A systematic review of nudge interventions to optimize medication prescribing

Talat, Usman, Schmidtke, Kelly Ann, Khanal, Saval ORCID: https://orcid.org/0000-0001-5201-0612, Chan, Amy, Turner, Alice, Horne, Robert, Chadborn, Tim, Gold, Natalie, Sallis, Anna and Vlaev, Ivo (2022) A systematic review of nudge interventions to optimize medication prescribing. Frontiers in Pharmacology, 13. ISSN 1663-9812

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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].

Item Type: Article
Additional Information: Funding Information: This work was supported by the Health Foundation’s Behavioral Insights Research program (Award 807263) and the National Institute for Health Research (NIHR) Applied Research Center (ARC) West Midlands (NIHR200165). The views expressed are those of the author(s) and not necessarily the funders. The funders had no role in the design of the study Publisher Copyright: Copyright © 2022 Talat, Schmidtke, Khanal, Chan, Turner, Horne, Chadborn, Gold, Sallis and Vlaev.
Uncontrolled Keywords: behavioural science,medical decision-making,nudge,costs,systematic reviews,pharmacology,pharmacology (medical) ,/dk/atira/pure/subjectarea/asjc/3000/3004
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Depositing User: LivePure Connector
Date Deposited: 17 Apr 2023 13:31
Last Modified: 14 Jul 2023 16:31
URI: https://ueaeprints.uea.ac.uk/id/eprint/91807
DOI: 10.3389/fphar.2022.798916


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