Changes in drug prescribing under the Public Health Reform Law--a survey of general practitioners' attitudes in East and West Germany.

The aim of the study was to examine general practitioners' attitudes towards drug prescribing in times of economic pressure, and to determine the relevance of different factors for changed prescribing behavior. A random sample of general practitioners in Eastern Germany and in Western Germany was surveyed, after the Public Health Reform Law, a budgetary initiative to reduce prescribing costs in Germany, had come into effect. Multiple logistic regression was performed to analyze the association between self-reported prescribing behavior and covariates (such as sex and age, level of certification, doctors' prescribing costs, criteria of prescribing, sources of drug information). Response rates had been 53.4% (n = 550) in Eastern Germany and 56.8% (n = 579) in Western Germany respectively. About two thirds of the doctors (East: 60.4%, West: 73%) believed that they had changed their prescribing behavior under the new law. They used generic drugs more often (East: 29.5%, West: 52.3%) and often used more generic drugs (East: 29.5%, West: 52.3%) and were less liberal in meeting patients' wishes (61.0% and 72.8%, respectively). Doctors whose total prescribing costs were above the average of their colleagues, more frequently reported change in prescribing behavior in response to the new law (OR: 3.11, 95% CI: 1.63, 5.91 for Eastern doctors and OR: 5.90, 95% CI: 2.49, 13.98 for Western doctors). This was also true for doctors who considered the price of a drug to be a very important criterion for drug selection (OR: 4.34, 95% CI: 2.69, 7.01 and OR: 3.23, 95% CI: 1.9, 5.49, respectively). "Price-oriented" and "cost-concerned" doctors were also more likely to handle patient prescription wishes less liberal and to prescribe generic rather than original brand name drugs more often. We conclude that budgetary initiatives, such as the German Public Health Reform Law, seem to influence general practitioners towards a more economic prescribing behavior. Doctors concerned about their prescribing costs or about drug costs may be more responsive to such administrative regulations.