Behavioural analysis of factors influencing prescribing for neurodegenerative diseases: A rapid review

The incidence and prevalence of neurodegenerative diseases (NDs) are growing worldwide. In an environment where healthcare resources are already stretched, it is important to optimise treatment choice to help alleviate healthcare burden. This rapid review aims to consolidate evidence on factors that influence healthcare professionals (HCPs) to prescribe medication for NDs and map them to theoretical models of behaviour change to identify the behavioural determinants that may support in optimising prescribing.

Embase and Ovid MEDLINE were used to identify relevant empirical research studies. Screening, data extraction and quality assessment were carried out by three independent reviewers to ensure consistency. Factors influencing prescribing were mapped to the Theoretical Domains Framework (TDF) and key behavioural determinants were described using the Capability, Opportunity, Motivation - Behaviour (COM-B) model. An initial 3,099 articles were identified, of which 53 were included for data extraction. Fifty-six factors influencing prescribing were identified and categorised into patient, HCP or healthcare system groups, then mapped to TDF and COM-B domains. Prescribing was influenced by capability of HCPs, namely factors mapped to decision making (e.g., patient age or symptom burden) and knowledge (e.g., clinical understanding) behavioural domains. However, most factors were influenced by HCP opportunity, underpinned by factors mapped to social (e.g., prescribing support or culture) and contextual (e.g., lack of resources or medication availability) domains. Less evidence was available on factors influencing the motivation of HCPs, where evident; factors primarily related to HCP belief about consequences (e.g., side effects) and professional identify (e.g., level of specialism) were often described.

This systematic analysis of the literature provides an in-depth understanding of the behavioural determinants that may support in optimising prescribing practices (e.g., drug costs or pressure from patients' family members). Understanding these approaches provides an opportunity to identify relevant intervention functions and behaviour change techniques to target the factors that directly influence HCP prescribing behaviour.