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Appears in Collections:Psychology Journal Articles
Peer Review Status: Refereed
Title: Factors influencing multiple sclerosis disease-modifying treatment prescribing decisions in the United Kingdom: A qualitative interview study
Author(s): Cameron, Elaine
Rog, David
McDonnell, Gavin
Overell, James
Pearson, Owen
French, David P
Keywords: Multiple sclerosis, relapsing-remitting
Nurse specialists
Clinical decision-making
Drug prescriptions
Qualitative research
Issue Date: Jan-2019
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.
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.
DOI Link: 10.1016/j.msard.2018.11.023
Rights: This article is available under the Creative Commons CC-BY-NC-ND license ( and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed. .
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