The Nudging Effect of a Reminder Letter to Reduce Duplicated Medications

A Randomized Controlled Trial

Bibliographic Data

ID9104074
AuthorsSimon H Cheng (0000-0001-7630-9934, National Taiwan University, corresponding author), Shou-Hsia Cheng (National Taiwan University), Kuo-Piao Chung (National Taiwan University), Kuo‐Piao Chung (0000-0001-9482-7065, National Taiwan University, corresponding author), Ying-Chieh Wang (National Taiwan University, corresponding author), Hsin-Yun Tsai (Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan), Hsin‐Yun Tsai (0000-0002-1793-5465, Development Center for Biotechnology)
Year2024
Volume62
Issue5
Pages326-332
Publication date2024-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001989
PMID38498873
OpenAlexW4392901223
LanguageEN
References cited46

BACKGROUND: The increasing trend of multiple chronic conditions across the world has worsened the problem of medication duplication in health care systems without gatekeeping or referral requirement. Thus, to overcome this problem, a reminder letter has been developed in Taiwan to nudge patients to engage in medication management. OBJECTIVE: To evaluate the effect of reminder letter on reducing duplicated medications. RESEARCH DESIGN: A 2-arm randomized controlled trial design. SUBJECTS: Patients with duplicated medications in the first quarter of 2019. MEASURES: The Taiwanese single-payer National Health Insurance Administration identified the eligible patients for this study. A postal reminder letter regarding medication duplication was mailed to the patients in the study group, and no information was provided to the comparison group. Generalized estimation equation models with a difference-in-differences analysis were used to estimate the effects of the reminder letters. RESULTS: Each group included 11,000 patients. Those who had received the reminder letter were less likely to receive duplicated medications in the subsequent 2 quarters (postintervention 1: odds ratio [OR]=0.95, 95% CI=0.87-1.03; postintervention_2: OR=0.99, 95% CI=0.90-1.08) and had fewer days of duplicated medications (postintervention 1: β=-0.115, P =0.015; postintervention 2 (β=-0.091, P =0.089) than those who had not received the reminder letter, showing marginal but significant differences. CONCLUSIONS: A one-off reminder letter nudge could mildly decrease the occurrence of duplicated medications. Multiple nudges or nudges incorporating behavioral science insights may be further considered to improve medication safety in health systems without gatekeeping

Family medicine · Gatekeeping · MEDLINE · Nudge theory · Odds ratio · Physical therapy · Randomized controlled trial · Referral · Emergency Medicine · Internal Medicine · Medication Adherence and Compliance · Medicine · Pharmaceutical Practices and Patient Outcomes · Pharmaceutical studies and practices · Psychology

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