Contributions
Abstract: EP1797
Type: ePoster
Abstract Category: Therapy - disease modifying - 32 Others
Background: The proportion of people with relapsing forms of multiple sclerosis prescribed disease modifying treatments (DMTs) in the United Kingdom is considered low compared with other countries. National surveys also indicate large differences between UK regions (England, Wales, Scotland, Northern Ireland) in the proportion of people eligible for DMTs who are prescribed these medications. Despite this, there has been little research into factors influencing prescribing which could explain variation in treatment rates, and very few studies of clinicians' views, decision-making processes, and prescribing practices. This study aims to investigate the experiences of neurologists who prescribe DMTs and MS specialist nurses who help patients access these drugs, to identify factors influencing prescribing and uptake of DMTs.
Methods: Semi-structured hour-long interviews were conducted with 18 consultant neurologists and 16 specialist nurses. Participants were purposively sampled from diverse National Health Service (NHS) settings across the four UK nations. Interview transcripts were analysed using a thematic framework analysis.
Results: Prescribing of DMTs is influenced by organisational, inter-professional, and individual factors. Services differed in procedures for identifying relapses, role of MS nurses in ascertaining eligibility for DMTs and facilitating patients' decisions, and responsibilities of general neurologists versus MS specialist neurologists. Individual prescribing practices are influenced by organisational prescribing “cultures”, informal “benchmarking” within peer networks, and prior experience with different DMTs, though non-specialist clinicians prescribing in isolation may miss out on these influences. Prescribers differ in their perceptions of the benefits and risks of DMTs, their preferences for managing patient decision-making, and personal “thresholds” for discerning relapses and determining eligibility for DMTs according to treatment guidelines. These individual differences influence conversations with patients and the strength of treatment recommendations. Variation in practice was more evident between prescribing centres and between individual prescribers than between UK regions.
Conclusions: These findings reveal organisational and individual differences in DMT prescribing practices, which have implications for equitability of care for people with relapsing multiple sclerosis seeking disease modifying therapy.
Disclosure: This research was funded by the Multiple Sclerosis Society of the United Kingdom.
E. Cameron, G. McDonnell, and D. French have no conflicts of interest to declare.
D. Rog has served on advisory boards and/or received speaking fees from Biogen, Sanofi Genzyme, Merck, Roche, Novartis and Teva Pharmaceuticals, and has had research support to an institutionally-managed fund from: Biogen, GW Pharma, Sanofi Genzyme, Merck, Mitsubishi, Novartis and Teva Pharmaceuticals.
J. Overell has received honoraria for speaking engagements and attendance at advisory boards from Teva, Novartis, Merck-Serono, Genzyme, Roche, Allergan and Biogen. Additionally his department has received educational grants, research funding and funds to provide nursing and administrative staff from these companies
O. Pearson served on the scientific advisory board for Biogen, Novartis, Roche, UK MS Register and has received travel funding and/or speaker honoraria from Biogen, Roche, Merck Serono, Novartis, Teva, Genzyme Sanofi.
Abstract: EP1797
Type: ePoster
Abstract Category: Therapy - disease modifying - 32 Others
Background: The proportion of people with relapsing forms of multiple sclerosis prescribed disease modifying treatments (DMTs) in the United Kingdom is considered low compared with other countries. National surveys also indicate large differences between UK regions (England, Wales, Scotland, Northern Ireland) in the proportion of people eligible for DMTs who are prescribed these medications. Despite this, there has been little research into factors influencing prescribing which could explain variation in treatment rates, and very few studies of clinicians' views, decision-making processes, and prescribing practices. This study aims to investigate the experiences of neurologists who prescribe DMTs and MS specialist nurses who help patients access these drugs, to identify factors influencing prescribing and uptake of DMTs.
Methods: Semi-structured hour-long interviews were conducted with 18 consultant neurologists and 16 specialist nurses. Participants were purposively sampled from diverse National Health Service (NHS) settings across the four UK nations. Interview transcripts were analysed using a thematic framework analysis.
Results: Prescribing of DMTs is influenced by organisational, inter-professional, and individual factors. Services differed in procedures for identifying relapses, role of MS nurses in ascertaining eligibility for DMTs and facilitating patients' decisions, and responsibilities of general neurologists versus MS specialist neurologists. Individual prescribing practices are influenced by organisational prescribing “cultures”, informal “benchmarking” within peer networks, and prior experience with different DMTs, though non-specialist clinicians prescribing in isolation may miss out on these influences. Prescribers differ in their perceptions of the benefits and risks of DMTs, their preferences for managing patient decision-making, and personal “thresholds” for discerning relapses and determining eligibility for DMTs according to treatment guidelines. These individual differences influence conversations with patients and the strength of treatment recommendations. Variation in practice was more evident between prescribing centres and between individual prescribers than between UK regions.
Conclusions: These findings reveal organisational and individual differences in DMT prescribing practices, which have implications for equitability of care for people with relapsing multiple sclerosis seeking disease modifying therapy.
Disclosure: This research was funded by the Multiple Sclerosis Society of the United Kingdom.
E. Cameron, G. McDonnell, and D. French have no conflicts of interest to declare.
D. Rog has served on advisory boards and/or received speaking fees from Biogen, Sanofi Genzyme, Merck, Roche, Novartis and Teva Pharmaceuticals, and has had research support to an institutionally-managed fund from: Biogen, GW Pharma, Sanofi Genzyme, Merck, Mitsubishi, Novartis and Teva Pharmaceuticals.
J. Overell has received honoraria for speaking engagements and attendance at advisory boards from Teva, Novartis, Merck-Serono, Genzyme, Roche, Allergan and Biogen. Additionally his department has received educational grants, research funding and funds to provide nursing and administrative staff from these companies
O. Pearson served on the scientific advisory board for Biogen, Novartis, Roche, UK MS Register and has received travel funding and/or speaker honoraria from Biogen, Roche, Merck Serono, Novartis, Teva, Genzyme Sanofi.