| 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 effective | Specialist and other support unavailable Multidisciplinary team working is absent or not effective | Environmental context and resources Beliefs about capabilities | Physical opportunity Reflective motivation | Environmental restructuring Education |
| Access 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 resources | Reflective motivation Physical opportunity | Education Persuasion Enablement Modelling Environmental restructuring |
| Competing priorities | Practice identifies dementia as a priority | Practice follows QOF designation of dementia | Environmental context and resources Reinforcement | Physical opportunity Automatic motivation | Environmental restructuring Training Incentivisation |
| Confidence, knowledge, and skills gaps | Information about NICE (NG97) guidance Training in prescribing memantine and care for moderate-to-severe AD Confidence in evidence supporting memantine | Lack of information about NICE (NG97) guidance No training or not available in preferred format | Knowledge Skills Beliefs about capabilities Beliefs about consequences | Psychological capability Reflective motivation | Education Training Persuasion Enablement Modelling |
| Patient-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 capabilities | Psychological capability Reflective motivation | Education Training Persuasion Enablement Modelling |
| Prescribing versus non-pharmacological care | Low concerns about memantine in terms of effectiveness, tolerability, and interactions Knowledge of memantine | Concerns about memantine Lack of knowledge about memantine | Beliefs about capabilities Beliefs about consequences Knowledge Optimism | Reflective motivation Psychological capability | Education Persuasion Enablement Modelling |
AD = Alzheimer's disease. BCW = behaviour change wheel. NICE = National Institute for Health and Care Excellence. QOF = Quality and Outcomes Framework. TDF = Theoretical Domains Framework.