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Zeschick N, Gollnick J, Muth J, Hörbrand F, Killian P, Donner-Banzhoff N, Kühlein T, Sebastião M. Physicians' assessment of the Bavarian drug-expenditure control system: a qualitative study. BMC Health Serv Res 2023; 23:961. [PMID: 37679698 PMCID: PMC10483772 DOI: 10.1186/s12913-023-09844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND In 2014 a new system for drug expenditures, the Wirkstoffvereinbarung (WSV, English: Active substance agreement) was implemented in Bavaria. In pre-defined indication groups, economic prescription of medications shall be enabled based on the selection, quantity, and proportion of an individual drug. Ambulatory care physicians receive quarterly trend reports on their prescribing behavior. This study examines physicians' perceptions of the WSV. METHODS Qualitative interviews (n = 20) and seven focus groups (n = 36) were conducted with ambulatory care physicians (e.g. general practitioners, cardiologists, pulmonologists). The methodology followed Qualitative Content Analysis. RESULTS Physicians generally accepted the necessity of prescribing economically. The majority of them rated the WSV positively and better than the previous system. As an improvement, they especially named timely feedback in form of easily understandable trend reports, encouraging self-reflection as well as allowing early control options. Problems perceived were drug discount contracts that were strongly criticized as leading to patients mixing up medications. Some perceived constraints of therapeutic freedom. CONCLUSIONS The implementation of the WSV is mostly viewed positively by physicians. The restrictions of therapeutic freedom partially perceived might be met by improved information on the reasons why some drugs are rated as less economical than others. TRIAL REGISTRATION NUMBER Main ID: DRKS00019820 (German Register of Clinical Studies and World Health Organization).
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Affiliation(s)
- Nikoletta Zeschick
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Allgemeinmedizinisches Institut, Universitätsstr. 29, 91054, Erlangen, Germany
| | - Julia Gollnick
- Abteilung Für Allgemeinmedizin, Philipps Universität Marburg, Präventive und Rehabilitative Medizin, Karl-Von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Julia Muth
- Abteilung Für Allgemeinmedizin, Philipps Universität Marburg, Präventive und Rehabilitative Medizin, Karl-Von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Franziska Hörbrand
- Kassenärztliche Vereinigung Bayerns, Elsenheimerstraße 39, 80687, Munich, Germany
| | - Peter Killian
- Kassenärztliche Vereinigung Bayerns, Elsenheimerstraße 39, 80687, Munich, Germany
| | - Norbert Donner-Banzhoff
- Abteilung Für Allgemeinmedizin, Philipps Universität Marburg, Präventive und Rehabilitative Medizin, Karl-Von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Thomas Kühlein
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Allgemeinmedizinisches Institut, Universitätsstr. 29, 91054, Erlangen, Germany
| | - Maria Sebastião
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Allgemeinmedizinisches Institut, Universitätsstr. 29, 91054, Erlangen, Germany.
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Zeschick N, Gollnick J, Muth J, Hörbrand F, Killian P, Krombholz W, Donner-Banzhoff N, Kühlein T, Sebastião M. [Prescribing behavior of Bavarian general practitioners at the inpatient-outpatient interface within the context of the Bavarian active substance agreement-qualitative results of the WirtMed Study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:900-908. [PMID: 35838813 PMCID: PMC9436878 DOI: 10.1007/s00103-022-03563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Hintergrund und Ziel Zur transparenten Steuerung der Arzneimittelausgaben im Rahmen des Wirtschaftlichkeitsgebots (§ 12 Fünftes Buch Sozialgesetzbuch (SGB V)) hat die Kassenärztliche Vereinigung Bayerns im Jahr 2014 die Wirkstoffvereinbarung (WSV) eingeführt. Diese hat die Richtgrößensystematik abgelöst. Mit Bezug auf die Rolle der WSV werden im Artikel die Gründe der Hausärzt*innen (HÄ) für oder gegen eine Weiterverordnung von Arzneimitteln aus dem Krankenhaus beschrieben. Material und Methode In einem qualitativen Studiendesign wurden im Zeitraum 11/2019 bis 03/2020 mit bayerischen HÄ Einzelinterviews (n = 18) und 2 Fokusgruppen (n = 10) durchgeführt und nach der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse Mit der Einführung der WSV nahmen die Regresssorgen der HÄ insgesamt ab. Große Bedeutung bei Verordnungen haben – vor der Wirtschaftlichkeit – die patient*innenorientierte Versorgung und fachliche Richtigkeit von Therapieentscheidungen. Mit der Entlassmedikation ergeben sich wirtschaftliche Herausforderungen, besonders mit dem Leitsubstanzziel der oralen Antikoagulation, den Generikazielen bei Antidiabetika und bei Therapeutika für das Herz-Kreislauf-System. Allgemein kritisiert werden Rabattverträge, die oft zu Umstellungen von Arzneimitteln führen. Vereinzelt wird von einer „Vormachtstellung“ der Klinikärzt*innen berichtet, die dem hausärztlichen wirtschaftlichen Handeln entgegenstehen. Es fehlt laut HÄ eine sektorenübergreifende Kostenverantwortung. Diskussion Ein reibungsloser Schnittstellenübergang ist aus Sicht der HÄ trotz des Rahmenvertrags Entlassmanagement und der neuen Steuerungssystematik der WSV im ambulanten Sektor noch nicht vorhanden. Für eine wirtschaftliche Arzneimittelversorgung bedarf es weiterhin einer sektorenübergreifenden, aber auch bundesländerübergreifenden politischen Diskussion. Zusatzmaterial online Im Onlinematerial sind vertiefende Informationen zu der Methodik (Onlinematerial 1: Interview- und Fokusgruppenleitfaden) sowie zur Auswertung (Onlinematerial 2: Kategoriensystem) dieser Studie (10.1007/s00103-022-03563-6) verfügbar.
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Affiliation(s)
- Nikoletta Zeschick
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Julia Gollnick
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps Universität Marburg, Marburg, Deutschland
| | - Julia Muth
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps Universität Marburg, Marburg, Deutschland
| | | | - Peter Killian
- Kassenärztliche Vereinigung Bayerns, München, Deutschland
| | | | - Norbert Donner-Banzhoff
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps Universität Marburg, Marburg, Deutschland
| | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Maria Sebastião
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland.
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Laux G, Berger S, Szecsenyi J, Kaufmann-Kolle P, Leutgeb R. Prescribing differences in family practice for diabetic patients in Germany according to statutory or private health insurance: the case of DPP-4-inhibitors and GLP-1-agonists. BMC FAMILY PRACTICE 2016; 17:146. [PMID: 27760528 PMCID: PMC5070366 DOI: 10.1186/s12875-016-0543-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
Background The objective of this study was to analyze prescription decisions for family practice (FP) patients with Diabetes mellitus type 2 (DM2) using the case of the incretin mimetics Dipeptidyl peptidase-4 (DDP-4) inhibitors and Glucagon-like peptide-1 (GLP-1) agonists dependent on patients’ health insurance status (statutory or private) in Germany. This study is important since the scientific debate is still open with regard to DPP-4-inhibitors and GLP-1-agonists, where some critics are raising questions on potential long-term risks for patients. Methods Data for this analysis were sourced from the German health services research register CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork), in which FP health services information, generated by family practitioners, is continuously collated, e.g. patients’ health insurance status, morbidity and pharmacotherapy. Patients with Diabetes mellitus type 1 (DM1) were excluded from the study. Results From the family practices collaborating in the CONTENT research network, there were 7298 patients treated with pharmacotherapeutic agents for DM2 between 01.09.2009 and 31.08.2014. 586 (8.03 %) of these patients had private insurance. Prescriptions for the incretin mimetics were 40.6 % higher (9.7 vs. 6.9 %; p < 0.0001) for patients with private insurance compared to patients with statutory health insurance. This finding was confirmed with multivariable analyses. Conclusions There was a statistically significant difference found in prescription patterns according to the patient’s health insurance status for the incretin mimetics in this sample population of German patients with DM2. Obviously, these differences result from the eligibility for reimbursement according to patients’ health insurance status. Whether incretin mimetics pose specific long term risks for particular patients is yet to be determined.
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Affiliation(s)
- Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.
| | - Sarah Berger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany
| | - Petra Kaufmann-Kolle
- AQUA-Institute for Applied Quality Promotion and Research in Health Care, Göttingen, Germany
| | - Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany
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Zeidan B, Anderson K, Peiris L, Rainsbury D, Laws S. The impact of tamoxifen brand switch on side effects and patient compliance in hormone receptor positive breast cancer patients. Breast 2016; 29:62-7. [DOI: 10.1016/j.breast.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 11/16/2022] Open
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Längst G, Seidling HM, Stützle M, Ose D, Baudendistel I, Szecsenyi J, Wensing M, Mahler C. Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals. Patient Prefer Adherence 2015; 9:1431-41. [PMID: 26508840 PMCID: PMC4612137 DOI: 10.2147/ppa.s88357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored. METHODS Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis. RESULTS Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient-provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs' focus was on fulfilling therapy and medication management responsibilities. CONCLUSION The findings suggest a noteworthy gap in perceptions between information provision and patients' needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients' perspective. Health care systems need to be structured in a way that supports this process.
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Affiliation(s)
- Gerda Längst
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
- Correspondence: Gerda Längst, Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vossstrasse 2, D-69115 Heidelberg, Germany, Tel +49 6221 56 35559, Fax +49 6221 56 1972, Email
| | - Hanna Marita Seidling
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Marion Stützle
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dominik Ose
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ines Baudendistel
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands
| | - Cornelia Mahler
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
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Graf J. The effects of rebate contracts on the health care system. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:477-487. [PMID: 23793870 DOI: 10.1007/s10198-013-0488-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 05/06/2013] [Indexed: 06/02/2023]
Abstract
Group purchasing organizations gain increasing importance with respect to the supply of pharmaceutical products and frequently use multiple, exclusive or partially exclusive rebate contracts to exercise market power. Based on a Hotelling model of horizontal and vertical product differentiation, we examine the controversy around whether a superior rebate scheme exists, as far as consumer surplus, firms' profits and total welfare are concerned. We find that firms clearly prefer partially exclusive over multiple, and multiple over exclusive rebate contracts. In contrast, no rebate form exists that lowers total costs per se for the consumers or maximizes total welfare.
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Affiliation(s)
- Julia Graf
- Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany,
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Generic substitution, financial interests, and imperfect agency. ACTA ACUST UNITED AC 2013; 13:115-38. [PMID: 23494466 DOI: 10.1007/s10754-013-9126-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
Policy makers around the world seek to encourage generic substitution. In this paper, the importance of prescribing physicians' imperfect agency is tested using the fact that some Swiss jurisdictions allow physicians to dispense drugs on their own account (physician dispensing, PD) while others disallow it. We estimate a model of physician drug choice with the help of drug claim data, finding a significant positive association between PD and the use of generics. While this points to imperfect agency, generics are prescribed more often to patients with high copayments or low incomes.
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Impact of drug discount contracts on pharmacies and on patients’ drug supply. J Public Health (Oxf) 2010. [DOI: 10.1007/s10389-010-0338-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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