Neurodegenerative prescribing decisions shaped by habits and confidence

A European study on neurodegenerative prescribing decisions found that clinicians’ choices about newer treatments are shaped by behavior, experience and health-system factors, not clinical evidence alone. Aston University said the findings could help improve access to newer therapies for conditions including Parkinson’s disease as cases rise.

The cross-sectional survey, published in PLOS One, included 279 health care professionals across Europe. Researchers from Alpharmaxim and Aston University carried out the work through a Knowledge Transfer Partnership, Aston University said.

The study is the third and final paper in a three-part research program examining how clinicians decide whether to use new, novel or nonroutine medicines for neurodegenerative disease. The researchers said the work supports using behavior-change methods to identify barriers that keep newer treatments from being used in practice.

What affects doctors' prescribing decisions for new Parkinson's medicines?

The researchers identified four main drivers: clinicians’ confidence in their own skills, their opportunity to prescribe, their motivation and their intention to prescribe. Opportunity included practical factors such as treatment access and the presence of clear guidelines, according to the study.

Aston University said strong trial evidence may not be enough to change prescribing. Clinicians may hold back because of previous poor experiences with similar medicines, established prescribing habits or uncertainty about how a patient will respond.

The patient’s disease stage also played a role, according to the researchers. In earlier disease, clinicians were more likely to stay with guidelines and routine treatment, while they were more likely to consider a newer or different medicine for patients with more advanced disease.

Neurodegenerative diseases are conditions in which nerve cells progressively lose function or die. Parkinson’s disease is one example, and Aston University said rising incidence and prevalence make treatment decisions an increasingly pressing health care issue.

Why behavior change is part of treatment uptake

The researchers said the strongest target for changing prescribing behavior was clinicians’ intention to prescribe. They said that could involve addressing beliefs about treatment outcomes, offering training, giving decision support and making guidance on newer medicines easier to use.

System-level backing and policy alignment can also improve clinicians’ opportunity to prescribe, according to the study. Alpharmaxim said the findings feed into its Healthcare Behavioural Insights Tool, a diagnostic framework intended to identify behavioral barriers and support communication strategies.

Aston University psychologist Carl Senior said the research offers a way to identify factors that may predict whether a doctor prescribes what he described as better therapy. He said the team studied European clinicians caring for Parkinson’s patients in a prescribing context where alternatives exist but can be difficult to introduce.

Jason Thomas, a senior lecturer in psychology at Aston University, said the study suggests decision-making can be measured and used to help expand access to newer treatments. He said that, on average, a newly diagnosed patient’s chance of receiving a new and potentially better drug was about even.

William Hind, Alpharmaxim’s chief executive, said prescribing is influenced by a mix of specific and general predictors, and that data alone rarely change behavior. He said understanding those factors can help health care professionals make informed treatment decisions and help patients receive therapies suited to their needs.

This story draws on original reporting from Medical Xpress.