Improving medication safety through behavioral nudges: An evaluation of unit sales trends following a pharmacy-based intervention

Authors

• Shiying Mai, Clinical Practice, Innovation, and Research Division, University of Wisconsin-Madison School of Pharmacy, 2505 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, USA. Electronic address: smai5@wisc.edu.
• Aaron M. Gilson, Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI, USA.
• Ronald E. Gangnon, Department of Population Health Sciences and Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, USA.
• Jamie A. Stone, Chui SAMS (Systems Approach to Medication Safety) Lab, University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, USA.
• Kenneth D. Walker, Advocate Health - MidwestFollow
• Joel D. Gollhardt, Advocate Health - MidwestFollow
• Michelle A. Chui, Chui SAMS (Systems Approach to Medication Safety) Lab, University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, USA. Electronic address: michelle.chui@wisc.edu.

Recommended Citation

Mai S, Gilson AM, Gangnon RE, et al. Improving medication safety through behavioral nudges: An evaluation of unit sales trends following a pharmacy-based intervention. Res Social Adm Pharm. Published online April 3, 2026. doi:10.1016/j.sapharm.2026.04.003

Affiliations

Aurora Pharmacy, Menomonee Falls

Abstract

Background: Over-the-counter (OTC) medication misuse among older adults is a patient safety concern, exacerbated by limited patient engagement about potential risks. Senior Safe™, a pharmacy-based intervention using human-factors engineering and participatory design,specifically, shelf signage, product repositioning, and patient engagement to nudge safer choices. Despite its safety intent, and demonstrated effectiveness, it was important to determine the intervention's impact on its financial sustainability.

Methods: This study evaluated Senior Safe's effect on daily unit sales of OTC analgesic, sleep, and cough/cold/allergy products across 65 community pharmacies in a Midwestern health system. Using Generalized Linear Mixed Model regressions with Poisson distribution, the analyses compared daily unit sales pre- and post-intervention trends for products marked with Green Banners (safer), Red Stop Signs (high-risk), or Behind-the-Counter (BTC) signage (very high-risk), controlling for pharmacy type, size, location, open hours, and staff hours.

Results: Senior Safe was associated with increased sales of safer analgesics and cough/cold/allergy medications (IRR = 1.064 and 1.106), along with significant decreases in unit sales of BTC and Red Stop Sign products (IRR = 0.424-0.869). These findings suggest a substitution effect, where patients chose safer alternatives rather than forgoing OTC purchases. Operational factors, such as longer open hours and higher staffing levels, were positively associated with safer product unit sales.

Conclusions: Senior Safe successfully shifted consumer behavior toward safer OTC medication use without reducing overall sales volume, suggesting patient safety interventions can be financially sustainable in retail pharmacy settings. These results support broader implementation of low-cost, system-level interventions that align safety with business operations.

Document Type

Article

PubMed ID

41963129