Ruof Jörg, Mittendorf Thomas, Pirk Olaf, von der Schulenburg J-Matthias Graf
Arbeitsbereich Versorgung und Okonomie, Abteilung Rheumatologie, Medizinische Hochschule Hannover, Carl-Neuberg Str. 5, D-30625 Hannover, Germany.
Health Policy. 2002 Apr;60(1):59-66. doi: 10.1016/s0168-8510(01)00191-9.
Systematic barriers seem to slow down the market penetration of innovative acethylcholinesterase (AChE) inhibitors in Alzheimer's disease. The goal of our study was to examine the diffusion of AChE inhibitors into the German market in more detail. On the basis of using the ongoing surveillance panel of the Institute of Medical Statistic (IMS) Health, the prescription patterns of 100 physicians (72 general practitioners, 28 neurologists) were examined. In addition, structured telephone interviews with the same 100 physicians were conducted. The interview included the assessment of a hypothetical treatment situation (i.e. physicians were asked what they would prescribe if a close relative of theirs had Alzheimer's disease) as well as qualitative items examining the physicians' attitudes towards AChE inhibitors and the perceived impact on drug budgets. As a major result, the analysis revealed that neurologists prescribed AChE inhibitors to 44.6% of their patients, while general practitioners only treated 9.0% of their patients with AChE inhibitors. The analysis of the qualitative items revealed positive attitudes regarding the safety and efficacy of AChE inhibitors, but negative attitudes regarding the budgetary limitations to prescribing these drugs. A correlation of r=0.21 (P<0.05) was found between the perceived impact on drug budgets and the adoption of AChE inhibitors and a correlation of r=0.32 (P<0.002) was seen between the physician's specialty and the adoption of AChE inhibitors. These data show that, while the AChE inhibitor adoption process has passed the early stages, various barriers slow down the final stages of AChE inhibitor adoption. The drug budget in particular seems to inhibit the adoption of the innovation by the majority of general practitioners. This leads to a more short-term cost control strategy instead of long-term disease management and cost saving approaches.
系统性障碍似乎减缓了创新型乙酰胆碱酯酶（AChE）抑制剂在阿尔茨海默病治疗领域的市场渗透。我们研究的目的是更详细地考察AChE抑制剂在德国市场的推广情况。基于使用医学统计研究所（IMS）健康部的持续监测小组，对100名医生（72名全科医生，28名神经科医生）的处方模式进行了研究。此外，还对这100名医生进行了结构化电话访谈。访谈内容包括对一个假设治疗情况的评估（即询问医生如果他们的一位近亲患有阿尔茨海默病，他们会开什么药），以及一些定性项目，用以考察医生对AChE抑制剂的态度以及对药物预算的感知影响。主要研究结果显示，神经科医生为44.6%的患者开具了AChE抑制剂，而全科医生仅为9.0%的患者使用AChE抑制剂进行治疗。对定性项目的分析显示，医生对AChE抑制剂的安全性和疗效持积极态度，但对开具这些药物的预算限制持消极态度。在对药物预算的感知影响与AChE抑制剂的采用之间发现了r = 0.21（P < 0.05）的相关性，在医生的专业与AChE抑制剂的采用之间发现了r = 0.32（P < 0.002）的相关性。这些数据表明，虽然AChE抑制剂的采用过程已度过早期阶段，但各种障碍减缓了AChE抑制剂采用的最后阶段。特别是药物预算似乎抑制了大多数全科医生对这种创新药物的采用。这导致了一种更注重短期成本控制的策略，而不是长期的疾病管理和成本节约方法。
