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PubMed2004

Abstinence incentive effects in a short-term outpatient detoxification program.

Despite being widely available, outpatient detoxification has limited efficacy as a stand-alone treatment. This study examined whether abstinence-contingent incentives would improve outcomes for patients entering outpatient opiate detoxification. Participants (N = 211) received a 100 US dollars voucher on the last day of detoxification either contingent on opiate and cocaine abstinence or noncontingently. Urine samples were collected at intake, on Wednesday, Friday (the last day of detoxification), and the following Monday. Among contingent-voucher participants, 31% were drug-free on Friday compared with 18% of noncontingent controls (Z = 2.4, p < .05). Few (12-13%) participants tested negative on Monday. Results support the ability of vouchers to produce modest improvements in abstinence initiation rates during brief detoxification but suggest that additional interventions are needed to sustain improvements.

Adult↗
PubMed2003

Academic incentives for faculty participation in community-based participatory research.

Recognizing the need to overcome the obstacles of traditional university- and discipline-oriented research approaches, a variety of incentives to promote community-based participatory research (CBPR) are presented. Experiences of existing CBPR researchers are used in outlining how this methodological approach can appeal to faculty: the common ground shared by faculty and community leaders in challenging the status quo; opportunities to have an impact on local, regional, and national policy; and opening doors for new research and funding opportunities. Strategies for promoting CBPR in universities are provided in getting CBPR started, changing institutional practices currently inhibiting CBPR, and institutionalizing CBPR. Among the specific strategies are: development of faculty research networks; team approaches to CBPR; mentoring faculty and students; using existing national CBPR networks; modifying tenure and promotion guidelines; development of appropriate measures of CBPR scholarship; earmarking university resources to support CBPR; using Institutional Review Boards to promote CBPR; making CBPR-oriented faculty appointments; and creating CBPR centers.

Community Health Planning↗
PubMed2003

The effect of incentive-based formularies on prescription-drug utilization and spending.

BACKGROUND: Many employers and health plans have adopted incentive-based formularies in an attempt to control prescription-drug costs. METHODS: We used claims data to compare the utilization of and spending on drugs in two employer-sponsored health plans that implemented changes in formulary administration with those in comparison groups of enrollees covered by the same insurers. One plan simultaneously switched from a one-tier to a three-tier formulary and increased all enrollee copayments for medications. The second switched from a two-tier to a three-tier formulary, changing only the copayments for tier-3 drugs. We examined the utilization of angiotensin-converting-enzyme (ACE) inhibitors, proton-pump inhibitors, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). RESULTS: Enrollees covered by the employer that implemented more dramatic changes experienced slower growth than the comparison group in the probability of the use of a drug and a major shift in spending from the plan to the enrollee. Among the enrollees who were initially taking tier-3 statins, more enrollees in the intervention group than in the comparison group switched to tier-1 or tier-2 medications (49 percent vs. 17 percent, P<0.001) or stopped taking statins entirely (21 percent vs. 11 percent, P=0.04). Patterns were similar for ACE inhibitors and proton-pump inhibitors. The enrollees covered by the employer that implemented more moderate changes were more likely than the comparison enrollees to switch to tier-1 or tier-2 medications but not to stop taking a given class of medications altogether. CONCLUSIONS: Different changes in formulary administration may have dramatically different effects on utilization and spending and may in some instances lead enrollees to discontinue therapy. The associated changes in copayments can substantially alter out-of-pocket spending by enrollees, the continuation of the use of medications, and possibly the quality of care.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

Impact of private health insurance incentives on obstetric outcomes in NSW hospitals.

The purpose of this study is to analyse the impact of changes in Australian private health insurance coverage as seen in NSW public and private hospital birth profies, and identify trends in obstetric outcomes from 1997-2001. NSW Midwives Data Collection unit record data is analysed for women who gave birth to a live singleton baby of term gestation (> or = 37 weeks) and cephalic presentation in NSW hospitals during 1997- 2001. Use of private hospitals for childbirth has increased in conjunction with increases in private health insurance coverage. Although some obstetric interventions have increased for both public and private hospitals over time, clinical factors do not explain the large differences in birth interventions and outcomes between NSW public and private hospitals. Incentives to increase private health insurance coverage appear to be having a negative impact on childbirth, in terms of higher birth intervention and operative birth rates in NSW private hospitals.

Anesthesia, Obstetrical↗
PubMed2005

Finding the common ground: where health and educational agendas meet--the School Health Incentive Program (SHIP) grants scheme.

ISSUE ADDRESSED: This paper investigates a school health promotion grants scheme as a strategy for increasing opportunities and support for schools to undertake a whole-school approach to health issues of their choice. METHOD: The School Health Incentive Program (SHIP) is an ongoing initiative offering annual grants and tailored support from health and education professionals. SHIP commenced in 2000 in the former South Eastern Sydney Area Health Service (SESAHS), New South Wales. It is a partnership between the Health Promotion Service (HPS), the three education sectors, parent groups, other health services and The Cancer Council NSW. RESULTS: Over the period 2000-04 SHIP awarded 103 grants to 71 schools from SESAHS, representing about 32,000 students. Average grant funding per student reached was $2.50. Schools used the Health Promoting Schools framework to plan and implement their health activities. Results included positive outcomes in the areas of curriculum planning, policy and procedure development, changes to physical and social environments and the development of partnerships between the school and the health sector, other organisations, parents and other schools. CONCLUSIONS: SHIP developed partnerships between health, education sectors and schools, encouraged schools to adopt a whole-school approach to health issues, and supported the development of subsequent health-focused initiatives.

Health Policy↗
PubMed1978

Negative and positive incentive contrast effects with saccharine versus sucrose.

Forty male white rats received 19 sessions of bar press training with sucrose (16% or 4%) as reward followed by a shift from 4% to 16% and from 16% to 4%. Three dependent measures indicated positive and negative contrast effects. In Experiment II, 70 male white rats received 14 sessions of bar press training with (1.2%, 1%, .10%, or .01%) saccharine, and water followed by a shift from 1.2% to .10%, 1.2% to .01%, 1 to .1%, and .10% to .01%. Three of the four measures indicated negative contrast effects. In Experiment III, 40 male white rats experienced 16 sessions of bar press training with 1%, .10%, .05%, or .01% of saccharine followed by an increase from .1%, to 1%, .05% to 1%, and .01% to 1%. Three of the measures indicated positive contrast effects. Confounding inherent in the use of solid food or sucrose did not appear to account for negative and positive incentive contrast effects.

Animals↗
PubMed1983

Saccharin hoarding by albino rats: further evidence on incentive and object retrieval.

Albino rats were allowed to retrieve dental pledgets soaked in water or pledgets soaked in 1.0% saccharin solution from wooden alleys into their home cages. Under ad lib conditions more saccharin pledgets were hoarded than water pledgets, but during water deprivation this preference was reversed. If rats were given saccharin pledgets alone, hoarding did not decline during water deprivation. Rats showed the ad lib saccharin preference although they did not hoard their normal diet of food pellets, and it was maintained in animals that had received saccharin since weaning. Hence sweetness of taste is a property of objects that can induce hoarding, and the reversal in hoarding during deprivation is due to an increased preference for water rather than a diminished saccharin preference. This indicates that incentive properties of objects are crucial to the expression of this species-typical behavior.

Animals↗
PubMed1990

The effect of increased incentive on free recall by learning-disabled and nondisabled children.

Immediate free recall by learning-disabled and nondisabled children was compared under two incentive conditions. Recall of the first few words of each list by disabled children and younger nondisabled children was lower than that by older nondisabled children, and receiving a monetary reward increased early list item recall by older disabled and nondisabled learners. These findings suggest that elaborative encoding processes, such as rehearsal, are impaired in younger disabled and nondisabled children and that receiving a reward increased elaborative encoding by older children. Similar recall of the last few list items by all groups suggests that attention and immediate memory are comparable in disabled and nondisabled children of different ages. Receiving a reward increased recall of the last few list items by younger disabled and nondisabled children, suggesting that a reward increased attention, immediate memory, or both, in these groups. Because receiving a reward increased recall equally in all groups, lower motivation did not appear to be responsible for the lower recall by younger nondisabled children and learning-disabled children.

Attention↗
PubMed1990

Physician reported incentives and disincentives for referring patients to hospice.

Previous research has affirmed the key role of the physician in the decision to use hospice. Yet at least 1/4 of the physicians who have the opportunity to discuss hospice with a terminally ill patient never do so, and those that do so are selective. The present study used a qualitative approach to investigate the factors considered by the physician when deciding to discuss hospice with a patient. Participants were 17 practicing physicians who had referred patients to the one certified hospice in the geographic area of the study. Data were gathered by means of semi-structured interviews, which were audiotaped and transcribed for thematic analysis. The final categorization of data divided themes along two dimensions: a content dimension and a second dimension called incentives and disincentives. It is proposed that the physician's proactive stance toward disclosure of the terminal diagnosis and perception of hospice as an opportunity for death with dignity create a culture within which the work that is necessary to make the other factors favorable toward use of hospice is accomplished.

Adult↗
PubMedDate not supplied

Safety and efficacy of L-tryptophan and behavioral incentives for treatment of cocaine dependence: a randomized clinical trial.

L-tryptophan(ie, tryptophan)has shown promise as a pharmacotherapy in cocaine addiction treatment. Abstinent contingent voucher incentives have shown efficacy in abstinence initiation and maintenance for treatment of cocaine dependence. The present study evaluated these two approaches singly and in combination in a relapse prevention+treatment design. A double-blind, parallel-group, placebo-controlled design was used. Cocaine-dependent patients(N=199) were stratified and randomized to one of four groups: tryptophan+contingent vouchers, tryptophan+non-contingent vouchers, placebo+contingent vouchers, and placebo+non-contingent vouchers. The study included residential stabilization (4-9 days), where patients achieved initial cocaine abstinence; outpatient treatment evaluation(16 weeks), where patients received medication, vouchers, and urine testing thrice weekly; and disposition. Main outcomes were retention in treatment, urinalysis, self-reported drug use, and self-reported side effects. Tryptophan did not significantly prevent relapse to cocaine use or attenuate cocaine use after relapse. Contingent vouchers significantly increased the time to cocaine relapse and produced less cocaine use relative to non-contingent vouchers. Results demonstrate the sensitivity of this methodology for detecting decreases in cocaine use, as evidenced by significant changes of the contingent voucher conditions; this suggests that tryptophan's lack of efficacy was not due to model insensitivity for detecting significant differences in cocaine use. This study also showed that contingent vouchers were effective in the novel experimental model of relapse prevention.

Adolescent↗
PubMed2004

A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum.

We report results from a pilot study examining the use of vouchers redeemable for retail items as incentives for smoking cessation during pregnancy and postpartum. Of 100 study-eligible women who were still smoking upon entering prenatal care, 58 were recruited from university-based and community obstetric practices to participate in a smoking cessation study. Participants were assigned to either contingent or noncontingent voucher conditions. Vouchers were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence. In the noncontingent condition, vouchers were earned independent of smoking status. Abstinence monitoring and associated voucher delivery was conducted daily during the initial 5 days of the cessation effort, gradually decreased to every other week antepartum, increased to once weekly during the initial 4 weeks postpartum, and then decreased again to every other week for the remaining 8 weeks of the postpartum intervention period. Contingent vouchers increased 7-day point-prevalence abstinence at the end-of-pregnancy (37% vs. 9%) and 12-week postpartum (33% vs. 0%) assessments. That effect was sustained through the 24-week postpartum assessment (27% vs. 0%), which was 12 weeks after discontinuation of the voucher program. Total mean voucher earnings across antepartum and postpartum were 397 US dollars (SD=414 US dollars) and 313 US dollars (SD=142 dollars) in the contingent and noncontingent conditions, respectively. The magnitude of these treatment effects exceed levels typically observed with pregnant and recently postpartum smokers, and the maintenance of effects through 24 weeks postpartum extends the duration beyond those reported previously.

Adult↗
PubMed1993

Working harder for less: effect of incentive value on force of instrumental response in humans.

The present article reports evidence from human subjects that high payoff for instrumental performance may cause reduced vigour of response compared to the vigour observed for lower payoffs. Vigour of response, as measured by force of pressing (Experiment 1) and number of fortune wheel turns (Experiment 2), was inversely related to payoffs, with higher vigour in the low payoff conditions. Experiment 2 further demonstrated this effect, regardless of whether or not payoff depended on performance. These findings are related to parallel animal data, and an analysis in terms of a learned incentive-effort hypothesis is offered. Experiment 3 presented support for this hypothesis. The results are argued to be of importance to the understanding of how reinforcers affect human instrumental performance.

Adult↗
PubMed2005

Integrated substance use and mental health treatment for adolescents: aligning organizational and financial incentives.

The high prevalence of the dual diagnosis of mental and substance use disorders (SUD) has been increasingly documented for both adolescents and adults (Crowley and Riggs 1995; Kandel et al. 1999; Whitmore et al. 1997). For more than a decade, the National Institute of Drug Abuse (NIDA) has included integrated treatment of comorbid psychiatric disorders as one of nine core treatment principles (National Institute on Drug Abuse 1999). Despite empirically supported practice guidelines, implementation of integrated treatment has been slow (New Freedom Commission on Mental Health 2003; U.S. Department of Health and Human Services 1999). In response to the growing call for integrated treatments and systems of care, this paper: (1) identifies systemic and economic barriers that have impeded widespread implementation of integrated care for adolescents with co-occurring SUD, specifically the supply of treatment providers, shifting priorities of gatekeepers to specialty care, and financing streams; and (2) describes possibilities for aligning economic incentives in order to facilitate the dissemination and implementation of integrated care for adolescents with co-occurring SUD.

Adolescent↗
PubMed1997

Effect of the introduction of a financial incentive for fee-paying A&E attenders to consult their general practitioner before attending the A&E department.

BACKGROUND: The Health (Out-Patient Charges) Regulations 1994 were designed to encourage those Irish patients liable for their own health care costs to attend their GP before their local Accident and Emergency (A&E) department. Such patients are referred to as General Medical Services (GMS)-ineligible. Prior to the introduction of the regulations in March 1994, there was a perverse financial incentive for these patients to attend directly A&E departments instead of their GP. OBJECTIVE: The aim was to compare the number of GMS-ineligible patients referred by a GP during the year before and the year after the implementation of the Regulations. METHOD: This study involved the audit of all new attendances to a large A&E department, for 1 year before and after the introduction of the new regulations. The main outcome measures were the number of new attenders in the subsequent year, the proportion of GMS-ineligible attenders, the proportion of GMS-ineligible attenders referred by a GP and the proportion of GMS-ineligible attenders referred by a GP and categorized as having neither critical nor urgent complaints. RESULTS: The total number of new attenders in the year subsequent to the introduction of the regulations was 45,302, an increase of 4.9% on the previous year's total. The proportion of GMS-ineligible attenders decreased from 45.3 to 44% (-1.3%; 95% confidence interval (CI) -0.6 to -1.9). The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The proportion of GMS-ineligible attenders, referred by a GP with complaints categorized as neither critical nor urgent, increased by 2.5% (95%; CI 1.8-3.2). CONCLUSIONS: The introduction of the regulations was associated with a small, but statistically significant, reduction in the number of GMS-ineligible patients who attended with non-emergency conditions. The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The overall workload of the A&E department was, however, unaffected. Further evaluation of the effects of this reduction on the health status of patients is required.

Adult↗
PubMed1978

Effects of social incentives on task performance in the elderly.

The performance of 60 elderly volunteers (mean age = 74.5 years) on two cancellation tasks was examined under one of three experimental conditions: social praise, social reproof, or no comment. When compared with the no-comment group, subjects in the reproof condition showed response increments over baseline performance (p less than .05). Praise, when compared with no comment, failed to reach statistical significance. Results are interpreted in terms of the possible negative reinforcement, challenge, or informational properties of reproof. The clear implications from these data are that social incentives may well facilitate behavioral change in the aged and that there is a need for further examination of the effects of this variable.

Age Factors↗
PubMed1980

Effects of overlearning and incentive on the acquisition and transfer of interpersonal skills with institutionalized elderly.

Structured Learning Therapy, a skill training program consisting of modeling, role playing, social reinforcement, and transfer of training was used to teach 56 elderly inpatients (mean age = 65.74) the interpersonal skill of "Starting a Conversation." The effects of three levels of overlearning and the addition of concrete (monetary) reinforcement on skill acquisition and transfer were also assessed. All patients acquired the target skill, and there was some evidence of transfer of skill training. Individuals not receiving concrete reinforcement during training showed greater skill transfer compared to those individuals receiving additional incentive. A transfer-enhancing effect of overlearning was found on the Structured Post-test, but no effect was obtained for the other post-test transfer measures.

Aged↗
PubMed1983

The incentive effect and sleep deprivation.

In order to examine the effect of a small amount of sleep following 3 3/4 days (90 h) of wakefulness, 10 infantry soldiers took part in a laboratory-based experiment. At the end of the vigil, a 2-h sleep was preceded and followed by a cognitive test session consisting of encoding and decoding. In order to simulate a realistic situation, subjects were not told the scheduled length of their vigil until a few hours before their 2-h sleep. Following the test-sleep-test period, 27 h were allowed for sleep and rest. Results indicated that after 3 nights without sleep, performance was, on the average, 55% of the control values. During the test session before the 2-h sleep, performance improved by 30%, to 85% of control values, indicating the considerable effect that incentive can have on even severely sleep-deprived subjects. The reserve mental capacity demonstrable during sleep deprivation indicates the caution that is needed if the effects of "undiluted" sleep loss are sought; it also emphasises once again the lack of knowledge concerning the function of sleep.

Adult↗