Table 1 Behavioral principles tested in the electronic health record tools across study arms
Behavioral principle | Definition in context of medication prescribing | Modification made to electronic health record tool to incorporate the principle | Trial arm(s) with this modification |
|---|---|---|---|
Salience | Noticeability or prominence of drug risk information | Presenting information about drug risks in ways that makes the information as impactful as possible | 1–14 |
Default bias | Pre-set course of action that leverages providers’ tendency to do status quo | Defaulting the options to (1) discontinuing the medication and (2) opening an order set that contains dose tapers, alternatives, and customized patient instructions | 1–14 |
Social accountability | Willingness to accept responsibility for prescribing action | Requiring providers to select “I accept the drug’s risks” or write a free-text response if they decide not to discontinue the medication or order a taper or alternative | 1–14 |
Timing of information (an aspect of choice architecture) | Organization of the context and timing in which providers make choices to influence decision-making | Modifying the timing of the tool to occur at different times in provider workflow (i.e., when ordering a medication, opening an encounter record, or approving a medication refilled by clinical staff) | -At ordering: 1, 3, 5, 7, 9, 11, 13, 15 -At encounter opening: 2, 4, 6, 8, 10, 12, 14 -At refill approval: 9, 10 |
Boostering | Renewal of the effect of a prior intervention | Providing an option for reminder message 4 weeks after a patient visit | 3, 4 |
“Cold-state” priming | Pre-exposure to information affects subsequent prescribing | Triggering an informational message 2 days before a scheduled visit with an eligible patient | 5, 6 |
Simplification | Simplification of risk information may make it more understandable | Simplifying the medication risks and recommended action language in the tool | 7, 8 |
Pre-commitment/consistency | Support of future decision to deprescribe by first asking providers to commit to an easier action | Prompting providers to discuss medication risks on their first visit (using a patient hand-out in the EHR) before prompting providers to stop medication or order a dose taper when the patients return for follow-up | 11, 12 |
Framing | Framing of risks in terms of clinical guidelines | Framing of risks in terms of clinical guidelines and published evidence | 13, 14 |