{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:18:17Z","timestamp":1789802297577,"version":"4.0.1"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100021638","name":"Social Sciences and Humanities Research Council","doi-asserted-by":"publisher","award":["435-2022-0187"],"award-info":[{"award-number":["435-2022-0187"]}],"id":[{"id":"10.13039\/100021638","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354817","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:24:12Z","timestamp":1787160252000},"page":"e0354817","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Physician management of immunoglobulin in Canada: A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3867-1072","authenticated-orcid":true,"given":"Kelly","family":"Holloway","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umair","family":"Majid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinn","family":"Grundy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"issue":"5","key":"pone.0354817.ref001","doi-asserted-by":"crossref","first-page":"103987","DOI":"10.1016\/j.transci.2024.103987","article-title":"Towards personalized and rational use of immunoglobulins amid expanding indications and shortages","volume":"63","author":"H Goubran","year":"2024","journal-title":"Transfus Apher Sci"},{"issue":"5","key":"pone.0354817.ref002","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/tme.12889","article-title":"Using a scenario approach to assess for the current and future demand of immunoglobulins: an interview and literature study from The Netherlands","volume":"32","author":"P Langi Sasongko","year":"2022","journal-title":"Transfus Med"},{"issue":"2","key":"pone.0354817.ref003","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/vox.13758","article-title":"Securing commitment and control for the supply of plasma derivatives for public health systems. 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The emergence of a national imperative","volume":"17","author":"A Farrugia","year":"2019","journal-title":"Blood Transfus"},{"issue":"5","key":"pone.0354817.ref005","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1111\/trf.17801","article-title":"A global analysis of the use of immunoglobulin, shortages in supply, and mitigating measures: a survey of hospital providers (a BEST Collaborative study)","volume":"64","author":"C So-Osman","year":"2024","journal-title":"Transfusion"},{"key":"pone.0354817.ref006","volume-title":"Report on EMA workshop on the challenges in drug development, regulation and clinical practice for immunoglobulins","author":"D Philadelphy","year":"2025"},{"key":"pone.0354817.ref007","doi-asserted-by":"crossref","first-page":"893770","DOI":"10.3389\/fpubh.2022.893770","article-title":"Dealing with immunoglobulin shortages: a rationalization plan from evidence-based and data collection","volume":"10","author":"G Sol\u00eds-D\u00edez","year":"2022","journal-title":"Front Public Health"},{"key":"pone.0354817.ref008","doi-asserted-by":"crossref","first-page":"879287","DOI":"10.3389\/fphar.2022.879287","article-title":"Prescribing practices of intravenous immunoglobulin in tertiary care hospitals in malaysia: a need for a national guideline for immunoglobulin use","volume":"13","author":"JL Lee","year":"2022","journal-title":"Front Pharmacol"},{"key":"pone.0354817.ref009","author":"Canadian Blood Services","year":"2021"},{"key":"pone.0354817.ref010","doi-asserted-by":"crossref","first-page":"37","DOI":"10.58931\/cht.2025.4380","article-title":"Rational use of immunoglobulin in adult patients with secondary Hypogammaglobulinemia in the setting of hematologic malignancy: a canadian perspective","author":"O Prokopchuk-Gauk","year":"2025","journal-title":"Canadian Hematology 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