non-maleficence, and justice). Patients and clinicians alike mentioned various advantages of M4M in clinical practice, such as increased medication adherence and improved illness insight; but also disadvantages such as reduced intrinsic motivation, loss of autonomy and feelings of dependence. Conclusions: Overall, patients evaluated financial incentives as an effective method of improving medication adherence and were willing to accept this reward during clinical treatment. Clinicians were also positive about the use of this intervention in daily practice. Ethical concerns are discussed in terms of patient autonomy, beneficence, non-maleficence and justice. We conclude that this intervention is ethically acceptable under certain conditions, and that further research is necessary to clarify issues of benefit, motivation and the preferred size and duration of the incentive. Trial registration: Nederlands Trial Register, number NTR2350
Depot-medication compliance for patients with psychotic disorders: The importance of illness insight and treatment motivation
Background: Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Methods: Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Results: Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Conclusion: Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discusse
Hyperelliptic Theta-Functions and Spectral Methods: KdV and KP solutions
This is the second in a series of papers on the numerical treatment of
hyperelliptic theta-functions with spectral methods. A code for the numerical
evaluation of solutions to the Ernst equation on hyperelliptic surfaces of
genus 2 is extended to arbitrary genus and general position of the branch
points. The use of spectral approximations allows for an efficient calculation
of all characteristic quantities of the Riemann surface with high precision
even in almost degenerate situations as in the solitonic limit where the branch
points coincide pairwise. As an example we consider hyperelliptic solutions to
the Kadomtsev-Petviashvili and the Korteweg-de Vries equation. Tests of the
numerics using identities for periods on the Riemann surface and the
differential equations are performed. It is shown that an accuracy of the order
of machine precision can be achieved.Comment: 16 pages, 8 figure
Money for medication
Background: Non-adherence with antipsychotic medication is a frequently occurring problem, particularly among
patients with psychotic disorders. Prior research has generally shown encouraging results for interventions based on
‘Contingency Management’ (CM), in which desirable behaviour is encouraged by providing rewards contingent
upon the behaviour. However, little is known about the application of CM on medication adherence in patients
with psychotic disorders. An earlier pilot-study by our study group showed promising results in reducing admission
days and increasing adherence. The current study is a randomized controlled trial concerning the effectiveness of a
CM procedure called ‘Money for Medication’ (M4M), aimed at improving adherence with antipsychotic depot medication
in psychotic disorder patients.
Methods/Design: Outpatients (n =168) with a psychotic disorder will be randomly assigned to either the experimental
group (n =84), receiving a financial reward for each accepted antipsychotic medication depot, or the control group
(n =84), receiving treatment as usual without financial rewards. Patients are included regardless of their previous
adherence. The intervention has a duration of twelve months. During the subsequent six months follow-up, the effects
of discontinuing the intervention on depot acceptance will be assessed.
The primary goal of this study is to assess the effectiveness of providing financial incentives for improving adherence
with antipsychotic depot medication (during and after the intervention). The primary outcome measure is the
percentage of accepted depots in comparison to prescription. Secondary, we will consider alternative measures of
medication acceptance, i.e. the longest period of uninterrupted depot acceptance and the time expired before depot is
taken. Additionally, the effectivene
Medical and social costs after using financial incentives to improve medication adherence: Results of a 1 year randomised controlled trial NTR2350 NTR
Objective: Offering a financial incentive ('Money for Medication') is effective in improving adherence to treatment with depot antipsychotic medications. We investigated the cost-effectiveness in terms of medical costs and judicial expenses of using financial incentives to improve adherence. The effects of financial incentives on depot medication adherence were evaluated in a randomised controlled trial. Patients in the intervention group received €30 a month over 12 months if antipsychotic depot medication was accepted. The control group received mental health care as usual. For 133 patients outcomes were calculated based on self-reported service use and delinquent behaviour and expressed as standard unit costs to value resource use. Results: The financial incentive resulted in higher average costs related to mental health care (€449.6 versus €355.7). and lower medical costs related to other healthcare services (€52.0 versus €78.4). Relevant differences in social costs related to delinquent behaviour were not found. Although wide confidence intervals indicate uncertainty, incremental cost-effectiveness ratio's (ICER) indicate that it costs €2080 for achieving a 20% increase in adherence or €3332 for achieving over 80% adherence. In sum, offering money as financial incentive for increasing compliance did not lead to an overall cost reduction as compared to care as usual. Trial registration NTR2350, 01 June 201
- …