Can Financial Incentives Improve Medication Adherence and Patient Outcomes After Involuntary Hospitalization?

Stanford University

Summary

This study is a randomized controlled trial evaluating the impact of financial incentives on medication adherence among individuals with schizophrenia, schizoaffective disorder, or bipolar disorder and/or co-occurring substance use disorder who are recently discharged from involuntary hospitalization or are at high risk of future involuntary hospitalization. Participants will be randomized to receive financial incentives for adherence to long-acting injectable medications or to a control group.

Description

The investigators seek to understand the effectiveness of financial incentives at reducing medication non-adherence and costly involuntary hospitalizations for individuals with acute mental health needs. The focus will be on patients diagnosed with schizophrenia, schizoaffective disorder, and/or bipolar disorder who have recent experiences with involuntary hospitalization and possibly a co-occurring substance use disorder. This population has been documented to have particularly high healthcare expenditures and mortality, as well as incidence of criminal charges. Partnering with UPMC Western P…

Eligibility

Age range: 18–65 years
Sex: All
Healthy volunteers: No

Detailed criteria

Inclusion Criteria: * Diagnosis of schizophrenia, schizoaffective disorder, and/or bipolar disorder * Recent (within 12 months) involuntary hospitalization or high risk of future hospitalization * Eligible for medication (antipsychotic or SUD-related) with an LAI formulation * Allegheny County, PA resident * Receiving or assigned to treatment at clinics participating in this study Exclusion Criteria: * Lack of injectable formulation for prescribed medication * Aged under 18 or 65 or older

Interventions

Behavioral
Financial incentives for adherence to long-acting injectable medication
This intervention is a randomized controlled trial where patients in the treatment group are offered financial incentives for taking long-acting injectable (LAI) versions of the antipsychotic and substance use disorder medications they need and the control group receives the status quo standard of care.
Behavioral
Standard of care with monthly surveys
Receives standard outpatient care and incentives for completing monthly surveys.

Compensation

Estimated

~$10 – $750

Arctuva estimate

Actual pay is set by the research site.

Screening fee: $25
Completion bonus: $25

Everyone enrolling will receive a debit card preloaded with $25. Like those in the treatment group, those in the control group will be eligible to receive $10 for each monthly survey they complete, with the money being deposited to their debit card. If randomly selected into the treatment group, individuals will receive a base reward of $2 for each day of LAI duration to treat schizophrenia, schizoaffective disorder, bipolar disorder, or substance use disorder. For example, if they receive two consecutive 4-week antipsychotic LAIs in a row, they will receive $2\*28 days + $0.25\*28 days = $63 the first time and $2\*28 + $0.25\*56 days = $70 the second time. Missing a scheduled LAI will result in no reward and the next LAI being rewarded again at the base payment of $2 per day, bringing the bonus reward streak down to 0 days. At the end of the study, treated individuals will be able to receive a $25 reward for signing a pledge to continue with their treatment plan even after the rewards in this study are no longer offered. The maximum amount that an individual receiving an LAI every 4 weeks (the most common duration) can receive over the course of the 12-month study is $1,218 for injections + $25 for enrollment + $25 for pledge at completion + $10\*12 completed surveys = $1,388. If an individual has co-occurring substance use disorder and takes up an LAI every 4 weeks for that as well, they can receive $1,218 x 2 = $2,436 for injections over the course of the year. The largest possible incentive received in a day for someone taking up an LAI every 4 weeks would be $140 at their 12th consecutive injection ($280 for someone who also receives their 12th consecutive LAI for substance use disorder).

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Details

NCT ID: NCT07130500
Type: Behavioral
Last updated: 3/27/2026

Conditions

Schizophrenia Disorder Schizoaffective Disorder Bipolar Disorder (BD)Substance Use Disorder (SUD)

Summary

Description

Eligibility

Interventions

Locations (5)