Study IDs factors influencing drug prescriptions in Parkinson’s disease
Behavioral drivers behind clinicians' choices may limit medication access
Prescribing medication for Parkinson’s disease is not straightforward, but instead is influenced by a wide range of factors and behavioral drivers, according to a new study from Europe that investigated possible reasons for the choices of prescription drugs given by treating clinicians.
Beyond clinical guidelines, the researchers found that healthcare professionals’ medication choices for their patients with Parkinson’s are shaped by a complex mix of medical knowledge, practical constraints, and social influences — all of which may inadvertently limit access to the most effective treatments, the team noted.
“Supporting people with Parkinson’s requires more than just providing habitual treatment options. … It demands a deeper understanding of the complex nuances shaping prescribing behaviour that could be hindering potentially efficacious therapies,” Emma Begley, PhD, a behavioral scientist from Aston University in the U.K. and the study’s lead author, said in a news story from Alpharmaxim. The healthcare communications agency collaborated with Aston researchers on the project.
To improve treatment outcomes, the researchers suggested that behavioral strategies should aim to support clinicians’ knowledge about available medications, address concerns that may prevent the use of certain therapies, ensure access to medications, and promote collaboration among healthcare professionals.
According to the researchers, all “specific behavioural domains [affecting clinician choices] … should be targeted to help optimise … prescribing decisions.”
The study, “Can behavioural science be used to understand factors that influence the prescription choice for Parkinson’s disease? A pan-European focus group study of clinicians’ prescribing practice,” was published in the journal BMJ Open.
Prescribing treatments for Parkinson’s is often a complex process that requires clinicians to tailor decisions to each patient’s unique symptoms, while choosing from a wide range of available therapies, including new options that continue to emerge.
“It is critical that, with the medication available, the best options are prescribed for each patient and, as new more effective drugs arrive, that healthcare professionals (HCSs) are informed in their choices,” the researchers wrote.
Researchers warn against ‘underestimating the role of these influences’
While clinical guidelines and evidence-based recommendations support treatment choices, “there is clearly a wide variety of factors that can influence HCP decision-making, and there is a risk of negatively impacting healthcare practice by underestimating the role of these influences,” the team wrote.
William Hind, a study coauthor and CEO at Alpharmaxim, noted that “the factors that influence prescribing decisions in Parkinson’s are not always well understood.”
Hind said researchers need to go beyond just numbers and data.
“By applying behavioural science, we can identify barriers to change and determine the behavioural components that may greatly help the appropriate personalisation of medicine,” Hind said.
To that end, the team launched a study seeking to identify the key drivers behind prescribing decisions in Parkinson’s care. Their study involved 18 clinicians from eight European countries — among them neurologists, consultants, and specialist nurses — all of whom had prescribed Parkinson’s medications in the prior two years. The participants were recruited through clinical societies, social media, and direct outreach.
Each clinician took part in one of seven online focus groups, each moderated by the research team. During the sessions, participants were asked to list the factors that influence their prescribing, discuss them with peers, and then rank those they considered most important.
In total, the clinicians identified 60 different influences. When asked to prioritize them, however, a few consistently stood out.
Among these, clinical factors — such as symptom severity, disease stage, and risk of side effects — were ranked highest across the groups. Patient-related factors such as age, frailty, cognitive function, and overall quality of life were also commonly ranked as key drivers in prescribing decisions.
Other commonly cited factors included access to treatment, patient preferences, and support at home to manage medications.
Aspects such as treatment cost, a drug’s efficacy and safety, collaborative team care, and individual treatment goals were also discussed, though ranked less consistently across groups.
3 groups of behavioral drivers seen in prescription drug choices in Parkinson’s
When analyzing the behavioral reasons behind prescribing choices, the researchers used tools from behavioral science to group the most frequently prioritized influences into three core behavioral domains.
The first, psychological capability, referred to mental resources that clinicians rely on when making prescribing decisions. This included how confident they felt in their understanding of different medications, and how they interpreted patient symptoms and clinical details to guide treatment choices.
The second category, reflective motivation, was focused on personal values and beliefs that guide a clinician’s choices — among them, concerns about side effects or reduced quality of life, alignment with patient preferences and needs, and the influence of previous experiences with certain therapies.
When developing an intervention to target optimised prescribing for [Parkinson’s], it will be important to create a strategy that will address each of these behavioural determinants.
The final group, opportunity, was related to the external factors that either support or limit treatment decisions. These included practical constraints like medication availability and cost, time constraints during appointments, and access to treatment guidelines. Social factors such as support from colleagues, shared decision-making with patients, and help from carers at home also played a role.
“To optimise the treatment that patients with [Parkinson’s] are prescribed, behavioural interventions should consider approaches that collectively target [healthcare professionals’] psychological (e.g., knowledge) capability, physical (e.g., availability of drugs) and social (e.g., peer influence) opportunities and reflective (e.g., reduce beliefs of potential consequences) motivation,” the researchers concluded. “When developing an intervention to target optimised prescribing for [Parkinson’s], it will be important to create a strategy that will address each of these behavioural determinants.”
The researchers noted that their end goal is to try to ensure the best care for people with Parkinson’s.
“The aim of the current work is to understand consensus on behaviour around prescribing, which will serve to allow us to highlight the ways in which it can, ultimately, be improved,” the team wrote.
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