An E-Nudge That Didn't Work

... but is an "electronic letter" really a "nudge"?

I’m generally a fan of “nudges", passive clinical decision-support, and other non-interruptive interventions to help clinicians do the right thing as a path of least resistance. So, I was a bit surprised to see a “nudge” intervention that didn’t work.

Well, my surprise evaporated rapidly once I had a chance to read the entirety of the trial and protocol.

This is a trial performed in Denmark, attempting to improve outcomes in chronic kidney disease. Denmark, unsurprisingly, like most nationalized health systems, cares a lot about their GPs keeping up with modern guidelines to ensure the highest-quality care for their citizens. So, for this 2x2 trial, they had a couple interventions – they contacted GPs to remind them regarding best practices, and they contacted patients to encourage them to follow-up with their GPs regarding their CKD.

And … nothing happens:

So … yeah.

General practices received one, very generic “hey, the Danish Nephrology Society updated their guidelines”. Patients received a generic “did you know you have kidney disease?” information sheet. These were each delivered through the national Danish electronic healthcare portal as a one-off event, absent any specific context.

Clearly, this is not even close to satisfying the 5 Rights of CDS (the right information, to the right person, in the right format, through the right channel, at the right time), so it’s clear how it was doomed from the start. There are some exploratory endpoints where patients were slightly better informed about their health, but this did not manifest in any objectively measured endpoint.

Not a nudge! And not a useful tool for a health system to change clinician behavior.