Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients’ and clinicians’ perspectives after a 12-month randomized controlled trial

BMC Psychiatry

Research Article

Maartje H. N. Schermer¹  André I. Wierdsma¹  Cornelis L. Mulder²  Ernst L. Noordraven³  Peter Blanken⁴ 

[1] Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, 3015CE, Rotterdam, The Netherlands;Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, 3015CE, Rotterdam, The Netherlands;Bavo-Europoort Mental Health Care, 3066 TA, Rotterdam, The Netherlands;Dual Diagnosis Center (CDP) Palier, Parnassia Psychiatric Institute, 2552 KS, The Hague, The Netherlands;Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, 3015CE, Rotterdam, The Netherlands;Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Psychiatric Institute, 2553 RJ, The Hague, The Netherlands;

关键词: Schizophrenia;    Ethics;    Financial incentives;    Antipsychotic depot medication;   

DOI  :  10.1186/s12888-017-1485-x

 received in 2017-05-22, accepted in 2017-08-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundA 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.MethodsThree 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.ResultsPatients (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.ConclusionsOverall, 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 registrationNederlands Trial Register, number NTR2350.

【 授权许可】

CC BY   
© The Author(s). 2017