CJEM · 2026
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.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Teare Adrian, Feng Xue, Janzen Donica, Maldonado Daza Fernando, Wilson Tracy D, Bouchard Braden
Аннотация
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.
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.