Effects of the Nudge Theory-Based Multifaceted Intervention on Reducing Inappropriate Proton Pump Inhibitors Use for Prophylaxis in Hospitalized Patients: A Non-Randomized Controlled Study.

Abstract

Background: Inappropriate use of proton pump inhibitors (PPIs) for prophylaxis among hospitalized patients continues to be a significant issue. Previous interventions have often been ineffective and lack evaluation of their longer-term impacts.

Aim: This study aims to assess the clinical and economic effects of a nudge theory-based multifaceted intervention on reducing inappropriate PPI prophylaxis in hospitalized patients.

Methods: This non-randomized controlled study was carried out in a teaching hospital's wards from January 2021 to June 2023, with a 12-month pre-intervention period, a 12-month intervention period (including the first and second stages of intervention), and a post-intervention period with 6-month follow-up. The intervention, based on nudge theory, was implemented among 114 doctors across 10 wards, sequentially involved peer comparison, information provision, and face-to-face feedback. The outcomes were assessed by randomly selecting cases of adult patients who received at least one PPI treatment during hospitalization, and the statistical analysis included univariate analysis, and multivariate and subgroup analyses.

Results: The study included 1782 patients, with a median age of 61 years. During and after intervention, the rate of appropriate PPI use significantly increased by 2.83- to 5.47-fold, rising from 23.82% (147/617) to 46.96% (139/296) after the first stage, to 63.13% (202/320) after the second stage, and remained at 53.01% (291/549) later on. The rate of PPI injections decreased from 92.54 to 74.13-84.12%, the median defined daily doses from 16 to 7-12, and PPI-related expenditures from 484.80 to 156.00-262.99 CNY per-patient. The cost associated with inappropriate PPI use dropped from 161.60 to 0-45.58 CNY per-patient. Subgroup analyses supported these findings.

Conclusion: A nudge theory-based multifaceted intervention led to increased appropriate PPI use, decreased PPI injections, and cost savings, with benefits lasting at least 6 months post-intervention.