Talat Usman, Schmidtke Kelly Ann, Khanal Saval, Chan Amy, Turner Alice, Horne Robert, Chadborn Tim, Gold Natalie, Sallis Anna, Vlaev Ivo
Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom.
Warwick Medical School, Coventry, United Kingdom.
Front Pharmacol. 2022 Jan 25;13:798916. doi: 10.3389/fphar.2022.798916. eCollection 2022.
The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges. The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply. Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants. The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts ( = 13). The MINDSPACE contextual influencer most often applied involved defaults ( = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence. The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors. : [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006].
药物优化的益处基本没有争议,但却难以实现。旨在优化开处方者与药物相关决策的行为改变干预措施,既不禁止任何选择,也不会显著改变经济激励措施,提供了一条很有前景的前进道路。这些干预措施通常被称为助推。当前的系统文献综述对已发表的研究进行了特征描述,这些研究通过它们打算影响的行为决定因素和应用的技术来描述助推干预措施以优化药物处方。检索了四个数据库(MEDLINE、Embase、PsychINFO和CINAHL),以识别采用助推型干预措施旨在优化处方决策的研究。为了描述干预者旨在影响的行为决定因素,根据理论领域框架(TDF)提取数据。为了描述所应用的干预技术,根据行为改变技术(BCT)分类法第1版和MINDSPACE提取数据。接下来,使用推荐的TDF-BCT映射来评估每种干预措施是否应用了足够的一系列技术来影响所有已识别的行为决定因素。当前的综述找到了15项研究,包括20种干预措施。在这20种干预措施中,16种干预措施(80%)是有效的。最常应用的行为改变技术涉及提示(n = 13)。最常应用的MINDSPACE情境影响因素涉及默认设置(n = 10)。根据推荐的TDF-BCT映射,只有两种干预措施应用了足够的一系列行为改变技术来解决干预者旨在影响的行为决定因素。如此多的干预措施成功改变了开处方者行为这一事实,鼓励了未来行为改变干预措施的发展,以在没有强制规定或经济激励的情况下优化处方。当前的综述鼓励干预者在选择和应用改变处方行为的技术之前,先了解他们试图影响的行为决定因素。来源:[https://www.crd.york.ac.uk/prospero/],标识符[CRD42020168006]