Article Figures & Data
Tables
Individual characteristic n Has initiated memantine Yes 5 No 18 Sex Male 13 Female 10 Years working as a GP 0–4 1 5–9 5 10–14 7 15–20 10 Special interest in dementia Yes 7 No 16 Mode of interviewa Online 17 Telephone 6 Practice characteristic Number of GPs in practiceb 1–5 3 6–10 8 >10 9 Deprivationb,c ≤5 12 >5 8 Region East of England 3 London 2 North East 2 North West 6 South East 3 South West 3 West Midlands 2 Yorkshire & Humberside 2 aInterviews conducted April–September 2024; average length of interview = 29 minutes and 45 seconds (range 17.43–54.54). b n = 3 not known. cIMD deprivation decile35 of general practice (lower number indicates greater deprivation). IMD = Index of Multiple Deprivation.
Characteristic n % Sex Male 50 48.1 Female 51 49.0 Prefer not to say 3 2.9 Years since qualifying as a GP 0–4 12 11.5 5–9 24 23.1 10–14 23 22.1 15–19 13 12.5 20–24 12 11.5 ≥25 20 19.2 Number of sessionsa worked per week 1–2 9 8.7 3–4 23 22.1 5–7 53 51.0 ≥8 16 15.4 Working as a locum No 78 75.0 Yes 26 25.0 Special interest in dementia No 73 70.2 Yes 31 29.8 Practice location East of England 10 9.6 East Midlands 4 3.8 London 20 19.2 North East England 2 1.9 North West England 21 20.2 South East England 9 8.7 South West England 26 25.0 West Midlands 4 3.8 Yorkshire and Humberside 7 6.7 Number of GPs in practice 1–5 20 19.2 6–10 49 47.1 11–15 25 24.0 16–20 2 1.9 21–25 4 3.8 26–30 3 2.9 aOne session = 4 hours and 10 minutes.36
Theme Facilitators for prescribing memantine in general practice Barriers to prescribing memantine in general practice TDF domain(s) BCW component(s) Potential function categories Existing division of responsibilities Change to formulary advice to match NICE NG97 Formulary continues to direct GP to specialist for treatment initiation Environmental context and resources Physical opportunity Environmental restructuring Availability of support GP has good access to specialist and other support
Multidisciplinary team working is effectiveSpecialist and other support unavailable
Multidisciplinary team working is absent or not effectiveEnvironmental context and resources
Beliefs about capabilitiesPhysical opportunity
Reflective motivationEnvironmental restructuring
EducationAccess and continuity of care Patients with AD can easily book appointments with the same GP Practice cannot offer continuity of care for patients with AD Social or professional role and identity
Beliefs about consequences
Environmental context and resourcesReflective motivation
Physical opportunityEducation
Persuasion
Enablement
Modelling
Environmental restructuringCompeting priorities Practice identifies dementia as a priority Practice follows QOF designation of dementia Environmental context and resources
ReinforcementPhysical opportunity
Automatic motivationEnvironmental restructuring
Training
IncentivisationConfidence, knowledge, and skills gaps Information about NICE (NG97) guidance
Training in prescribing memantine and care for moderate-to-severe AD
Confidence in evidence supporting memantineLack of information about NICE (NG97) guidance
No training or not available in preferred formatKnowledge
Skills
Beliefs about capabilities
Beliefs about consequencesPsychological capability
Reflective motivationEducation
Training
Persuasion
Enablement
ModellingPatient-centred care Belief that GP has the skills and is appropriate for prescribing for AD Belief in current division of responsibilities between GP and specialists Knowledge
Skills
Social or professional role and identity
Beliefs about capabilitiesPsychological capability
Reflective motivationEducation
Training
Persuasion
Enablement
ModellingPrescribing versus non-pharmacological care Low concerns about memantine in terms of effectiveness, tolerability, and interactions
Knowledge of memantineConcerns about memantine
Lack of knowledge about memantineBeliefs about capabilities
Beliefs about consequences
Knowledge
OptimismReflective motivation
Psychological capabilityEducation
Persuasion
Enablement
ModellingAD = Alzheimer's disease. BCW = behaviour change wheel. NICE = National Institute for Health and Care Excellence. QOF = Quality and Outcomes Framework. TDF = Theoretical Domains Framework.
Supplementary Data
- MDC_10.3399BJGPO.2025.0023_supp_v1.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Prescribing memantine in general practice in England: a mixed-methods study
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