Physician management of immunoglobulin in Canada: A qualitative study

BACKGROUND: The uses of plasma-derived medical products like Immunoglobulin (Ig) have expanded in recent years. This increasing demand has prompted countries globally to undertake efforts to both increase plasma sufficiency, and develop mitigation measures for shortages in supply, including engaging in demand management. METHODS: We conducted among the first qualitative studies of physician management of Ig in Canada. We used semi-structured interviews and analyzed data with interpretive thematic analysis. RESULTS: Our findings reflect perspectives from 12 clinicians who prescribe Ig in Canada in the context of rising use of and demand for this treatment. Across the sample, we identified three general orientations toward Ig prescribing: 1, concern and uncertainty about prescribing Ig; 2, good stewardship of a scarce resource; 3, advocacy for access to treatment. CONCLUSION: This study examined how physicians who prescribe Ig understand their practice in relation to the rising international demand for, and cost of this treatment. To date, policy efforts focusing on physician prescribing have encouraged a rational and evidence-based approach to prescribing. Our study complicates that approach. We identified three general orientations toward Ig prescribing. These should not replace rational prescribing but suggest that a mechanistic approach solely focused on the rational application of the best evidence could be inadequate.