Determinants of and interventions for Proton Pump Inhibitor prescription behavior: A systematic scoping review.

BACKGROUND: Proton Pump Inhibitors (PPI) are frequently prescribed. Long-term use is associated with side-effects and patients often lack a valid indication. Inappropriate PPI prescribing thus needs to be addressed. This review aims to scope 1) what determinants are studied as reasons for PPI prescribing, 2) what strategies are used for changing PPI (de)prescribing, and 3) whether important determinants are addressed in these interventions. METHODS: We searched eight databases for papers on determinants of physician PPI prescribing. Studies were included if they were conducted in a Western country and focused on oral PPIs for an adult population. By following the Behaviour Change Wheel, we extracted information regarding PPI prescribing behavior, behavioral determinants and intervention strategies. FINDINGS: We included 74 papers. Most focused on the determinants knowledge and beliefs about consequences. The latter was consistently related to PPI prescribing. Results for knowledge were mixed. Most interventions used education or enablement (e.g., algorithms, quality check improvements, involvement of pharmacists) as strategies. Enablement consistently improved PPI prescribing, while results for education were mixed. INTERPRETATION: There is an overemphasis on reflective processes in studies on PPI prescribing. Future research should comprehensively identify behavioral determinants, focusing on reflective and impulsive processes, such that interventions can address the most important determinants.

Boosters, anyone? Exploring the added value of booster sessions in a self-management intervention.

The current study explored the benefits of adding booster sessions to a validated and successful self-management intervention for type 2 diabetes patients (i.e. Beyond Good Intentions). Although the addition of booster sessions to self-management interventions is often recommended, it has not been empirically established to what extent booster sessions are in fact appreciated by participants. Participants in the current study (N = 129) followed the Beyond Good Intentions program and were offered a series of three booster sessions at 1, 3 and 5 months afterwards. Primary outcome variables included participants' attendance and evaluations of the booster phase. In addition, self-management behavior was assessed at baseline (T1), after the initial phase (T2) and after the booster phase (T3). Results showed that more than one-fourth of participants who completed the initial phase dropped out during the booster phase, and those who did complete both phases evaluated the booster phase significantly less positive as compared to the initial phase. With regard to the behavioral outcomes, we replicated previous findings showing positive effects on all measures during the initial phase. The booster phase, however, did not result in further improvements. It was concluded that the added value of booster sessions was, at best, questionable.