Abstract
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.
Highlights
A randomized controlled trial ‘Money for Medication’(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication
Clinicians were positive about using this intervention in clinical practice, and had ethical concerns that were similar to those identified by their patients
Ethical concerns were grouped on the basis of the fourprinciples approach in terms of patient autonomy, beneficence, non-maleficence and justice
Summary
A randomized controlled trial ‘Money for Medication’(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. Providing financial incentives for taking antipsychotic depot medication is an effective intervention for improving adherence [6,7,8,9], clinicians and healthcare workers have several ethical reasons for criticising the use of financial incentives among patients with severe mental illnesses. If illness or medication impairs patients’ decision-making capacities, it is unreasonable to expect them to make informed decisions about their treatment process, including the incentive [12]. This raises ethical concerns about respecting patient autonomy
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