Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Allgemeinmedizinisches Institut, Universitätsstr. 29, 91054, Erlangen, Germany.
Abteilung Für Allgemeinmedizin, Philipps Universität Marburg, Präventive und Rehabilitative Medizin, Karl-Von-Frisch-Straße 4, 35032, Marburg, Germany.
BMC Health Serv Res. 2023 Sep 7;23(1):961. doi: 10.1186/s12913-023-09844-3.
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.
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.
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.
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.
Main ID: DRKS00019820 (German Register of Clinical Studies and World Health Organization).
2014 年，巴伐利亚州实施了一种新的药物支出系统——活性物质协议（Wirkstoffvereinbarung，WSV）。在预先定义的适应证组中，应根据药物的选择、数量和比例来实现药物的经济处方。门诊医生会收到关于其处方行为的季度趋势报告。本研究考察了医生对 WSV 的看法。
对门诊医生（如全科医生、心脏病专家、肺病专家）进行了 20 次定性访谈（n=20）和 7 次焦点小组（n=36）。采用定性内容分析法进行分析。
医生普遍接受经济处方的必要性。他们中的大多数人对 WSV 的评价是积极的，优于之前的系统。作为改进，他们特别提到了以易于理解的趋势报告形式及时反馈，鼓励自我反思，并允许早期控制选项。被认为存在问题的是药物折扣合同，这些合同受到了强烈批评，因为它们导致患者混淆药物。一些人认为治疗自由受到了限制。
医生对 WSV 的实施大多持积极态度。部分感知到的治疗自由的限制，可以通过更好地了解某些药物被评为不太经济的原因来缓解。
主要 ID：DRKS00019820（德国临床研究注册处和世界卫生组织）。
