Evidence map›Paper›PMID 36657758›Full record

SynthesisBMJ open2023

Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review.

Magdalena Z Raban, Gabriela Gonzalez, Amy D Nguyen, Ben R Newell, Ling Li, Karla L Seaman, Johanna I Westbrook

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  11. [Antibiotic use: psychological factors influencing perceptions and behavior of physicians and patients].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026
    Review
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  15. Nudge for governmental change in health policy.Frontiers in public health · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Magdalena Z RabanAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia magda.raban@mq.edu.au.ORCID 0000-0002-6995-2849
Gabriela GonzalezAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Amy D NguyenAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Ben R NewellSchool of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
Ling LiAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0002-1642-142X
Karla L SeamanAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Johanna I WestbrookAustralian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0003-1083-8192

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesAntibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall.

methodsMedline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group's tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness.

resultsNineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13; 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3; with 2 reporting a reduction), providing reminders (n=2; 2 reporting a reduction) and facilitating commitment (n=1; reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers.

conclusionsNudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects.

Indexed as

Anti-Bacterial AgentsPhysiciansBiasFeedbackHumansPrimary Health CareAnti-Bacterial AgentsINFECTIOUS DISEASESPRIMARY CAREPublic healthQuality in health careRespiratory infections

Identifiers

PMID36657758
PMCPMC9853249

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.