Danish Center for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, Odense, Denmark.
Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Med Decis Making. 2024 Nov;44(8):986-1011. doi: 10.1177/0272989X241270001. Epub 2024 Sep 19.
Nudges have been proposed as a method of influencing prescribing decisions.
The purpose of this article is to 1) investigate associations between nudges' characteristics and effectiveness, 2) assess the quality of the literature, 3) assess cost-effectiveness, and 4) create a synthesis with policy recommendations.
We searched health and social science databases. We included studies that targeted prescribing decisions, included a nudge, and used prescribing behavior as the outcome. We recorded study characteristics, effect size of the primary outcomes, and information on cost-effectiveness. We performed a meta-analysis on the standardized mean difference of the studies' primary outcomes, tested for associations between effect size and key intervention characteristics, and created a funnel plot evaluating publication bias.
We identified 21 studies containing 25 nudges. In total, 62 of 85 (73%) outcomes showed a statistically significant effect. The average effect size was -0.22 standardized mean difference. No studies included heterogeneity analyses. We found no associations between effects and selected study characteristics. Study quality varied and correlated with study design. A total of 7 of 21 (33%) studies included an evaluation of costs. These studies suggested that the interventions were cost-effective but considered only direct effects. We found evidence of publication bias.
Heterogeneity and few studies limit the possibilities of statistical inference about effectiveness.
Nudges may be effective at directing prescribing decisions, but effects are small and health effects and cost-effectiveness are unclear. Future nudge studies should contain a rationale for the chosen nudge, prioritize the use of high-quality study designs, and include evaluations of heterogeneity, cost-effectiveness, and health outcomes to inform decision makers. Moreover, preregistration of the protocol is warranted to limit publication bias.
Nudging as a method to improve prescribing decisions has gained popularity during the past decade.We find that nudging can improve prescribing decisions, but effect sizes are mostly small, and the size of derived health outcomes is unclear.Most studies use feedback and error-stopping nudges to target excessive opioid or antibiotic prescribing, making heterogeneity analyses across nudge types difficult.Further research on the cost-effectiveness of nudges and generalizability is needed to guide decision makers considering nudging as a tool to guide prescribing decisions.
助推已被提议作为一种影响处方决策的方法。
本文的目的是 1）调查助推的特征与效果之间的关联，2）评估文献的质量，3）评估成本效益，以及 4）提出政策建议。
我们检索了健康和社会科学数据库。我们纳入了针对处方决策的研究，其中包含了助推，并将处方行为作为结果。我们记录了研究特征、主要结果的效应大小以及成本效益信息。我们对研究主要结果的标准化均数差进行了荟萃分析，检验了效应大小与关键干预特征之间的关联，并绘制了漏斗图评估发表偏倚。
我们确定了 21 项包含 25 个助推的研究。总共，85 项结果中的 62 项（73%）显示出统计学上显著的效果。平均效应大小为-0.22 标准化均数差。没有研究进行了异质性分析。我们没有发现效果与所选研究特征之间的关联。研究质量参差不齐，与研究设计相关。21 项研究中有 7 项（33%）包括了成本评估。这些研究表明干预是具有成本效益的，但仅考虑了直接效应。我们发现了发表偏倚的证据。
异质性和研究数量有限，限制了对有效性进行统计推断的可能性。
助推可能有助于指导处方决策，但效果较小，健康效果和成本效益尚不清楚。未来的助推研究应包含对所选助推的理由说明，优先使用高质量的研究设计，并包括对异质性、成本效益和健康结果的评估，以便为决策者提供信息。此外，有必要对方案进行预先登记，以限制发表偏倚。
在过去十年中，作为改善处方决策的一种方法，助推已受到关注。我们发现，助推可以改善处方决策，但效果大小大多较小，并且衍生的健康结果大小尚不清楚。大多数研究使用反馈和错误停止助推来针对过度开具阿片类药物或抗生素处方，使得不同助推类型之间的异质性分析变得困难。需要进一步研究助推的成本效益和推广性，以指导决策者将助推作为指导处方决策的工具。
