A Systematic Review of Nudge Interventions to Optimize Medication Prescribing

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].

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

“…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.…”

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

“…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.…”

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

“…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).…”

“…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).…”