Study, May/19: German GP's concepts re:out-of-pocket scripts for benzos/Z-drugs

[[La...]]

The full title of this German study is "General practitioners' concepts on issuing out-of-pocket prescriptions for hypnotics and sedatives in Germany".

 

https://www.ncbi.nlm.nih.gov/pubmed/31066894 

 

Abstract

 

BACKGROUND:

 

In Germany, almost 50% of prescriptions for benzodiazepines and drugs as Zolpidem and Zopiclone are as out-of-pocket (OOP) prescriptions-requiring patients to buy the drug at their own expense-although almost 90% of the population has statutory health insurance covering medication costs.

 

OBJECTIVE:

 

To understand why general practitioners (GPs) choose this prescribing method since needed medications are insurance covered, and unnecessary drugs should not be prescribed at all.

 

METHODS:

 

In this qualitative study, 17 semi-structured interviews with GPs were conducted, audio recorded and transcribed verbatim. Transcripts were analysed with grounded theory to extract a model explaining the described behaviour.

 

RESULTS:

 

Knowing the significant medical risks and insecurity about regulations makes GPs wish to avoid hypnotics and sedatives. They achieve this by 'Creating a barrier' (central phenomenon) and employing the strategy 'Using an out-of-pocket prescription', which not only generates costs for the patient but also reduces the physicians´ legal and financial accountability. The perceived patient type, expected problem duration and diagnosis influence the decision about the prescription form: patients with an alcohol or drug addiction or those with 'uncomplicated' insomnia are more likely to receive an OOP prescription. Patients with any psychiatric diagnosis will likely receive a statutory health insurance prescription.

 

DISCUSSION:

 

Current regulations do not provide guidance to GPs regarding hypnotics and sedatives. A clear regulatory framework and guidelines could possibly reduce physicians' defensive attitudes about these drugs and their use of OOP prescriptions. The approach to use OOP prescriptions as a barrier to reduce patients' medication use lacks evidence regarding effectiveness.

[[Ma...]]

haha interesting, I had forgotten that I had to pay for Ativan and Zolpidem out of my own pocket!! You need a prescription but  they only give you a blue one (then you get the med in a pharmacy but you need to pay the full price like 40 Euro for Ativan instead of 5 Euro with a red prescription formular).

What they forget in this study is that also psychiatrists chose that way. The reason is simple. Blue prescriptions are "private costs" of the patient. The red prescprrptions are 1) a burden to the budget of the doctor 2) and here it comes: The red ones get registrated!

That means the more blue prescriptions they hand out - the less benzo users are registrated.

 

A wonderful system. Taper can make you poor. Staying on the meds not.

 

I really forgot that..

[[La...]]

Thanks for your comments, Marigold! I was hoping you'd have a look at this one. It's interesting that it was studied at all.

[[Ma...]]

Thanks for your comments, Marigold! I was hoping you'd have a look at this one. It's interesting that it was studied at all.

 

Its typical. Money for studies like that okey, but for resaarch on the field of benzos no.

Ugh.