Nudges to Optimise Prescriber Behaviour of Physicians

Duration: Mid-April 2025 – November 2025 (3 PM)
Language: English (with German summary)

Background:
In the healthcare sector, the pressure to comply with clinical and administrative guidelines has intensified considerably in recent years - a development that aims to optimise the quality of care for patients and reduce costs simultaneously [1]. Findings from the behavioural sciences are becoming more popular to improve the quality of medical decision-making processes [2, 3]. In this context, the concept of '''nudging' has attracted particular attention [4]. Nudges are targeted modifications to the decision-making environment that are intended to gently steer people towards certain behaviours. However, these modifications are not dependent on financial/economic incentives, nor are they subject to any commandments or prohibitions. Because nudge interventions are typically straightforward and inexpensive, they are very popular with health managers and policymakers.

Scientific findings from various areas, such as financial markets, education policy, and the health sector, prove the effectiveness of nudges [5]. In the healthcare sector, research on nudging strategies focuses primarily on patient-centred interventions, such as vaccination reminders, improved malaria testing procedures, and self-management of chronic diseases. However, specific nudging approaches for healthcare professionals have also been developed to help increase adherence to guidelines and improve prescribing practices [5, 6].

Prescribing decisions are inherently complex and frequently need to be made under considerable time constraints whilst managing patient expectations. Under such circumstances, extraneous factors —potentially irrelevant from a clinical perspective—may influence medication prescribing patterns. Even highly experienced clinicians might make decisions that deviate from evidence-based practice under these conditions, particularly in therapeutic areas characterised by significant uncertainty regarding benefit-risk profiles, such as opioid prescribing [5]. In this context, strategically designed nudging interventions can favourably influence prescribing behaviour by reconfiguring the decision architecture whilst preserving the professional autonomy of physicians.

Project aims:
The project aims to systematically categorise nudging strategies in healthcare that can positively influence the prescribing behaviour of physicians. This involves documenting implemented approaches from the literature and evaluating them about their effectiveness and utility. A further focus lies in analysing the transferability of these strategies to the context of the Austrian healthcare system. This leads to the following three research questions:

1.     Which nudges for optimising prescribing behaviour have been implemented and evaluated internationally, and how can they be categorised?

2.     How effective and safe are the nudges described in international literature for optimising prescribing behaviour?

3.     Which nudges have proven to be effective and safe internationally and would be suitable for implementation in the Austrian healthcare system? What criteria should be considered for successful implementation in the Austrian context?

The aim of this study is not to develop implementation strategies or carry out a budget impact analysis.

Methods:
The following methods are used to answer the research questions:

RQ1 + RQ2: To answer the first two research questions, a manual search for current systematic reviews will be conducted first. After selecting a recent systematic review of high methodological quality, a systematic literature search in several databases (update search) will be conducted based on their search strategy to identify relevant primary studies. Following the literature selection, the nudging measures described therein to improve physician prescribing behaviour are categorised, and the evidence on efficacy and safety is extracted in prefabricated tables and then summarised narratively. Depending on the study design, a quality assessment is carried out for the selected literature using a suitable instrument.

RQ3: For the third research question, those nudges that have proven to be effective in the second research question are evaluated for their potential feasibility and usefulness in the Austrian healthcare system. Criteria, supporting and inhibiting factors for successful implementation in the Austrian context are described. This assessment could, if necessary, be empirically collected through a survey of practising doctors (survey and qualitative analysis).

All work steps for answering the three research questions (literature selection, quality assessment, data extraction, and synthesis) are carried out by the two authors (VH and JAP) in a dual control principle.

Inclusion criteria (PICO):

Timetable:

References:

[1]        Nwafor O., Singh R., Collier C., DeLeon D., Osborne J. and DeYoung J. Effectiveness of nudges as a tool to promote adherence to guidelines in healthcare and their organizational implications: A systematic review. Social Science & Medicine. 2021;286:114321.

[2]        Faria R., Barbieri M., Light K., Elliott R. A. and Sculpher M. The economics of medicines optimization: policy developments, remaining challenges and research priorities. British medical bulletin. 2014;111(1):45-61.

[3]        Avorn J. The psychology of clinical decision making—implications for medication use. New England journal of medicine. 2018;378(8):689-691.

[4]        Vlaev I., King D., Dolan P. and Darzi A. The theory and practice of “nudging”: changing health behaviors. Public Administration Review. 2016;76(4):550-561.

[5]        Wolf A., Sant'Anna A. and Vilhelmsson A. Using nudges to promote clinical decision making of healthcare professionals: A scoping review. Preventive Medicine. 2022;164:107320. DOI: https://dx.doi.org/10.1016/j.ypmed.2022.107320.

[6]        Hallett M. F., Kjaer T. and Bjornskov Pedersen L. The Use of Nudge Strategies in Improving Physicians' Prescribing Behavior: A Systematic Review and Meta-analysis. Medical Decision Making. 2024;44(8):986-1011. DOI: https://dx.doi.org/10.1177/0272989X241270001.