RESUMEN
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.
Asunto(s)
Prescripciones de Medicamentos/normas , Medicina Familiar y Comunitaria , Reforma de la Atención de Salud/legislación & jurisprudencia , Pautas de la Práctica en Medicina , Adulto , Anciano , Actitud del Personal de Salud , Recolección de Datos , Prescripciones de Medicamentos/economía , Medicamentos Genéricos , Femenino , Alemania , Reforma de la Atención de Salud/economía , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
Using the German data of the European referral study from primary to secondary care this paper attempts to answer the following questions: which are the specialties GPs refer to, and which referrals were initiated by the patients. According to the study's methodology the gatekeeper function of the GPs or the patient initiative should be described by distinguishing between direct and indirect referrals. A direct referral is defined by a face to face encounter between patient and GP, while an indirect referral requires no such contact. For direct referral the GPs recorded the influence of the patient on their referral decision. In 71 practices (only the western part of the Federal Republic of Germany) 2077 direct and 1665 indirect referrals were documented. Every second direct referral was influenced by the patients. Women had a greater influence than men. An analysis by specialty showed that most of the direct referrals were directed to orthopaedics (14%), surgery (12%) and internal medicine (10%) and most of the indirect referrals to ophthalmology (25%), gynaecology (20%) and dermatology (8%) (64% of all indirect referrals were given to women). These results could be taken as an example how patients take over the responsibility of managing their complaints and illnesses by themselves in a health system with free access to specialist care. The role of the German GP as a gatekeeper and co-ordinator in the health care system turned out to be very limited. In consequence this might result in future problems such as a lack of co-operation, deficiencies in the continuity of medical treatment, over-medication unnecessary parallel investigations and additional costs.
Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Alemania , Humanos , Lactante , Masculino , Medicina/estadística & datos numéricos , Persona de Mediana Edad , Participación del Paciente/estadística & datos numéricos , Factores Sexuales , Especialización , Revisión de Utilización de RecursosRESUMEN
The large inter-doctor variation in referrals to specialists known from previous research can only partly be explained by differences in presented morbidity, in practice setting or in general practitioners' (GPs') attitudes to their own work. The objective of this study was to analyse GPs' attitudes towards their own work and their influence on referral behaviour. This work is a follow up of the European study of referrals from primary to specialist care carried out in nine countries. We present an analysis of the West German part involving the same sample as in the European referral study. To 75 GPs a questionnaire with 26 items was sent, which validity and reliability was measured in studies before. 71 GPs took part in the study (response rate 95%). GPs with a high referral rate perform some technical procedures less frequently than GPs with a low referral rate. Many GPs consider their clinical responsibilities to be greater than their actual performance would suggest. In general, GPs tended to minimize risks. Significant correlations between attitudes and referral rates were found for 7 items only. GPs attitudinal consensus had no firm association to their referral behaviour (as measured by the instruments used). To explain this finding structural and financial aspects of the health care system should be taken into account. Further investigations about the referral process including a qualitative approach are necessary.