Prescribing memantine in general practice in England: a survey and interview study.

Abstract

Background: Acetylcholinesterase inhibitors (AChEIs) are routinely prescribed for mild-to-moderate Alzheimer's Disease (AD). National guidance advises GPs to initiate memantine for patients already taking an AChEI, as it offers small benefits for moderate-to severe AD, with good tolerability. But this is not routinely done, potentially depriving patients of a beneficial treatment.

Aim: To assess prescribing for AD in general practice, explore factors influencing prescribing, and identify additional education needs.

Design & setting: Mixed methods study involving GPs in England.

Method: An online survey and semi-structured interviews were conducted. Survey responses were analysed in StataNow v18.5©. Interview transcriptions were coded in NVivo v14© by two researchers, who agreed themes. Quantitative and qualitative analyses were integrated and mapped to the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW).

Results: Survey respondents (n=115) mostly continued rather than initiated memantine. Fewer than half were confident in identifying AD stages and developing care plans for moderate-to-severe AD. Over 40% were unaware of current national guidance concerning memantine. Interviews (n=23) mostly concurred with survey findings. Direction from local formularies conflicts with current national guidance. Mapping to TDF and BCW identified barriers, facilitators and interventions for changing practice.

Conclusion: Limited time, patchy support and QOF downgrading contribute to a perception that dementia is not prioritised in general practice. Local systems for diagnosis and treatment reinforce GPs' feelings of inadequacy. GPs assess the impact of AD on patients/families but may not map assessments to a disease stage for memantine initiation. Interventions to change practice should boost knowledge and confidence; local pathways should clearly reflect national guidance.