Key Points Question Can a social norm–based behavioral intervention delivered by email reduce non–evidence-based prescriptions of nimodipine for treating cognitive impairment in older adults? Findings This randomized clinical trial included 1811 high–nimodipine-prescribing physicians within the national health care system for older adults in Argentina. Physicians randomized to the social norm email treatment group reduced nimodipine prescribing after receiving 2 emails with evidence-based information about the drug and a comparison of the recipient ’s and peers’ rates of prescription compared with control physicians who received only information about the risks of overprescribing. Meaning These findings suggest that reduction of non–evidence-based prescribing could be achieved through a highly cost-effective, noncoercive, and easily replicable behavioral intervention.

Objectives: The only recommended pharmacological treatments for specific dementias are donepezil, galantamine, rivastigmine, and memantine (recommended drugs, RD). However, other drugs without recommendations (not recommended drugs, NRD) are often used to treat patients with cognitive impairment (CI) in Argentina. The INSSJyP is the largest health insurance in Argentina. The objective of this study is to analyze the prescription pattern, cost, and implications of NRD used for the treatment of CI in the INSSJyP. Materials: This is a retrospective, population-based study of the INSSJyP outpatients' prescriptions database for drugs usually prescribed for CI during 2015. These data were compared with the same database in 2009. The number of "prescriptions" always refers to dispensed packages. Results: A total of 3 255 438 packages of drugs usually indicated for CI were prescribed during 2015: 1 912 476 packages of RD (59%) and 1 342 962 packages of NRD (41%).Comparing the results with those obtained in 2009, there is a 148% gross increase in the prescription of both RD and NRD for CI, although the rates/1000 affiliates/year show a lesser rise for NRD (70.1%) compared to RD (103.9 %).The expenditure on CI drugs prescribed during 2015 was 77 million USD. NRD cost represented approximately 20 million USD. Conclusion: Inappropriate drug use increases health costs in developing countries.We found a high number of patients with a probable diagnosis of CI treated with NRD. It is extremely relevant that all the healthcare professionals can update their knowledge and modify behavioral insights about appropriate prescription for specific dementias.

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