Psychological barriers limit prescribing of new neurodegenerative treatments

A new pan-European study has identified the key behavioral factors that influence whether healthcare professionals prescribe new, novel or non-routine treatments for patients with neurodegenerative diseases.

The findings provide important insights into how behavior change frameworks could support the uptake of new and potentially transformative treatments. With incidence and prevalence continuing to rise, neurodegenerative diseases such as Parkinson's represent a growing global healthcare challenge. As new treatment options become available, understanding the factors that influence prescribing decisions is becoming increasingly important to ensure that patients can access the most appropriate therapies.

Published as the third and final paper in a three-part research program, the large-scale statistical analysis - completed by researchers from Alpharmaxim and Aston University as part of their Knowledge Transfer Partnership (KTP) funded by Innovate UK - surveyed 279 healthcare professionals across Europe and examined the psychological and contextual factors that shape decision-making.

The researchers, which include Aston University's Dr Carl Senior, reader in psychology, and Dr Jason Thomas, senior lecturer in psychology, found that getting new treatments used in practice is as much a behaviour change problem as it is a medical one. They identified several key predictors of prescribing behavior.

Even where the clinical evidence for a new medication is strong, healthcare professionals can be reluctant to prescribe it for several reasons, including past negative experiences with similar new drugs, established habits and uncertainty about the outcome.

The stage of a patient's disease also influences a healthcare professional's decision as to whether to prescribe new medication. In the early stages of a disease, a doctor is more likely to adhere to existing guidelines and routine prescribing. They are more likely to consider prescribing a new or different medication to a patient with more advanced disease.

The researchers found four main influences on prescribing - a clinician's confidence in their skills, opportunity to prescribe new medication, including guidelines and access, motivation, and their intention (or conscious readiness) to prescribe.

Improving uptake of innovative treatments isn't just about better drugs, it requires targeted behaviour change strategies for clinicians. The researchers found that the strongest lever to change behaviour around prescribing is to shift intention to prescribe. This might include addressing beliefs about outcomes, and providing training, decision support and clear, accessible guidelines about new therapies. System-level support and policy alignment helps to improve opportunity.

The study is the culmination of a wider research program designed to better understand prescribers' decision-making in neurodegenerative disease. The systematic review results published in PLoS One identified potential intervention strategies to support change, while the focus group study published in BMJ Open established expert consensus on the factors that influence prescribing behavior. Together, the findings of these three papers triangulate to validate the identified barriers to behavior change. This research forms the backbone of Alpharmaxim's Healthcare Behavioural Insights Tool (H-BIT), a diagnostic framework for behavioral barriers that enables stakeholders to design more effective communications strategies.

This study is the final piece of the puzzle. We now have an established method for identifying the factors that may predict the likelihood of a doctor prescribing better therapy. We studied European clinicians caring for patients with Parkinson's disease, where the dominant therapy has several well-known side effects. Despite the availability of alternatives, it is notoriously difficult to encourage doctors to prescribe them. Our findings identified ways to facilitate decision change in this uniquely resistant prescribing context."

Dr. Carl Senior, reader in psychology, Aston University

Jason Thomas, senior lecturer in psychology at Aston University, said:

"On average, the chance of a newly diagnosed patient receiving a new and potentially better drug is around 50:50. Or put another way, your doctor's decision of whether to give you the latest treatment could be replaced by flipping a coin. This is not reassuring. This study shows that we can identify what determines healthcare professionals' decision-making and help unlock access to the latest, most efficacious treatments."

William Hind, CEO of Alpharmaxim, said:

"Data alone rarely changes behavior. This research demonstrates that prescribing decisions are influenced by a complex interplay of specific and generic predictors. By understanding these factors, we can design more effective approaches to support healthcare professionals in making informed treatment decisions and help ensure patients receive the therapies most appropriate for their needs."