Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults

Torrente, Fernando; Bustín, Julián; Triskier, Fabián; Ajzenman, Nicolás; Tomio, Ailín; Mastaï, Ricardo; Bóo, Florencia López

doi:10.1001/jamanetworkopen.2020.27082

Cited by 13 publications

(10 citation statements)

References 23 publications

(59 reference statements)

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“…Physicians in the intervention group made fewer inappropriate prescriptions than physicians in the control group, mean 93.25 prescriptions (95% CI: 89.27–97.24) versus 98.99 (95% CI: 95.00–102.98). 341 In Thailand, a large study of 11 915 patients across four community hospitals found that computerized decision support systems that detect potentially inappropriate medications were associated with 13.3 percentage points decrease (from 87.7% to 74.4%) in potentially inappropriate medications. 275 …”

Section: Resultsmentioning

confidence: 99%

Overuse of medications in low- and middle-income countries: a scoping review

Albarqouni

Palagama

Chai

et al. 2023

Bull World Health Organ

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Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.

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Section: Resultsmentioning

confidence: 99%

Overuse of medications in low- and middle-income countries: a scoping review

Albarqouni

Palagama

Chai

et al. 2023

Bull World Health Organ

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“…They can also increase the demand for vaccination (Batteux et al, 2022;Busso et al, 2015;Dombkowski et al, 2017;Martinez Villarreal, 2023;Milkman et al, 2022;Moehring et al, 2023). Messages that employ digital tools are proven to benefit meaningful public health decisions and reduce the cost of these interventions, and they can even change the behavior of doctors and nurses (Cuesta et al, 2021;Kannisto et al, 2014;Murtaugh et al, 2005;Torrente et al, 2020). The results presented in this paper constitute evidence that information interventions are also effective in promoting telemedicine use.…”

Section: Introductionmentioning

confidence: 73%

Increasing the Use of Telemedicine: A Field Experiment

González¹,

Scartascini²

2023

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Patients are reluctant to use telemedicine health services. Telemedicine is an “experience good,” one that can be accurately evaluated and compared to its substitute (in this case, in-person visits) only after the product has been adopted and experienced. As such, an intervention that increases the probability of a first experience can have lasting effects. This article reports the results of a randomized field experiment conducted in collaboration with a health insurance company in Argentina. During the intervention, about two thousand households with no previous experience with telemedicine received periodic e-mails with information about the available services. It effectively increased the take-up and demand for telemedicine. Within the first eight months of the experiment, patients assigned to the treatment group were 6pp more likely to have used the service at least once (12pp higher for those who opened at least one e-mail.) This first use led to large cumulative effects over time. After eight months, the number of virtual consultations by the treatment group was six times larger than those of the control group. These results provide additional evidence about how information interventions can increase technological take-up within the health sector and add to the understanding of how behavioral barriers affect patients resistance to technological adoption.

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“…Feedback and comparison of clinical practices is a strategy that can be used to improve compliance with a desired change in clinical behaviour [ 31 , 32 ]. Clinical performance feedback has been shown to be an effective low-cost intervention in several settings for changing prescribing behaviour [ 17 , 33 , 34 ]. Although systematic reviews have concluded that audit and feedback overall may provide only a small benefit, a review looking at various mailed intervention techniques reported that well-constructed mailed interventions, focusing on a single topic, and providing patient data, have the potential to evoke significant changes in physician prescribing [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

Carney,

Maclure,

Patrick

et al. 2023

PLoS ONE

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Objective To evaluate the impact of personalized prescribing portraits on antibiotic prescribing for treating uncomplicated acute cystitis (UAC) by Family Physicians (FPs). Design Cluster randomized control trial. Setting The intervention was conducted in the primary care setting in the province of BC between December 2010 and February 2012. Participants We randomized 4 833 FPs by geographic location into an Early intervention arm (n = 2 417) and a Delayed control arm (n = 2 416). Intervention The Education for Quality Improvement in Patient Care (EQIP) program mailed to each FP in BC, a ‘portrait’ of their individual prescribing of antibiotics to women with UAC, plus therapeutic recommendations and a chart of trends in antibiotic resistance. Main outcome measures Antibiotic prescribing preference to treat UAC. Results Implementing exclusion criteria before and after a data system change in the Ministry of Health caused the arms to be unequal in size–intervention arm (1 026 FPs, 17 637 UAC cases); control arm (1 352 FPs, 25 566 UAC cases)–but they were well balanced by age, sex and prior rates of prescribing antibiotics for UAC. In the early intervention group probability of prescribing nitrofurantoin increased from 28% in 2010 to 38% in 2011, a difference of 9.9% (95% confidence interval [CI], 9.1% to 10.7. Ciprofloxacin decreased by 6.2% (95% CI: 5.6% to 6.9%) and TMP-SMX by 3.7% (95% CI: 3.1% to 4.2%). Among 295 FPs who completed reflective surveys, 52% said they were surprized by the E. coli resistance statistics and 57% said they planned to change their treatment of UAC. Conclusion The EQIP intervention demonstrated that feedback of personal data to FPs on their prescribing, plus population data on antibiotic resistance, with a simple therapeutic recommendation, can significantly improve prescribing of antibiotics. Trial registration: ISRCTN 16938907.

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Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults

Cited by 13 publications

References 23 publications

Overuse of medications in low- and middle-income countries: a scoping review

Overuse of medications in low- and middle-income countries: a scoping review

Increasing the Use of Telemedicine: A Field Experiment

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

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