A Systematic Review of Nudge Interventions to Optimize Medication Prescribing

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

doi:10.3389/fphar.2022.798916

Cited by 21 publications

(23 citation statements)

References 54 publications

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“…Nudges do not always work. A recent systematic review of 15 studies, evaluating 20 different intervention studies found that 20% of the interventions did not work [ 25 ]. Nudges are designed to non-coercively influence behaviour without forbidding options [ 26 , 27 , 28 , 29 ], and it is the clinicians who must interpret and act.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of Two Nudges in a Hospital’s Electronic Prescribing System to Optimise Cost-Effective Prescribing

et al. 2022

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Providing healthcare workers with cost information about the medications they prescribe can influence their decisions. The current study aimed to analyse the impact of two nudges that presented cost information to prescribers through a hospital’s electronic prescribing system. The nudges were co-created by the research team: four behavioural scientists and the lead hospital pharmacist. The nudges were rolled out sequentially. The first nudge provided simple cost information (percentage cost-difference between two brands of mesalazine: Asacol® and Octasa®). The second nudge provided information about the potential annual cost savings if the cheaper medication were selected across the National Health Service. Neither nudge influenced prescribing. Prescribing of Asacol® and Octasa® at baseline and during the implementation of the first nudge did not differ (at p ≥ 0.05), nor was there a difference between the first nudge and second (at p ≥ 0.05). Although these nudges were not effective, notable administrative barriers were overcome, which may inform future research. For example, although for legal reasons the cost of medicine cannot be displayed, we were able to present aggregated cost information to the prescribers. Future research could reveal more behavioural factors that facilitate medication optimisation.

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Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of Two Nudges in a Hospital’s Electronic Prescribing System to Optimise Cost-Effective Prescribing

et al. 2022

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“…Nudges do not always work. A recent systematic review of 15 studies, evaluating 20 different interventions studies found that 20% of the intervention did not work [11]. Nudges are designed to non-coercively influence behaviour without forbidding options [12][13][14][15], and it is the clinicians who must interpret and act.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of Two Nudges in an Electronic Prescribing System to Optimise Cost-Effective Prescribing in the Hospital

Khanal¹,

Schmidtke²,

Talat³

et al. 2022

Preprint

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Providing healthcare workers with cost information about the medications they prescribe can influence their decisions, particularly when that information is provided at the very moment they are faced with a prescribing decision. The current study aimed to analyse the impact of nudges that presented cost information to prescribers through their organisation's electronic prescribing system. The nudges were co-created by the research team (composed of behavioural scientists) and the lead hospital pharmacist. One nudge provided simple cost information (percentage difference between two brands of Mesalazine – Asacol and Octasa). The second nudge provided the potential annual cost-saving that could result if the cheaper medication was selected across the organisation. While the statistical analyses revealed that these nudges were not effective, several administrative barriers were overcome, which may inform future research. For example, presenting aggregated cost information to the prescribers is possible even when the actual cost of medicine is confidential and can not be displaced. In addition, future research could reveal more behavioural factors that facilitate medication optimisation.

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“…Step 1 -De ning The Problem During early consultations with hospital teams, we would present up to 20 nudge intervention options to optimise medication use previously identi ed in a systematic review (17). The hospital teams appeared overwhelmed and often did not choose any option, plausibly due to "choice overload" (19).…”

Section: Methodsmentioning

confidence: 99%

“…Interventions dictating which medications clinicians can prescribe could prove effective, but they may be di cult to implement as they appear to question clinician authority or ability to offer patients the best care. Nudge interventions offer an opportunity to optimise medication use without curtailing clinicians' ability to choose the medications they believe best serve patients (17).…”

Section: Introductionmentioning

confidence: 99%

Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England: A case study

Khanal

Schmidtke

Talat

et al. 2022

Preprint

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Background Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. Method An MCDA was conducted to rank-order four types of interventions that could optimise medication use in England’s National Healthcare System (NHS) hospitals, including Computerised Interface, Built Environment, Written Communication, and Face-to-Face Interactions. Initially, a core group of quality improvers (N = 10) was convened to determine criteria that could influence which interventions are taken forward according to the Consolidated Framework for Implementation Research. Next, to determine preference weightings, a preference survey was conducted with a diverse group of quality improvers (N = 356) according to the Potentially All Pairwise Ranking of All Possible Alternatives method. Then, rank orders of four intervention types were calculated according to models with criteria unweighted and weighted according to participant preferences. Results The most important criteria influencing what interventions were preferred was whether they addressed ‘patient needs’ and their financial ‘cost’. In both the unweighted and weighted models, the top-ranked intervention type was Computerised Interface followed by Built Environment. In the unweighted model, Written Communication and Face-to-Face intervention types were ranked similarly, while in the weighted model the Face-to-Face type was ranked lower. Conclusions An MCDA was conducted to rank order intervention types that stand to increase medication optimisation across hospitals in England. The top-ranked intervention type was Computerised Interface. This finding does not imply Computerised Interface interventions are the most effective interventions but suggest that successfully implementing lower-ranked interventions may require more conversations to appreciate stakeholder concerns.

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A Systematic Review of Nudge Interventions to Optimize Medication Prescribing

Cited by 21 publications

References 54 publications

Implementation and Evaluation of Two Nudges in a Hospital’s Electronic Prescribing System to Optimise Cost-Effective Prescribing

Implementation and Evaluation of Two Nudges in a Hospital’s Electronic Prescribing System to Optimise Cost-Effective Prescribing

Implementation and Evaluation of Two Nudges in an Electronic Prescribing System to Optimise Cost-Effective Prescribing in the Hospital

Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England: A case study

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