Nudging healthcare professionals to improve treatment of COVID-19: a narrative review

Vilhelmsson, Andreas; Sant'Anna, Anita Pinheiro; Wolf, Axel

doi:10.1136/bmjoq-2021-001522

Cited by 11 publications

(6 citation statements)

References 64 publications

(79 reference statements)

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“…For example, nudging via prescheduled appointments or switching the default option increased COVID-19 vaccination rates ( Bonander et al, 2022 ; Tentori et al, 2022 ). A narrative review indicated that nudging strategies, including default rules, could be important tools for improving the treatment of COVID-19 ( Vilhelmsson et al, 2021 ). However, previous attempts focused on improving health decision-making relevant to COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19

2023

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The global COVID-19 pandemic has created significant financial and operational challenges for some businesses. As a result, temporary welfare benefit reduction may be a tough but future-oriented choice for both employers and employees. The present study examined whether default nudges can be used to promote employees’ approval of welfare-cutting policy while avoiding negative attitudes. Two online surveys were conducted during the first pandemic wave in China (February 2020). In the first study (N = 310), the participants were presented with a hypothetical welfare-cutting policy that used either an opt-in approach or an opt-out approach. We aimed to investigate how their approval and attitudes were different between two conditions. The results showed that the employees in the opt-out condition were more likely to accept the welfare-cutting policy than those in the opt-in condition, while participants’ attitudes toward the policy employing opt-out approach were as negative as that employing opt-in approach. Study 2 (N = 1,519) involved a replication of Study 1 with two additional improved opt-out approaches (opt-out education and opt-out transparency). Compared with the opt-in approach and standard opt-out approach, the opt-out education approach both increased policy support and improved attitudes toward the welfare-cutting policy. The theoretical and practical implications of these findings are discussed.

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Section: Discussionmentioning

confidence: 99%

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19

2023

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“…Furthermore, clinicians appear to have a higher response to nudges which 'change default options' , or 'enable choice' as opposed to nudges which solely provide information through prompt reminders [21]. Passive and asynchronous nudge interventions, or those non-aligned with patient preferences have been found to be less successful than those that use an active, synchronous intervention that requires immediate action [22,23].…”

Section: Discussionmentioning

confidence: 99%

Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial

et al. 2022

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Background Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people’s preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes. Methods A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as ‘at-risk’ and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life. Results In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of − 0.08; 95% CI: − 0.12 to − 0.04 and − 0.14; 95% CI: − 0.21 to − 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of − 0.20; 95% CI: − 0.28 to − 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of − 0.01, 0.02 and 0.04. Discussion The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life. Trial registration Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).

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“… 21 A December 2021 narrative review found that nudging strategies targeting COVID-19 vaccination orders for patients, such as text message reminders, had a positive result. 22 A 2021 systematic review found that clinical nudging interventions that make information more salient are the most successful in improving vaccine uptake. 23 This concept also been tested successfully through randomised control trials.…”

Section: Discussionmentioning

confidence: 99%

“…Nudging has been used in multiple clinical settings to better align health care provider decision-making with established guidelines 21. A December 2021 narrative review found that nudging strategies targeting COVID-19 vaccination orders for patients, such as text message reminders, had a positive result 22. A 2021 systematic review found that clinical nudging interventions that make information more salient are the most successful in improving vaccine uptake 23.…”

Section: Discussionmentioning

confidence: 99%

An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak

et al. 2022

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BackgroundIn response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system.MethodsAll patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention.ResultsDuring the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA’s use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time.ConclusionsEMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.

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Nudging healthcare professionals to improve treatment of COVID-19: a narrative review

Cited by 11 publications

References 64 publications

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19

Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial

An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak

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