Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review
Objectives Antibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge inte...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/1/e062688.full |
| _version_ | 1797948156286074880 |
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| author | Ling Li Johanna I Westbrook Magdalena Z Raban Amy D Nguyen Karla L Seaman Gabriela Gonzalez Ben R Newell |
| author_facet | Ling Li Johanna I Westbrook Magdalena Z Raban Amy D Nguyen Karla L Seaman Gabriela Gonzalez Ben R Newell |
| author_sort | Ling Li |
| collection | DOAJ |
| description | Objectives Antibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall.Methods Medline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group’s tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness.Results Nineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13; 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3; with 2 reporting a reduction), providing reminders (n=2; 2 reporting a reduction) and facilitating commitment (n=1; reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers.Conclusions Nudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects. |
| first_indexed | 2024-04-10T21:38:48Z |
| format | Article |
| id | doaj.art-0e638124a2a6426c947eb82c10ce23ea |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-10T21:38:48Z |
| publishDate | 2023-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-0e638124a2a6426c947eb82c10ce23ea2023-01-19T06:30:08ZengBMJ Publishing GroupBMJ Open2044-60552023-01-0113110.1136/bmjopen-2022-062688Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic reviewLing Li0Johanna I Westbrook1Magdalena Z Raban2Amy D Nguyen3Karla L Seaman4Gabriela Gonzalez5Ben R Newell6Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China1 Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, AustraliaCentre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, AustraliaDepartment of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Sydney, Australia1 School of Health Sciences, The University of Notre Dame, Fremantle, Western Australia, AustraliaAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, AustraliaSchool of Psychology, University of New South Wales, Sydney, New South Wales, AustraliaObjectives Antibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall.Methods Medline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group’s tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness.Results Nineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13; 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3; with 2 reporting a reduction), providing reminders (n=2; 2 reporting a reduction) and facilitating commitment (n=1; reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers.Conclusions Nudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects.https://bmjopen.bmj.com/content/13/1/e062688.full |
| spellingShingle | Ling Li Johanna I Westbrook Magdalena Z Raban Amy D Nguyen Karla L Seaman Gabriela Gonzalez Ben R Newell Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review BMJ Open |
| title | Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review |
| title_full | Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review |
| title_fullStr | Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review |
| title_full_unstemmed | Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review |
| title_short | Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review |
| title_sort | nudge interventions to reduce unnecessary antibiotic prescribing in primary care a systematic review |
| url | https://bmjopen.bmj.com/content/13/1/e062688.full |
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