Scholarlink

Objectives <p>Medications for alcohol use disorder, or “anti-craving medications”, are effective yet underutilized treatments for alcohol use disorder. This study examined whether a pre-printed prescription embedded in a printable order set could “nudge” clinicians to increase prescribing for medications for alcohol use disorder.</p> Methods <p>We conducted a prescription database review comparing prescribing rates at baseline to those at monthly intervals up to 12&#xa0;months following implementation of a new provincial pre-printed order set for alcohol withdrawal syndrome in Saskatchewan. Patients were included if they had an alcohol-related emergency department (ED) visit, were discharged home, had a prescription for a medication for alcohol use disorder filled within 3&#xa0;days of ED discharge, and did not have a previous prescription for a medication for alcohol use disorder filled within a washout window prior to the ED visit. The review captured all provincial prescriptions of naltrexone and acamprosate—the two medications available on the pre-printed prescription—for patients who fit the inclusion criteria.</p> Results <p>A total of 5740 pre-implementation and 6021 post-implementation patients met inclusion criteria. Baseline demographics and comorbidities were similar across groups. The rate of ED visits with a filled prescription increased from 1.8% pre-implementation to 3.4% post-implementation. Naltrexone prescribing rose from 1.6 to 2.7%, and acamprosate from 0.2 to 0.7%. Interrupted time-series and logistic regression analyses confirmed a statistically significant increase in prescribing post-implementation (adjusted OR 1.9; 95% CI 1.5–2.5).</p> Conclusions <p>Introducing an order set incorporating pre-printed prescriptions for medications for alcohol use disorder effectively increased prescribing rates for physicians treating patients with alcohol-related ED visits, validating use of a “nudge” to effect behavioural change. While promising, sustaining these gains may require reinforcement. In resource-constrained EDs, nudges offer a feasible strategy to improve alignment with evidence-based treatment for alcohol use disorder.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Nudging for practice change: a comparison of medications for alcohol use disorder prescribing in the emergency department before and after implementation of a standardized order set for patients with alcohol withdrawal

  • 期刊论文

  • 发表日期：

    2026年3月31日

查看全文
  • Adrian Teare,
  • Xue Feng,
  • Donica Janzen,
  • Fernando Maldonado Daza,
  • Tracy D. Wilson,
  • Braden Bouchard

摘要

Objectives

Medications for alcohol use disorder, or “anti-craving medications”, are effective yet underutilized treatments for alcohol use disorder. This study examined whether a pre-printed prescription embedded in a printable order set could “nudge” clinicians to increase prescribing for medications for alcohol use disorder.

Methods

We conducted a prescription database review comparing prescribing rates at baseline to those at monthly intervals up to 12 months following implementation of a new provincial pre-printed order set for alcohol withdrawal syndrome in Saskatchewan. Patients were included if they had an alcohol-related emergency department (ED) visit, were discharged home, had a prescription for a medication for alcohol use disorder filled within 3 days of ED discharge, and did not have a previous prescription for a medication for alcohol use disorder filled within a washout window prior to the ED visit. The review captured all provincial prescriptions of naltrexone and acamprosate—the two medications available on the pre-printed prescription—for patients who fit the inclusion criteria.

Results

A total of 5740 pre-implementation and 6021 post-implementation patients met inclusion criteria. Baseline demographics and comorbidities were similar across groups. The rate of ED visits with a filled prescription increased from 1.8% pre-implementation to 3.4% post-implementation. Naltrexone prescribing rose from 1.6 to 2.7%, and acamprosate from 0.2 to 0.7%. Interrupted time-series and logistic regression analyses confirmed a statistically significant increase in prescribing post-implementation (adjusted OR 1.9; 95% CI 1.5–2.5).

Conclusions

Introducing an order set incorporating pre-printed prescriptions for medications for alcohol use disorder effectively increased prescribing rates for physicians treating patients with alcohol-related ED visits, validating use of a “nudge” to effect behavioural change. While promising, sustaining these gains may require reinforcement. In resource-constrained EDs, nudges offer a feasible strategy to improve alignment with evidence-based treatment for alcohol use disorder.