Applications of behavioral economics-based nudge theory in hospital pharmacy practice: A scoping review

This scoping review systematically examines the application of behavioral economics-based nudge interventions in hospital pharmacy practice.

The aim is to evaluate intervention settings, target populations, nudge strategies, and delivery modalities, as well as their potential to enhance pharmacy service efficiency, promote appropriate medication use, and support clinical decision-making.

Following the PRISMA-ScR guidelines, a systematic search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library from January 1, 2008, to December 14, 2025. A total of 669 abstracts were screened, with studies explicitly applying nudge theory in hospital pharmacy practice included. Data were extracted independently by two reviewers and analyzed descriptively. Nudge strategies were categorized into three domains: decision information (A), decision structure (B), and decision assistance (C).

Twenty studies published between 2016 and 2025 were included. Most interventions targeted healthcare professionals (65%), with the remainder focusing on patients. Interventions primarily involved prescribing optimization, especially for opioids and antimicrobials, as well as medication adherence. Nudge strategies were predominantly delivered through digital platforms such as electronic health records and prescribing tools. Decision-structure strategies, such as altering default options and simplifying pathways, showed consistent improvements in prescribing behavior, whereas effects on long-term adherence and clinical outcomes were more variable. Twelve studies reported significant improvements in primary outcomes, mainly related to prescribing behavior and medication appropriateness.

Nudge interventions show promise for improving prescribing and medication-use processes in hospital pharmacy practice, particularly when integrated into clinical workflows. Decision-structure strategies demonstrated the most consistent effects, although evidence regarding long-term outcomes remains limited.