Zeschick Nikoletta, Gollnick Julia, Muth Julia, Hörbrand Franziska, Killian Peter, Donner-Banzhoff Norbert, Kühlein Thomas, Sebastião Maria
Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Germany.
Institute of General Practice/Family Medicine, Philipps University of Marburg, Germany.
Health Serv Insights. 2025 Jun 21;18:11786329251341083. doi: 10.1177/11786329251341083. eCollection 2025.
Direct oral anticoagulants (DOACs) have been increasingly prescribed instead of vitamin-K-antagonists (VKA) although VKAs cost considerably less than DOACs. In 2014, a new system for drug expenditures, the Wirkstoffvereinbarung (WSV, Active substance agreement), was implemented in Bavaria, Germany to control pharmaceutical expenditures transparently. Achieving the targets for the VKAs set by the WSV was difficult for general practitioners (GPs). We explored the determinants of prescribing VKAs (specifically phenprocoumon) versus DOACs.
Qualitative interviews (n = 18) and two small group discussions (n = 10) were conducted with GPs. For the qualitative content analysis, we formed a system of categories based on the domains of the Theoretical Domains Framework (TDF).
Participants actively weighed various factors when deciding between prescribing phenprocoumon or DOACs. Costs played a subordinate role although all participants were aware that DOACs come at a higher cost than phenprocoumon. Trend reports served as a tool for GPs to assess their prescribing practices, however did not lead to a change in prescribing behaviour. The interviewees had a very heterogeneous view of safety, effect, and evidence of phenprocoumon or DOACs. The cooperation of the patients is crucial. Time is a significant challenge for participants when initiating patients on or switching them to phenprocoumon, which is especially problematic as all of the patients discharged from the hospital are put on DOACs.
GPs are caught between economic requirements, patients' wishes, and good collegial cooperation when deciding for or against phenprocoumon. As oral anticoagulant therapy (OAC) is mostly initiated in the hospital, and as physicians almost exclusively prescribe DOACs there, participating GPs feel overchallenged in reaching the targets set by the WSV.
Main ID: DRKS00019820 (German Register of Clinical Studies and World Health Organization).
尽管维生素K拮抗剂（VKA）的成本远低于直接口服抗凝剂（DOAC），但DOAC的处方量却越来越多。2014年，德国巴伐利亚州实施了一种新的药物支出系统——活性物质协议（WSV），以透明地控制药品支出。全科医生（GP）很难实现WSV为VKA设定的目标。我们探讨了开具VKA（特别是苯丙香豆素）与DOAC的决定因素。
对全科医生进行了18次定性访谈和2次小组讨论（共10人）。对于定性内容分析，我们基于理论领域框架（TDF）的领域构建了一个类别系统。
在决定开具苯丙香豆素还是DOAC时，参与者会积极权衡各种因素。成本起着次要作用，尽管所有参与者都意识到DOAC的成本高于苯丙香豆素。趋势报告是全科医生评估其处方行为的工具，但并未导致处方行为的改变。受访者对苯丙香豆素或DOAC的安全性、效果和证据有非常不同的看法。患者的合作至关重要。在让患者开始使用或转用苯丙香豆素时，时间对参与者来说是一个重大挑战，这尤其成问题，因为所有出院患者都使用DOAC。
在决定是否使用苯丙香豆素时，全科医生陷入了经济要求、患者意愿和良好的同行合作之间的困境。由于口服抗凝治疗（OAC）大多在医院开始，而且医生在医院几乎只开具DOAC，参与的全科医生在实现WSV设定的目标方面感到压力过大。
主要编号：DRKS00019820（德国临床研究注册中心和世界卫生组织）
