Telephone delivered incentives for encouraging adherence to supervised methadone (TIES): development and feasibility study
Background: The majority of people in treatment for their addiction to heroin are prescribed methadone for which there is an extensive evidence base. In England, at the start of treatment, individuals take their daily dose of methadone under supervision at a community pharmacy. There is a network of community pharmacists in England who dispense methadone and supervise its consumption. Supervision guarantees methadone is taken as directed by the individual for whom it has been prescribed; and helps to ensure individuals take their correct dose every day to ensure they experience little or no withdrawal or craving. Moreover, supervision safeguards against diversion and overdose. However, individuals often fail to attend the pharmacy to take their methadone. Each missed dose is of concern. We need to develop effective interventions for medication adherence. Contingency management (CM) is a behavioural intervention based on the principles of operant conditioning; it uses positive reinforcement (verbal praise and small financial incentives) to encourage positive behaviour change. There is a growing evidence base for its effectiveness and it has been recommended to encourage medication adherence. Provision of CM requires time and organisational systems which can be challenging in pharmacies. We believe CM delivered by technology could encourage medication adherence among individuals receiving OST, could be resource light and cost effective and maintained as long as treatment needed and delivered remotely in low resource settings. This study aimed to develop a telephone text-message system for delivering incentives and assessing the feasibility of conducting a future randomised controlled trial (RCT) of the clinical and cost-effectiveness of telephone-delivered incentives.
Methods: We have developed the technology to deliver incentives by mobile telephone to encourage individuals to attend their pharmacy every day to consume their methadone under supervision. A mobile telephone automated text-message system reminds individuals of their appointments, or rewards them when they attend. Software monitors all individuals and their supervised methadone consumption through an internet login at the pharmacy and contacts individuals via mobile telephone text-message. A linked system sends reports of their attendance and consumption of methadone to their prescriber /keyworker and early warning of missed doses. The feasibility of conducting a future RCT of the clinical and cost effectiveness of telephone delivered incentives was undertaken. The study design was a cluster RCT. Three drug services (each with two/three local community pharmacies supervising methadone consumption to 20 individuals) were allocated to i.) telephone text message incentives (including small financial incentives), ii.) Telephone text message reminders or iii.) no telephone text messages. Acceptability, recruitment, follow-up, and suitable measures of clinical and cost effectiveness were be assessed.
Results: Acceptability, recruitment, follow-up, and suitable measures of clinical and cost effectiveness were assessed. Outcomes will be assessed against progression criteria.
Conclusions/Discussion: The feasibility and best operational practices of a future confirmatory cluster trial will be reported.