A Systematic Review of Nudge Interventions to Optimize Medication Prescribing.

Anna Sallis,Robert Horne,Alice Turner,Tim Chadborn,Usman Talat,Kelly Ann Schmidtke,Natalie Gold,Ivo Vlaev,Amy Chan,Saval Khanal

doi:10.3389/fphar.2022.798916

Abstract

Background: The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges. Objective: The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply. Methods: Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants. Results: The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts (n = 13). The MINDSPACE contextual influencer most often applied involved defaults (n = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence. Conclusion: The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006].

Highlights

To prescribe medications optimally healthcare practitioners must make decisions about whether prescribing medication is appropriate, and, if so, how much, how often, and what type of medications they use (National Institute for He, 2015)
To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE
The recommended Theoretical Domains Framework (TDF)-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants

Summary

Introduction

The benefits of medication optimization are largely uncontroversial but challenging to achieve (Faria et al, 2014) This difficulty arises, in part, due to the many stakeholders (e.g., patients and clinicians) and processes involved (e.g., prescribing, dispensing, administering, monitoring, and record-keeping involved). Other reviews have focused on a more specific set of intervention modes (e.g., e-prescribing) (Nuckols et al, 2014; Williams et al, 2020) or types of patients (e.g., patients with dementia) (McGrattan et al, 2017; ShafieeHanjani et al, 2019) They do not focus on interventions aiming to change prescribing behavior without forbidding options or changing economic incentives. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward These interventions are often referred to as nudges

Methods

Results

Discussion

Conclusion