Did knowledge, opinions, background, and health authority advice influenceearly prescribing of the novel Alzheimer's disease drug donepezil in general practice? National postal survey

Background - Donepezil was licensed in the UK in February 1997 for the trea tment of Alzheimer's disease. Aims - To determine the advice from health authorities about prescribing Al zheimer's disease drugs. To determine whether the first general practitione rs who prescribed donepezil in England differed from non-prescribers in ter ms of knowledge, opinions, background, and the prescribing-advice issued by their health authority, Methods - National postal survey of pharmaceutical advisors. Structured pos tal survey of all general practitioners in England who prescribed donepezil to two or more patients within the first 6 months of launch, compared with a random sample of non-prescribers. Results - Pharmaceutical advisors' survey: 75/100 pharmaceutical advisors r esponded, of whom 83% indicated that general practitioners should not initi ate prescribing of Alzheimer's disease drugs and 63% said that they should not prescribe, even under shared care arrangements. General practitioner su rvey: 311/473 (66%) prescribers and 484/947 (51%) non-prescribers responded after two mailings. Prescribers were similar to non-prescribers in terms o f demographic and practice characteristics, knowledge about Alzheimer's dis ease, diagnostic and initial management strategies, and the prescribing adv ice from health authorities. Prescribers were significantly more likely tha n non-prescribers to strongly agree/agree that new drugs should be prescrib ed for mild (p = 0.0008) and moderate (p = 0.003) Alzheimer's disease, that they should normally be initiated (p = 0.003) and monitored by a general p ractitioner (p < 0.0001), and that financial constraints should not be a co nsideration (p = 0.0001). Conclusion - Early prescribers differed from non-prescribers in their opini ons about using Alzheimer's disease drugs. Future research should examine m ethods to promote nationally equitable and rational prescribing of new drug s. Copyright (C) 1999 John Wiley & Sons, Ltd.