Financial Incentives for Schizophrenia

Not yet recruiting at 4 trial locations

Overseen By Antoine Douaihy, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Stanford University

Must be taking: Antipsychotics, SUD-related

Disqualifiers: Under 18, 65 or older, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether financial rewards can help individuals with schizophrenia, schizoaffective disorder, or bipolar disorder adhere better to their medication schedules. It targets those recently discharged from involuntary hospitalization or at high risk of readmission. Participants will either receive financial incentives for taking long-acting injectable medications or continue with their usual care. Individuals hospitalized in the past year and residing in Allegheny County, PA, may qualify if treated at a participating clinic. As an unphased trial, this study offers a unique opportunity to explore innovative methods to improve medication adherence and potentially enhance quality of life.

Do I have to stop taking my current medications for this trial?

The trial does not specify if you need to stop your current medications. It focuses on adherence to long-acting injectable medications, so you may need to continue with those if prescribed.

What prior data suggests that financial incentives for medication adherence are safe?

Research has shown that offering money can help people adhere to their medication schedules, particularly for those using long-acting injectable medications. Studies have found that financial rewards significantly boost patients' motivation to take their medication as prescribed. For instance, one study discovered that 28% of patients who received financial incentives maintained a 95% adherence rate, compared to only 5% in the group without incentives. This finding indicates that using money as a motivator is both well-received and highly effective in encouraging regular medication use. Overall, financial incentives appear to be a safe and promising method to promote consistent medication adherence. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard treatments for schizophrenia, which typically involve medication adherence through patient self-management, the approach of using financial incentives for medication adherence is quite innovative. Researchers are excited about this trial because it explores whether providing financial rewards for adherence to long-acting injectable (LAI) medication can improve patient outcomes. By offering bonuses for consecutive adherence, this method taps into behavioral motivation, potentially increasing the effectiveness of standard care. This new protocol could revolutionize how we support adherence, leading to more stable patient outcomes and potentially reducing relapse rates.

What evidence suggests that financial incentives are effective for medication adherence in schizophrenia?

This trial will compare financial incentives for medication adherence with standard care. Studies have shown that offering money can help people take their antipsychotic depot (long-acting injectable) medication more regularly. Specifically, research indicates that patients who received money adhered to their medication at an average rate of 85%, compared to those who did not receive money. Another study found that financial incentives improved adherence during the early follow-up period. Overall, offering money is considered an effective way to encourage patients to take their medication as prescribed. ^{6 7 8 9 10}

Who Is on the Research Team?

Antoine Douaihy, MD

Principal Investigator

University of Pittsburgh

Valentin Bolotnyy, PhD

Principal Investigator

Stanford University

Are You a Good Fit for This Trial?

This trial is for individuals recently discharged from involuntary hospitalization or at high risk of it, who have schizophrenia, schizoaffective disorder, bipolar disorder, and/or substance use disorder. They must be prescribed long-acting injectable medications.

Inclusion Criteria

I have been diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder.

Recent (within 12 months) involuntary hospitalization or high risk of future hospitalization

Allegheny County, PA resident

Exclusion Criteria

My prescribed medication is not available in an injectable form.

I am either younger than 18 or 65 years old or older.

Having a representative payee

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Treatment

Participants receive financial incentives for adherence to long-acting injectable medications over a 12-month period

12 months

Monthly visits (in-person or virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with surveys conducted at 6 and 12 months post-study

12 months

2 follow-up surveys

What Are the Treatments Tested in This Trial?

Interventions

• Financial incentives for adherence to long-acting injectable medication

Trial Overview The study tests if giving financial rewards helps patients stick to their medication schedules after leaving the hospital. Participants are randomly placed into two groups: one gets money for taking their shots on time; the other follows usual care with monthly check-ins.

How Is the Trial Designed?

Group I: Financial Incentives for Medication Adherence Experimental Treatment 1 Intervention

Receives financial incentives for each LAI administered and increasing bonus for consecutive adherence.

Group II: Standard of Care Active Control 1 Intervention

Receives standard outpatient care and survey incentives only.

Who Is Running the Clinical Trial?

Stanford University

Lead Sponsor

Trials

2,527

Recruited

17,430,000+

University of Pittsburgh Medical Center

Collaborator

Trials

78

Recruited

77,600+

Arnold Ventures

Collaborator

Trials

3

Recruited

2,100+

Pittsburgh Mercy

Collaborator

Stanford Impact Labs

Collaborator

Federal Reserve Bank of New York

Collaborator

Trials

1

Recruited

3,000+

Allegheny County Department of Human Services

Collaborator

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK385565/

Financial incentives to improve adherence to antipsychotic ... Financial incentives have been considered for increasing adherence to medication in non-adherent patients.

2. bmj.com bmj.com/content/347/bmj.f5847

Effectiveness of financial incentives to improve adherence ... In this study, the average baseline adherence of 67% improved by only 4% in the control group.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2215036617300457

Articles Financial incentives for improving adherence to ... At 12 months, mean adherence to antipsychotic depot medication was significantly better in patients receiving financial incentives (85% [SD 15]) than in those ...

4. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1730-y

The effect of financial incentives on patients' motivation for ... Offering financial incentives is an effective intervention for improving adherence in patients taking antipsychotic depot medication.

5. mental.jmir.org mental.jmir.org/2022/10/e37184/

A Digital Intervention Using Daily Financial Incentives to ... We found that small financial incentives increased medication adherence during the initial 2 weeks of our follow-up period, yet this increase ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5968496/

The effect of financial incentives on patients' motivation for ... Offering financial incentives is an effective intervention for improving adherence in patients taking antipsychotic depot medication.

7. mentalhealth.bmj.com mentalhealth.bmj.com/content/17/2/62

Financial incentives improve adherence to maintenance ... Financial incentives improved the 95% adherence rate compared with control (28% vs 5%, OR 8.21, 95% CI 2.00 to 33.67). Financial incentives improved subjective ...

8. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0343-3

Money for medication: a randomized controlled study on the ... The primary goal of this study is to assess the effectiveness of providing financial incentives for improving adherence with antipsychotic depot ...

9. psychiatryonline.org psychiatryonline.org/ps/doi/10.1176/appi.ps.201900116

Use of Behavioral Economics to Improve Medication ... To overcome present bias, financial incentives have been implemented in a wide range of disorders as a strategy to enhance medication adherence ...

10. jmcp.org jmcp.org/doi/10.18553/jmcp.2021.27.6.772

Perceived appropriateness of medication adherence ... Of the 1,009 total survey participants, 933 (92.5%) preferred to receive a financial (eg, cash, gift card, or voucher) rather than a social ...