14 Low-cost, innovative behavioral interventions known as nudges can also reduce inappropriate prescribing. Various strategies to change physicians’ prescribing practices have been attempted, ranging from continuing education, which is difficult and costly to scale up, to providing physicians with feedback on their prescribing behavior, which has provoked small but significant changes. 5 - 7 In Argentina, nonrecommended drugs account for between 41% and 45% of prescriptions for cognitive impairment, the most widely used of which is nimodipine 8 - 10-a drug recommended for use with acute subarachnoid hemorrhage during short hospital stays, not outpatient use for cognitive impairment. 1 - 4 Elderly patients are often prescribed inappropriate medications and supplements for mild cognitive impairment and dementia. The practice of prescribing drugs without evidence to support their use may become a significant public health problem by contributing to inappropriate polypharmacy in elderly patients and by increasing adverse drug effects and health system costs without reciprocal patient benefits. V torrente ls models registration#Trial Registration identifier: ISRCTN17823729 It was highly cost-effective and well accepted by participants. Expenditures were 7.18% lower in the treatment group, resulting in an estimated annual net cost benefit of US $234 893.35 (95% CI, $225 565.35 to $237 112.30).Ĭonclusions and Relevance In this randomized clinical trial, the social norm email feedback program showed an effect on curbing the nonrecommended prescription of nimodipine. Physicians who effectively opened the email in the treatment group (427 physicians ) prescribed the drug 11.3% less compared with the control group (426 physicians) (mean difference, –10.78 prescriptions P = .006). The observed difference corresponds to a 4.48% reduction in nimodipine prescriptions per 1000 prescriptions of all drugs made by physicians in the treated group compared with the control group. Regression analysis revealed a significant association of the group condition with number of prescriptions per 1000 total prescriptions when controlling for baseline prescriptions (B = –0.312 P < .001). Physicians in the treatment group wrote a mean of 93.25 (95% CI, 89.27 to 97.24) prescriptions of nimodipine, compared with 98.99 (95% CI, 95.00 to 102.98) prescriptions among practitioners in the control group during the half-year of the intervention (mean difference, –5.73 prescriptions P = .046), which meant a 5.79% reduction. Results Of 1811 physicians enrolled, 906 physicians (354 women mean age, 57.10 years) were randomized to treatment and 905 participants (331 women mean age, 56.49 years) to the control group. Secondary outcomes included annual monetary savings attributable to the intervention and physicians’ qualitative perceptions of the acceptability of the procedure. Main Outcomes and Measures The primary outcome was the cumulative number of nimodipine prescriptions per 1000 prescriptions of all drugs made by the targeted physicians during the 6 months of the study. The control group received 2 emails with general information about the risks of overprescription in older adults. V torrente ls models plus#Interventions The treatment group received 2 emails with evidence-based information about nimodipine plus the individual’s level of nimodipine prescription compared with their peers. The study was conducted from May 2019 to October 2019, and data were analyzed from November 2019 to February 2020. General practitioner physicians in the national health care system for older adults in Argentina (INSSJP-PAMI) with history of high nimodipine prescription rate were enrolled. Objective To test the effectiveness of a behavioral intervention based on social norm feedback to reduce prescription of nimodipine for cognitive impairment in Argentina.ĭesign, Setting, and Participants This pragmatic parallel-group randomized clinical trial included 2 arms with a 1:1 allocation ratio. There is little evidence to support the use of nimodipine for cognitive impairment and dementia. Importance Nimodipine is a highly prescribed drug for the treatment of cognitive impairment and dementia in Argentina.
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