PONE-D-24-24221A behavioural analysis of factors influencing prescribing for neurodegenerative diseases: a rapid reviewPLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for inviting me to review this rapid review of the literature which has been capably and comprehensively conducted. I applaud the authors for their work and diligence in adhering to all the reporting guidelines and appropriate checklists. It is also pleasing to see a mix of inductive and deductive approaches being applied to the analysis as this is something that has been raised as a potential limitation of applying the COM-B/TDF to the mapping of data if this is done without exploration of other factors. I have a few minor issues to be addressed.

1. What was the role of Alpharmaxim Healthcare Communications Ltd in the research? The acknowledgement section recognises the contributions but I wondered why they were involved in the first place? Are there any potential conflicts? It is difficult to judge this without further supporting information.

2. Introduction - I was wondering why all NDs were pooled for the purpose of this review. This became clearer later on in the Methods section when it is explained that preliminary searches for PD only yielded few outputs. However the reader is left wondering about this much earlier in the paper. Can the rationale for this be made clearer earlier on?

3. Results - The final number of PD papers was 13 which is sufficient for a rapid review. Whilst I liked the way the data were synthesised - I would have liked to have seen some categorisation of data for specific NDs such as PD and Alzheimer's. I feel that this would be more beneficial for clinicians in practice and would strengthen the significance / implications of the findings. Are there plans to do this in the future? I am not suggesting a reanalysis at this stage, but can these issues be addressed somewhere in the Discussion?

Line 198 - what does 'logical fallacy' mean? I think I can guess, but it is not a term that I am familiar with.

Line 217 and others - please add 'Capability - Patient related factors' to the sub-heading for Patient, HCP and healthcare system factors etc. for all the COM - otherwise it it easy for the reader to loose track of which COM-B domain is referred to.

Line 260 - I was shocked to read that HCPs adjusted the diagnosis to avoid delays in prescribing (ref 41) - this should be picked up for Discussion and merits further investigation.

Line 333-334 - I was not sure what the sentence in parenthesis meant? Is this needed?

Line 341 - add 'reducing' before QoL.

Line 361 - trigging - should this be 'triggering'?

Line 391-391 - I was unsure how Ref 69 had been managed during the searching and screening process (systematic review). Were the individual studies included in the 48? Please make this clearer.

Reviewer #2: It was a pleasure to read and review this paper reporting a rapid review of the behavioural determinants of prescribing for neurodegenerative diseases. Overall, this is a well conducted and well reported review that I enjoyed reading. I think it will be a useful contribution to the field - and particularly useful for any teams who carry out audits of prescribing practices. and, I have a few minor comments, to aid those less familiar with behaviour change theory, I hope these are helpful.

Abstract:

- can you indicate in here the type of studies included in the review, and also stating that it is a rapid review in your abstract would be helpful

- your conclusion could be improved I think. You have taken the time in the discussion, to consider potential behaviour change techniques that could address behavioural determinants of prescribing, and help optimise prescribing. You don't have space to list them all, but perhaps including one example in the conclusion of your abstract would be useful, and I think it creates a nice 'hook' to keep people reading onto the main body of the paper.

Methods

I think somewhere in your methods, probably the study inclusion criteria, to be explicit that you were including all types of prescribing. Although I do wonder whether your search strategy really captures all types of prescribing as there were no search terms for non-medical prescribing / supplementary or independent prescribing, You state in the discussion that the review was focussed on clinical specialism rather than type of prescriber but - I am not entirely sure what you mean by this, and whether you have considered the different types of prescribers that people with ND might encounter. So I think it would be very useful to be clear in the methods, whether your review was focussed on medical prescribing only, or whether you sought to capture non-medical prescribing in this review too.

Discussion

Where you discuss behaviour change techniques in relation to your COM-B/TDF analysis, I think it would be helpful to add in an explainer, (for those not used to behavioural science) along these lines: "Our review provides an overview of prescribing behaviour across a number of neurodegenerative conditions, and highlights a number of potential determinants of sub-optimal prescribing. In order to optimise prescribing, this review could be used, alongside a review or audit of prescribing for a condition or a prescribing audit for a specific medication or class of medications, to understand the factors that might be driving sub-optimal prescribing of a specific medicine / class of medicines / for a specific neurodegenerative condition (e.g. PD)." --- At the moment, your review covers so many types of prescribing behaviour and different conditions, and prescribing can be sub-optimal in so many different ways (e.g. prescribed too much, wrong formulation, wrong dose / suboptimal dose, wrong dosing schedule, not prescribing to guidelines, not prescribing within local prescribing budget limits, co-prescribing with other drugs when its contraindicated etc), it isn't really a behavioural analysis, as you haven't specified your target behaviour. Narrowing down the target behaviour, would slim down the number of behavioural determinants you had to work with / design an intervention to address.

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Reviewer #1: Yes:  Prof Delyth James

Reviewer #2: Yes:  Dr Hannah Family

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A behavioural analysis of factors influencing prescribing for neurodegenerative diseases: a rapid review

PONE-D-24-24221R1

Dear Dr. Senior,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Vaibhavi Peshattiwar, PhD

Guest Editor

PLOS ONE

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All my comments have been addressed. Thanks for the detailed responses. I wish you the best of luck with the larger programme of research within which this study sits.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: Yes:  Professor Delyth James

Reviewer #2: Yes:  Hannah Family

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