Start Submission Become a Reviewer

Reading: Can E-mails Affect Decision Making? The Effects of a Behavioral Economic Strategy on Antipsy...


A- A+
Alt. Display

Poster Abstracts

Can E-mails Affect Decision Making? The Effects of a Behavioral Economic Strategy on Antipsychotic Prescribing Behavior


Liliane DeAguiar-Rocha

The Behavior Web, LLC, US
X close



Despite the lack of evidence supporting its practice, antipsychotic polypharmacy (APP), is widely used1,2,3,. To change the outcomes that are directly related to doctors’ decisions, it is important to understand the decision-making process and the factors which affect it. Behavioral Economics is a field that blends social psychology and economics, and it seeks to understand how biases affecting the human decision-making process. Strategies based on Behavioral Economics principles have been successful in addressing many issues in healthcare. This paper describes a quality improvement project designed with the aim of reducing APP prescribing behavior in a large psychiatric hospital in Brazil.

Aims Objectives Theory or Methods

Nineteen units participated in this case study.  The intervention targeted all prescribers and it involved the use of norms and peer comparison, behavioral economics principles which indicate that individuals are more likely to adjust their behavior if they perform below the average performance of their peers. After baseline, where the APP prescribing rate for the whole hospital and for each unit in particular were assessed, a weekly email was sent to each prescriber with information about the hospital-wide APP prescribing rate, feedback related to the APP prescribing rates in their units, and how they compared to other units.

Highlights or Results or Key Findings

The intervention was successful in reducing hospital-wide APP prescribing rate.  After the second e-mail, we observed a steep drop in the APP prescribing rate, and the rate never returned to pre-intervention levels.  The weekly emails with feedback and peer comparisons yielded an average statistically significant difference of about 8.02% (t(10) = 4.7491, p < 0.008) over a brief 11-week period. This study demonstrated that e-mails designed according to a Behavioral Economics strategy can affect prescribing behavior. 


Information about the lack of evidence for the use of antipsychotic combinations, about the rates in other parts of the world, and information about the rates in hospitals with a similar population within their own state was enough to yield statistically significant results..

Implications for applicability/transferability sustainability and limitations

Future quality improvement projects targeting prescribing behavior should consider a combined use of guidelines and training with norms and peer comparison.

How to Cite: DeAguiar-Rocha L. Can E-mails Affect Decision Making? The Effects of a Behavioral Economic Strategy on Antipsychotic Prescribing Behavior. International Journal of Integrated Care. 2022;22(S2):203. DOI:
Published on 16 May 2022.


  • PDF (EN)