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

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.