Beeinflusst eine Budgetierung Qualität und Wirtschaftlichkeit der ambulanten Arzneimitteltherapie?: Anwendung von Indikatoren am Beispiel des Verordnungsverhaltens niedergelassener Ärzte einer norddeutschen Region mit festgestellten Qualitätsdefiziten von der Einführung des GSG

Application of indicators exemplified by the prescribing conduct of physicians in a specific region of northern Germany showing deficits before implementation of the new GSG (Health Structure Law). The prescriptions of physicians in a specific region of northern Germany were examined to see whether the quality of drug therapy in this region, which showed deficits before the implementation of the GSG, had been influenced by this law. After encoding the prescription data the 100 most often prescribed drugs were identified as physician-related the resulting costs determined and arranged in order of precedence («medicine charts»). The indicators were defined as to which «medicine-chart» drug they related, to facilitate a qualitative analysis of the prescriptions. The indicators were: drugs, whose therapeutic advantage is not proven; drugs based on obsolete therapeutic concepts; drugs with lower-priced and/or therapeutic equal alternatives Standard-Therapeutics. The qualitative analysis of the prescriptions from the 4th quarter of 1991 and the 1st quarter of 1993 shows a reduction in the number of prescriptions and prescription costs corresponding with the overall Federal German trend due to the GSG and the fixed budget. It was however observed in qualitative analysis that the 33% portion of drugs with dubious efficacy or obsolescence, remained constant. Furthermore, the indicator referring to uneconomical prescriptions because of the higher-priced drugs, remained nearly unchanged between 1991 and 1993 at 34% and 37%, respectively. One can conclude that a fied-budget within the limits of the GSG resulted in neither a loss of quality nor in an improvement in the quality of the drug therapy prescribed by this group of analysed physicians. On the whole, the prescription costs per patient were reduced by 28% from the 4th quarter of 1991 of the 1st quarter of 1993. However, the potential savings prescription costs between 1991 and 1993, based upon therapeutic considerations,