Article
Details
Citation
Cameron E, Rog D, McDonnell G, Overell J, Pearson O & French DP (2019) Factors influencing multiple sclerosis disease-modifying treatment prescribing decisions in the United Kingdom: A qualitative interview study. Multiple Sclerosis and Related Disorders, 27, pp. 378-382. https://doi.org/10.1016/j.msard.2018.11.023
Abstract
Background
The proportion of people with relapsing-remitting multiple sclerosis prescribed disease modifying treatments (DMTs) in the United Kingdom (UK) is considered low compared with other countries. There are differences in DMT prescription rates between UK nations (England, Wales, Scotland, Northern Ireland). Despite this, there has been little research into decision-making processes and prescribing practices.
Objective
To investigate views and experiences of neurologists prescribing DMTs and MS specialist nurses to identify factors influencing prescribing.
Methods
Semi-structured interviews with 18 consultant neurologists and 16 specialist nurses from diverse settings across the four UK nations. Data were analysed using thematic framework analysis.
Results
Prescribing practices are influenced by organisational prescribing “cultures”, informal “benchmarking” within peer networks, and prior experience with different DMTs. Health professionals differ in their perceptions of benefits and risks of DMTs and personal “thresholds” for discerning relapses and determining eligibility for DMTs. Prescribers in England felt most constrained by guidelines.
Conclusion
To achieve equity in access to DMTs for people with MS eligible for treatment, there is a need for public discussion acknowledging differences in health professionals’ interpretations of “relapses” and guidelines and perceptions of DMTs, variation in organisational prescribing “cultures”, and whether the prevailing culture sufficiently meets patients’ needs.
Keywords
Multiple sclerosis, relapsing-remitting; Neurologists; Nurse specialists; Clinical decision-making; Drug prescriptions; Qualitative research
Journal
Multiple Sclerosis and Related Disorders: Volume 27
Status | Published |
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Funders | Multiple Sclerosis Society |
Publication date | 31/01/2019 |
Publication date online | 22/11/2018 |
Date accepted by journal | 20/11/2018 |
URL | http://hdl.handle.net/1893/30476 |
Publisher | Elsevier BV |
ISSN | 2211-0348 |
People (1)
Lecturer in Health Psychology, Psychology