Himmel W, Kron M, Thies-Zajonc S, Kochen M M
Department of General Practice, University of Göttingen, Germany.
Int J Clin Pharmacol Ther. 1997 Apr;35(4):164-9.
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.
该研究的目的是调查全科医生在经济压力时期对药物处方的态度，并确定不同因素与处方行为变化的相关性。在德国为降低处方成本而实施的预算举措《公共卫生改革法》生效后，对东德和西德的全科医生进行了随机抽样调查。采用多元逻辑回归分析自我报告的处方行为与协变量（如性别和年龄、认证水平、医生的处方成本、处方标准、药物信息来源）之间的关联。东德的回应率为53.4%（n = 550），西德的回应率为56.8%（n = 579）。约三分之二的医生（东部：60.4%，西部：73%）认为他们在新法律下改变了处方行为。他们更频繁地使用通用药物（东部：29.5%，西部：52.3%），并且经常使用更多的通用药物（东部：29.5%，西部：52.3%），在满足患者意愿方面也不那么随意（分别为61.0%和72.8%）。处方总成本高于同事平均水平的医生更频繁地报告因新法律而改变处方行为（东部医生的OR：3.11，95%CI：1.63，5.91；西部医生的OR：5.90，95%CI：2.49，13.98）。对于认为药物价格是药物选择非常重要标准的医生来说也是如此（分别为OR：4.34，95%CI：2.69，7.01和OR：3.23，95%CI：1.9，5.49）。“以价格为导向”和“关注成本”的医生也更有可能不那么随意地处理患者的处方意愿，并且更频繁地开通用药物而不是原品牌药物。我们得出结论，诸如德国《公共卫生改革法》这样的预算举措似乎会影响全科医生采取更经济的处方行为。关注其处方成本或药物成本的医生可能对这类行政法规反应更敏感。
