Comparative Effectiveness of Narratives to Promote Provider Adoption of Evidence Related to Antipsychotics Use for High-Risk Youth

Will communicating research through narratives have a greater impact on clinicians’ prescribing behaviors than evidence-based guidelines?

Clinicians are prescribing antipsychotic medications at alarming rates to children enrolled in Medicaid. Rubin and colleagues think that clinicians’ prescribing behaviors are amenable to change, but that standard evidence-based guidelines are unlikely to affect clinicians’ behavior. However, narratives—stories with an identifiable beginning, middle and end, which provide information about characters, scenes, and conflicts—have been recognized as a persuasive tool to promote patients’ health behavior change. Rubin hypothesizes that pairing guidelines with narratives that engage clinicians in concerns related to the misuse of antipsychotics will help shift attitudes, norms, and, ultimately, prescribing behaviors. The two-phase project will eventually include up to 4,000 clinicians in Pennsylvania who treat Medicaid-enrolled youth ages 5–18 with behavioral conditions. In phase one the research team will interview clinicians to ascertain the factors motivating their decision-making and prescribing behaviors. The interviews will also elicit patient care narratives and professional experiences. Phase two will involve a randomized controlled trial to test the effectiveness of these narratives in both written and video form, as compared to standard evidence-based guidelines presented in newsletter form.

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