Hintergrundanalysen von wirtschaftlich auffälligem Verordnungsverhalten aus der Perspektive der Arzneimittelsicherheit
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Philipps-Universität Marburg
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Abstract
Rising costs for drugs represents a challenge for the healthcare system - both in Germany and internationally. The reasons for this are an ageing population with an increased need for drugs, but also rising prices of drugs. In order to counter this financial burden, the efficiency principle was established in Germany. This states that the statutory health insurance funds must cover services that are economical and appropriate, but do not exceed the level of necessity. This also applies to drugs prescribed by doctors. Various surveillance instruments have been developed for implementing and monitoring this cost-reducing requirements, including the Bavarian Drug Agreement.
As part of this dissertation, the prescribing behaviour of Bavarian doctors who missed their drug targets was investigated, reasons for being an outlier were identified and evaluated against the background of medication safety. The Bavarian Drug Agreement aims to prefer established, proven and therefore cheaper drugs. This is intended to counter rising costs on drugs and contributes to the economical and responsible use of limited resources in the healthcare system. This contrasts with the aims of the pharmaceutical industry, which wants to bring its new drugs onto the market and raise their profile.
The guidelines, agreements and information on the Bavarian Drug Agreement are available for little money or free of charge but are less attractive in some respects and involve more proactive research. Pharmaceutical representatives, on the other hand, visit doctors and provide them directly with customised information on medicines and the documentation and coding information required for prescribing these not preferred drugs. The requirements of the Bavarian Drug Agreement predominantly reflect the typical daily prescribing practice of eight investigated specialisation groups and drug targets with high prescribing volume measured in defined-daily-doses are mostly achieved. While showing only little prescribing volume missed drug targets are rarely part of the typical daily prescribing of the investigated specialisation groups. Nevertheless, some targets pose difficulties and represent a challenge in everyday practice, for example prescribing anticoagulants. There are also some drugs, for example Humira®, Prolia® or branded drugs, which oppose drug target achievement.
Particularly practices that do not correspond to the average and deviate from the required prescribing behaviour due to special patient clientele, specialisations, practice location or additional challenges for the specialisation group miss their drug targets. Also, smaller practices with fewer patients within a quart show a higher risk for not achieving their drug
targets. In addition to these objective influencing factors, individual drug prescribing behaviour is influenced by other factors that make it more difficult to achieve targets. Doctors aim to provide their patients with good care and prescribe to the best of their knowledge and belief. However, due to misunderstood or inadequate information, this can lead to inadequate conceptions about individual drugs and prescribing behaviour opposed to prescribing behaviour intended by surveillance instruments.
The guidelines of the Bavarian Drug Agreement consider aspects of drug therapy safety by focussing on established drugs and limiting overuse. This is particularly reflected in the PPI target and the limit on the quantity of PPIs prescribed. However, advanced stages of the disease cannot always be treated within this framework according to the guidelines and new drugs are included in the targets with a delay, making it difficult for new and effective drug therapies to become established. Doctors who deviate from the prescribing requirements in their prescribing behaviour often do so intentional and for good reason. Reasons from the areas of ideas about drug therapy, information behaviour, experience, flexibility for example in adjusting the prescribing behaviour, personal needs and patient-centredness are particularly relevant and influential. Some of the reasons can be found and confirmed in the literature, and the deviating prescribing behaviour is associated with increased drug therapy safety. In other cases, however, the deviating prescribing behaviour also stands for a possibly inadequate therapy (in advance) or overuse of the patient. This is where effective information systems are getting relevant. Conspicuous prescribing behaviour is therefore not associated with better or worse medication safety across the board but must be considered and evaluated in a differentiated manner. If doctors all receive the same information on drug therapy and evidence on a regular basis, attempts can be made to further promote and disseminate behaviour patterns with increased medication safety and, in the case of lower medication safety, to provide information on improvement options and improve the quality of prescribing.
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Created: 2024Issued: 2025-08-06Updated: 2025-08-06
Faculty
Fachbereich Pharmazie
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
ambulatory care/economicsArzneimitteltherapiesicherheitVerordnungsverhaltenVerordnungsvorgabenprescribing behaviourbudgetsArzneimittelkostenArzneimittelverordnungdrug prescriptionsdrug therapy/economics
DFG-subjects
Arzneimitteltherapiesicherheit
DDC-Numbers
615
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Gollnick, Julia: Hintergrundanalysen von wirtschaftlich auffälligem Verordnungsverhalten aus der Perspektive der Arzneimittelsicherheit. : Philipps-Universität Marburg 2025-08-06. DOI: https://doi.org/10.17192/z2024.0501.
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Except where otherwised noted, this item's license is described as Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 - CC BY NC ND