Prescribing memantine in general practice in England: a mixed-methods study

Area of Science:

• Gerontology
• Pharmacology
• General Practice Research

Background:

• Acetylcholinesterase inhibitors (AChEIs) are standard for mild-to-moderate Alzheimer's Disease (AD).
• National guidelines recommend memantine for moderate-to-severe AD patients on AChEIs, offering modest benefits and good tolerability.
• Current practice shows memantine initiation is not routine, potentially limiting patient access to effective treatment.

Purpose of the Study:

• To evaluate memantine prescribing patterns for Alzheimer's Disease in UK general practice.
• To identify factors influencing memantine prescription by General Practitioners (GPs).
• To determine educational needs for improving AD management and treatment adherence.

Main Methods:

• A mixed-methods study involving General Practitioners (GPs) in England.
• Online surveys (n=115) and semi-structured interviews (n=23) were conducted.
• Data were analyzed using quantitative and qualitative methods, integrated and mapped to the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW).

Main Results:

• Most surveyed GPs continued rather than initiated memantine for AD.
• Less than half of GPs felt confident staging AD or managing moderate-to-severe cases.
• Over 40% of GPs were unaware of national guidance on memantine; local formularies often conflicted with national recommendations.

Conclusions:

• Perceived lack of prioritization, limited time, and inadequate support affect dementia care in general practice.
• Local diagnostic and treatment systems can undermine GP confidence in managing AD.
• Interventions should focus on enhancing GP knowledge and confidence, aligning local pathways with national AD treatment guidelines.