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A Systematic Review of Nudge Interventions to Optimize Medication Prescribing
Usman Talat1, Kelly Ann Schmidtke2, Saval Khanal3
1Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom.
Frontiers in Pharmacology
|February 11, 2022
Summary
Nudge interventions successfully optimized prescriber behavior in 80% of studies. Future interventions should target specific behavioral determinants for effective medication optimization without mandates or financial incentives.
Area of Science:
- Behavioral Science
- Health Services Research
- Clinical Pharmacy
Background:
- Medication optimization benefits are clear but challenging to implement.
- Behavior change interventions, or nudges, offer a promising approach to improve prescribing decisions without forbidding options or altering financial incentives.
- Nudges aim to optimize medication-related decisions by influencing prescriber behavior.
Purpose of the Study:
- To systematically review and characterize nudge interventions for optimizing medication prescribing.
- To analyze interventions based on the behavioral determinants they target and the techniques employed.
- To assess the alignment between targeted determinants and applied techniques.
Main Methods:
- Systematic literature search across four databases (MEDLINE, Embase, PsychINFO, CINAHL).
- Data extraction using the Theoretical Domains Framework (TDF) for behavioral determinants and the Behavior Change Techniques (BCT) Taxonomy v1 and MINDSPACE for intervention techniques.
- Appraisal of interventions using recommended TDF-BCT mappings.
Main Results:
- Fifteen studies comprising 20 interventions were identified; 16 interventions (80%) were effective.
- Prompts were the most frequently used behavior change technique (n=13).
- Defaults were the most frequently used MINDSPACE influencer (n=10); only two interventions adequately mapped TDF determinants to BCTs.
Conclusions:
- Successful interventions demonstrate the potential of nudges for optimizing prescribing without coercion.
- Future intervention design should prioritize understanding and targeting specific behavioral determinants.
- A comprehensive approach linking behavioral determinants with appropriate techniques is crucial for effective medication optimization.
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