Reducing antibiotic prescribing using nudges: a systematic review of interventions in primary care

Dr Magdalena Raban¹, Ms Gabriela Gonzalez¹, Dr Amy Nguyen¹, A/Prof Ling Li¹, Professor Ben Newell², Professor Johanna Westbrook¹

¹Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
²School of Psychology, University of New South Wales, Sydney, Australia

Introduction

Inappropriate antibiotic use in primary care is high. Nudge interventions, from the field of behavioural economics, are an approach to behaviour change that has been making significant inroads in healthcare. We conducted a systematic review to assess the effect of nudge interventions to reduce inappropriate antibiotic prescribing in primary care.

Methods

Medline and Embase were searched for randomised trials and regression discontinuity studies. At full-text review, interventions were assessed to determine whether they were a nudge and classified using a taxonomy of nudges. A promise ratio (PR) was calculated for categories of nudges and for features of social norm nudges (e.g. frequency of feedback). A PR was the count of all studies that showed a statistically significant favourable change in one or more outcomes evaluated, divided by the number of studies with no favourable change in all outcomes. A PR≥2 was considered promising.

Results

Sixteen studies were eligible for inclusion, testing a total 22 nudge interventions. Social norms (n=16; PR=3.3) and changing option consequences (n=2; PR=2) were promising; while providing reminders (n=2; PR=1) was not promising (PR=1), and facilitating commitment was used in a single study with positive impacts. Features of social norm nudges, such as the frequency of feedback and which prescribers were targeted (high vs. all), likely played an important role in intervention effects.

Conclusions

Nudges are promising interventions to improve antibiotic prescribing in primary care. There is scope for further exploring nudges other than the use of social norms in this setting.

Biography:

Dr Magda Raban (BPharm, MIPH, PhD) is a Senior Research Fellow and NHMRC Early Career Fellow at the Centre for Health Systems and Safety Research. She is the lead for the Medication Safety and Electronic Decision Support research stream. Dr Raban’s research focuses on the use of information technology to improve the quality use of medicines and patient outcomes across a range of care settings. Her interests include how routinely collected data can drive quality improvement and policy change. Dr Raban has experience leading multi-method evaluations, including randomised trials, of health service interventions.