Article
Details
Citation
Maier M, Powell D, Harrison C, Gordon J, Murchie P & Allan JL (2024) Assessing Decision Fatigue in General Practitioners’ Prescribing Decisions Using the Australian BEACH Data Set. Medical Decision Making, 44 (6), pp. 627-640. https://doi.org/10.1177/0272989x241263823
Abstract
Background
General practitioners (GPs) make numerous care decisions throughout their workdays. Extended periods of decision making can result in decision fatigue, a gradual shift toward decisions that are less cognitively effortful. This study examines whether observed patterns in GPs’ prescribing decisions are consistent with the decision fatigue phenomenon. We hypothesized that the likelihood of prescribing frequently overprescribed medications (antibiotics, benzodiazepines, opioids; less effortful to prescribe) will increase and the likelihood of prescribing frequently underprescribed medications (statins, osteoporosis medications; more effortful to prescribe) will decrease over the workday.
Methods
This study used nationally representative primary care data on GP-patient encounters from the Bettering the Evaluation and Care of Health program from Australia. The association between prescribing decisions and order of patient encounters over a GP’s workday was assessed with generalized linear mixed models accounting for clustering and adjusting for patient, provider, and encounter characteristics.
Results
Among 262,456 encounters recorded by 2,909 GPs, the odds of prescribing antibiotics significantly increased by 8.7% with 15 additional patient encounters (odds ratio [OR]?=?1.087; confidence interval [CI]?=?1.059–1.116). The odds of prescribing decreased significantly with 15 additional patient encounters by 6.3% for benzodiazepines (OR?=?0.937; CI?=?0.893–0.983), 21.9% for statins (OR?=?0.791; CI?=?0.753–0.831), and 25.0% for osteoporosis medications (OR?=?0.750; CI?=?0.690–0.814). No significant effects were observed for opioids. All findings were replicated in confirmatory analyses except the effect of benzodiazepines.
Conclusions
GPs were increasingly likely to prescribe antibiotics and were less likely to prescribe statins and osteoporosis medications as the workday wore on, which was consistent with decision fatigue. There was no convincing evidence of decision fatigue effects in the prescribing of opioids or benzodiazepines. These findings establish decision fatigue as a promising target for optimizing prescribing behavior.
Keywords
decision fatigue; drug prescribing; general practitioners; clinical decision-making; practice patterns; physicians
Journal
Medical Decision Making: Volume 44, Issue 6
Status | Published |
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Funders | |
Publication date | 31/08/2024 |
Publication date online | 26/07/2024 |
Date accepted by journal | 02/07/2024 |
URL | |
Publisher | SAGE Publications |
ISSN | 0272-989X |
eISSN | 1552-681X |
People (1)
Professor in Psychology, Psychology