‘Behavioral nudge’ influences doctors’ prescribing habits

A new study suggests that simply sending doctors letters informing them that they’re high prescribers of a medication with potentially dangerous side effects is enough to lead them to write fewer of those prescriptions.

The study, from researchers at Harvard T.H. Chan School of Public Health and Columbia University’s Mailman School of Public Health, targeted 5,055 primary care physicians nationwide who were the highest prescribers to Medicare patients of Seroquel (quetiapine)—an antipsychotic with potentially harmful side effects in the elderly. Half of the doctors received letters stating that their prescribing of quetiapine was high relative to their peers and was under review. The letters also noted that high quetiapine prescribing could be appropriate but was concerning for medically unjustified use, and encouraged the doctors to review their prescribing patterns. The other half of the group received letters about an unrelated Medicare regulation.

The physicians who received the peer comparison letters dropped their overall quetiapine prescribing for patients in Medicare by 11% over the next nine months and 16% over the next two years. And new prescriptions of the drug dropped by 24% over two years.

“Overprescribing of antipsychotic drugs is a huge and persistent problem, particularly in the elderly,” said Michael Barnett, assistant professor of health policy and management at Harvard Chan School and second author on the study, in an August 1, 2018 Science Daily article. “We think our results are striking for something as simple and cheap as sending letters.” He added that sending peer comparison letters may be useful for nudging physician behavior more broadly.

Read the Science Daily article: Behavioral Nudges lead to striking drop in prescriptions of potent antipsychotic