Factors influencing multiple sclerosis disease-modifying treatment prescribing decisions in the United Kingdom: A qualitative interview study

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • David Rog
  • Gavin Mcdonnell
  • James Overell
  • Owen Pearson

Abstract

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.

Bibliographical metadata

Original languageEnglish
Pages (from-to)378-382
JournalMultiple sclerosis and related disorders
Volume27
Early online date22 Nov 2018
DOIs
Publication statusPublished - 1 Jan 2019

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