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. 2022 Jun 15;12(6):e059526.
doi: 10.1136/bmjopen-2021-059526.

Can incentives improve antipsychotic adherence in major mental illness? A mixed-methods systematic review

Nathan Hodson  1 , Madiha Majid  2 , Ivo Vlaev  3 , Swaran Preet Singh  2
Affiliations

Can incentives improve antipsychotic adherence in major mental illness? A mixed-methods systematic review

Nathan Hodson et al. BMJ Open. .

Abstract

Objectives: Incentives have been effectively used in several healthcare contexts. This systematic review aimed to ascertain whether incentives can improve antipsychotic adherence, what ethical and practical issues arise and whether existing evidence resolves these issues.

Design: Systematic review of MEDLINE, EMBASE and PsycINFO. Searches on 13 January 2021 (no start date) found papers on incentives for antipsychotics. Randomised controlled trials (RCTs), cohort studies, qualitative research and ethical analyses were included. Papers measuring impact on adherence were synthesised, then a typology of ethical and policy issues was compiled, finally the empirical literature was compared with this typology to describe current evidence and identify remaining research questions.

Results: 26 papers were included. 2 RCTs used contingent financial incentives for long-acting injectable antipsychotic preparations. Over 12 months, there were significantly larger increases in adherence among the intervention groups versus control groups in both RCTs. There were no consistently positive secondary outcomes. 39 ethical and practical issues were identified. 12 of these are amenable to empirical study but have not been researched and for 7 the current evidence is mixed.

Conclusions: In keeping with other areas of healthcare, antipsychotic adherence can be increased with financial incentives. Payments of 2.5 times minimum wage changed behaviour. The typology of issues reported in this systematic review provides a template for future policy and ethical analysis. The persistence of the effect and the impact of incentives on intrinsic motivation require further research.

Prospero registration number: CRD42020222702.

Keywords: adult psychiatry; ethics (see Medical Ethics); health policy; mental health; schizophrenia & psychotic disorders.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

References

    1. García S, Martínez-Cengotitabengoa M, López-Zurbano S, et al. . Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review. J Clin Psychopharmacol 2016;36:355–71. 10.1097/JCP.0000000000000523 - DOI - PMC - PubMed
    1. Velligan DI, Sajatovic M, Hatch A, et al. . Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness. Patient Prefer Adherence 2017;11:449–68. 10.2147/PPA.S124658 - DOI - PMC - PubMed
    1. Montes JM, Medina E, Gomez-Beneyto M, et al. . A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia. Psychiatry Res 2012;200:89–95. 10.1016/j.psychres.2012.07.034 - DOI - PubMed
    1. Priebe S, Yeeles K, Bremner S, et al. . Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ 2013;347:f5847. 10.1136/bmj.f5847 - DOI - PMC - PubMed
    1. Kirson NY, Weiden PJ, Yermakov S, et al. . Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiatry 2013;74:568–75. 10.4088/JCP.12r08167 - DOI - PubMed

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