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Assessing Decision Fatigue in General Practitioners' Prescribing Decisions Using the Australian BEACH Data Set.

Mona Maier1, Daniel Powell1, Christopher Harrison2

  • 1Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|July 26, 2024
PubMed
Summary

General practitioners (GPs) showed increased antibiotic prescribing and decreased statin/osteoporosis medication prescribing as their workday progressed, consistent with decision fatigue. This highlights decision fatigue as a target for optimizing prescribing behavior.

Keywords:
clinical decision-makingdecision fatiguedrug prescribinggeneral practitionersphysicianspractice patterns

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Area of Science:

  • Medical Decision Making
  • Clinical Pharmacy
  • Health Services Research

Background:

  • General practitioners (GPs) face numerous daily decisions, potentially leading to decision fatigue.
  • Decision fatigue can cause a shift towards less cognitively demanding choices.
  • This study investigated if GP prescribing patterns reflect decision fatigue.

Purpose of the Study:

  • To examine if GPs' prescribing decisions change over the workday due to decision fatigue.
  • To test the hypothesis that prescribing overused medications increases while underused medications decrease as the workday progresses.

Main Methods:

  • Analysis of nationally representative primary care data from Australia (Bettering the Evaluation and Care of Health program).
  • Utilized generalized linear mixed models to assess the association between prescribing decisions and encounter order.
  • Adjusted for patient, provider, and encounter characteristics.

Main Results:

  • Prescribing antibiotics increased by 8.7% with 15 additional patient encounters (OR=1.087).
  • Prescribing of statins decreased by 21.9% (OR=0.791) and osteoporosis medications by 25.0% (OR=0.750) with 15 additional encounters.
  • No significant effects observed for opioids; mixed results for benzodiazepines.

Conclusions:

  • GP prescribing patterns align with decision fatigue, with increased antibiotic and decreased statin/osteoporosis medication prescriptions later in the workday.
  • Decision fatigue appears to influence prescribing of certain medication classes.
  • Findings suggest decision fatigue is a modifiable factor for improving guideline-compliant prescribing.