There was a general consensus

that (if there was evidence of effectiveness), the use of CM in principle might be a useful addition to the therapeutic armamentarium. This idea was most positively endorsed by those in the professional groups with greatest experience and training. AUY-922 clinical trial However, there was a range of views expressed: from unequivocal benefit, through to a more cautious acceptance of it. Concerns were raised that in a system with limited resources it may be seen as a cost saving alternative, replacing established and more valued interventions (e.g., time with a member of staff) and therefore best kept as a ‘last resort’. Much of the discussions of aspects of treatment delivery are common to other aspects of health care where incentives are used as part of treatment. They were framed within the concepts of health economics and medical ethics and included the following five themes: practicalities of implementation; the opportunity costs of the intervention; the possibility of CM acting as a perverse incentive; issues of equity; and the potential impact on the therapeutic relationship (see Fig. 2 and Table 2.1). The practicalities and potential problems of implementation was a major theme across all but one

focus group (service users) and included Selleckchem OTX015 aspects that would be anticipated from any discussion about change management. However, concerns were also expressed that were more specific to implementing a behavioural intervention, where it is well recognised that the precise details are integral to the effectiveness of the implementation, and the possibility of unintended consequences. Regarding

Calpain the implementation of CM within a publicly funded system, participants in four groups (3 professional groups and the ex-service user group) expressed concerns about the opportunity cost of such a change of focus. All nine groups expressed concerns about the feasibility of the level of urine testing (three times per week). However, whilst the professional teams viewed this as being resource heavy and had concerns about the potential opportunity costs of delivery (see Table 2.1), the service user groups felt strongly that such a regime acted as a disincentive that would outweigh any benefit from the financial incentive offered. Concerns about the notion of equity of access to interventions within the treatment system, and that CM might act to incentivise non-engagement (i.e., act as a perverse incentive) were discussed in 6/9 groups. Concerns about equity were primarily expressed in the professional groups. Service user groups felt it more appropriate for CM to be offered on an individual basis depending on the needs of the service user at a particular time, rather than being mandated to particular groups and certain points in their treatment journey.