Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review

Abstract

Background An epidemic of health disorders can be triggered by a collective manifestation of inappropriate behaviors, usually systematically fueled by non-medical factors at the individual and/or societal levels. This study aimed to (1) landscape and assess the evidence on interventions that reduce inappropriate demand of medical resources (medicines or procedures) by triggering behavioral change among healthcare consumers, (2) map out intervention components that have been tried and tested, and (3) identify the “active ingredients” of behavior change interventions that were proven to be effective in containing epidemics of inappropriate use of medical resources. Methods For this systematic review, we searched MEDLINE, EMBASE, the Cochrane Library, and PsychINFO from the databases’ inceptions to May 2019, without language restrictions, for behavioral intervention studies. Interventions had to be empirically evaluated with a control group that demonstrated whether the effects of the campaign extended beyond trends occurring in the absence of the intervention. Outcomes of interest were reductions in inappropriate or non-essential use of medicines and/or medical procedures for clinical conditions that do not require them. Two reviewers independently screened titles, abstracts, and full text for inclusion and extracted data on study characteristics (e.g., study design), intervention development, implementation strategies, and effect size. Data extraction sheets were based on the checklist from the Cochrane Handbook for Systematic Reviews. Results Forty-three studies were included. The behavior change technique taxonomy v1 (BCTTv1), which contains 93 behavioral change techniques (BCTs), was used to characterize components of the interventions reported in the included studies. Of the 93 BCTs, 15 (16%) were identified within the descriptions of the selected studies targeting healthcare consumers. Interventions consisting of education messages, recommended behavior alternatives, and a supporting environment that incentivizes or encourages the adoption of a new behavior were more likely to be successful. Conclusions There is a continued tendency in research reporting that mainly stresses the effectiveness of interventions rather than the process of identifying and developing key components and the parameters within which they operate. Reporting “negative results” is likely as critical as reporting “active ingredients” and positive findings for implementation science. This review calls for a standardized approach to report intervention studies. Trial registration PROSPERO registration number CRD42019139537

Effectiveness of Interventions to Reduce Potentially Inappropriate Medication in Older Patients: A Systematic Review

“…A recent systematic review focused on non-clinical programs to reduce the inappropriate or unnecessary use of medicines observed that interventions consisting of education messages and recommended behavior alternatives were more likely to be successful in reducing the inappropriate use of medicines or medical procedures ( Lin et al, 2020 ). Educational strategies are essential to improve prescription, as observed by Amorim et al (2021) since physician-related characteristics can influence the number of PIM prescriptions.…”

Using longitudinal antibiotic point prevalence survey (PPS) to drive antimicrobial stewardship programmes in a Nigerian tertiary hospital

“…Often AMS has failed to make a convincing case for itself and justify the resources it deserves from the management without which it cannot function (5,8). Behavioural change has been demonstrated to be one of the most difficult things to achieve but persistent reinforcement of the message increases the chances for success (11,18). This applies when trying to persuade managers and prescribers in healthcare providing institutions of the need to formally incorporate it into their healthcare policy and adopt new prescribing behaviours respectively (9).…”

Nonbiomedical factors affecting antibiotic use in the community: authors' response

“…[9] Dr. Lin also identified the research gap that public target interventions were absent in low-to-middle-income settings. [8] According to our data (unpublished), most of the interventions aiming to reducing inappropriate antibiotic use in China were implemented in primary care settings to reduce inappropriate antibiotic prescribing, largely ignoring demand-side factors, and sociocultural determinants were scarcely embedded in the intervention designs. Therefore, we very much agree with the correspondents that few interventions J o u r n a l P r e -p r o o f tailored the interventions to specific settings and individuals; campaign should convey information targeting on multiple components, such as incorporating theory-grounded framework in our recent publication (the Health Belief Model and Socio-ecological Model).…”

“…[7] To address the gap, Dr. Lin led an Implementation Science systematic review in 2020 identifying 25 public target intervention studies with behavioural change techniques aiming to reducing unnecessary antibiotic use. [8] Most of them conducted campaigns for public education and were in high-income settings. However, intervention assessments revealed that conveying knowledge to the public did not change people's attitudes and behaviours.…”