[Prescribing behavior of primary care physicians in diabetes therapy: effect of drug budgeting].

BACKGROUND AND OBJECTIVE

In spite of the great importance of diabetes in Germany, little is known about the medical treatment of diabetic patients by primary health care practices and the effects of the drug budget, introduced by the German Health Care Structure Reform Act (GSG) from 1993.

PATIENTS AND METHODS

Computerized data (MediPlus, IMS HEALTH) on prescriptions of the most important drugs were analysed in 2892 diabetic patients of 362 primary care physicians for the period of July 1992 to December 1994.

RESULTS

There was an initial decrease in prescriptions per treated patient of antidiabetic drugs and antihypertensive drugs according to the GSG, which was not maintained during the study period. Nevertheless, a cost saving per treated patient with respect to beta-blocker and ACE inhibitors was observed, mainly as a result of a change of preparations and a drop in drug company sales prices. When beginning of a new therapy with oral antidiabetics, the physicians increasingly used acarbose rather than less expensive sulphonylureas. A previous trend of increased use of ACE inhibitors and diuretics for antihypertensive treatment was maintained. In 1993 and 1994, the number of prescriptions and the prescription costs for lipid lowering drugs decreased compared to the values of the last six months of 1992. A global decrease in prescription use of drugs without proven efficacy observed in the first six months of 1993, did not persist.

CONCLUSION

The data show, that the drug budget had no relevant long term impact on drug prescribing by internists and general practitioners for diabetic patients.