Elaine Cameron1, David Rog2, Gavin McDonnell3, James Overell4, Owen Pearson5, David P French6. 1. School of Health Sciences, University of Manchester, Manchester, United Kingdom. Electronic address: elaine.cameron@manchester.ac.uk. 2. Department of Medical Neurosciences (Neurology), Salford Royal NHS Foundation Trust, Salford, United Kingdom. 3. MS Clinic, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom. 4. Glasgow MS Clinical Research Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom. 5. Department of Neurology, Abertawe Bro Morgannwg University Health Board, Swansea, United Kingdom. 6. School of Health Sciences, University of Manchester, Manchester, United Kingdom.
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.
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.