Diagnostic uncertainty and prescription practices among pharmacists

Last registered on July 01, 2024
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Pre-Trial

Trial Information

General Information

Title
Diagnostic uncertainty and prescription practices among pharmacists
RCT ID
AEARCTR-0013910
Initial registration date
June 28, 2024

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
July 01, 2024, 12:58 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
Ghana
Region
Greater Accra

Primary Investigator

Name
Jan Priebe
Affiliation
Bernhard Nocht Institute for Tropical Medicine (BNITM)
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Other Primary Investigator(s)

PI Name
Edward Asiedu
PI Affiliation
University of Ghana
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PI Name
Christoph Strupat
PI Affiliation
German Institute of Development and Sustainability (IDOS)
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PI Name
Matthias Rieger
PI Affiliation
Erasmus School of Health Policy & Management
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Additional Trial Information

Status
In development
Start date
2024-07-02
End date
2024-09-15
Keywords
Health
Additional Keywords
health care, pharmacy, uncertainty, Africa
JEL code(s)
D81, D83, I12
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Our study aims to explore to what extent diagnostic uncertainty influences treatment choices of pharmacists in urban Ghana. A focus of the study will be to explore how pharmacists’ knowledge and economic preferences (e.g. risk aversion) influence dispensing practices.
External Link(s)

Registration Citation

Citation
Asiedu, Edward et al. 2024. " Diagnostic uncertainty and prescription practices among pharmacists." AEA RCT Registry. July 01. https://doi.org/10.1257/rct.13910-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
• Vignettes: Individuals will receive 4 vignettes that aim to vary patients’ symptoms to signal more/less clear underlying medical conditions. The order of the vignettes is randomized.
• Audit study: We employ an audit study in which characters portray different systems with characters being linked to diagnostically more or less clear medical conditions. The order of characters visiting pharmacies is randomized.
Intervention (Hidden)
• Vignettes: Individuals will receive 4 vignettes that aim to vary patients’ symptoms to signal more/less clear underlying medical conditions. The order of the vignettes is randomized.
• Audit study: We employ an audit study in which characters portray different systems with characters being linked to diagnostically more or less clear medical conditions. The order of characters visiting pharmacies is randomized.
Intervention Start Date
2024-08-01
Intervention End Date
2024-09-15

Primary Outcomes

Primary Outcomes (end points)
I) Decision to give and sell antibiotics to patient (binary indicator)
II) Quality of advice related to antibiotics and condition
Primary Outcomes (explanation)
Quality score and binary indicators related to (i) antibiotic dispensing practices and (ii) health condition behavior & monitoring

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study employs a within-pharmacists design. Pharmacists receive a set of vignettes and are visited by mystery shoppers. The order of vignettes and of the different mystery shopper characters is randomized. Furthermore, actor-roles are randomized.
Experimental Design Details
Randomization Method
The random assignment will be done by (i) survey software (REDCAP) and (ii) principal investigators (STATA).
Randomization Unit
Pharmacist
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
No clustering.
Sample size: planned number of observations
1,600 (4 observations per pharmacist (N=400).
Sample size (or number of clusters) by treatment arms
800 (2 observations per pharmacist (N=400).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Comparison across alternative diagnostic uncertainties: In a basic group means comparison with 80% power, a significance level of 0.05, and 0.8 unit standard deviations, the MDE is 18pp for the total sample of 1,600 observations (4 per pharmacy). (Assumption: Baseline mean of 0.3 & 1 treatment vs. 1 control group comparison).
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
University of Ghana
IRB Approval Date
2024-06-11
IRB Approval Number
ECH 259/ 23-24
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials