Prescribing practices of general practioners and internists in the treatment of diabetic patients: influence of drug budgeting

Background and objective: In spite of the great importance of diabetes in G ermany, little is known about the medical treatment of diabetic patients by primary health care practices and the effects of the drug budget, introduc ed by the German Health Care Structure Reform Act (GSG) from 1993. Patients and methods: Computerized data (MediPlus, IMS HEALTH) on prescipti ons of the most important drugs were analysed in 2892 diabetic patients of 362 primary care physicians for the period of July 1992 to December 1994. Results: There was an initial decrease in prescriptions per treated patient of antidiabetic drugs and antihypertensive drugs according to the GSG, whi ch was not maintained during the study period. Nevertheless, a cost saving per treated patient with respect to beta-blocker and ACE inhibitors was obs erved, mainly as a result of a change of preparations and a drop in drug co mpany sales prices. When beginning of a new therapy with oral antidiabetics , the physicians increasingly used acarbose rather than less expensive sulp honylureas. A previous trend of increased use of ACE inhibitors and diureti cs for antihypertensive treatment was maintained. In 1993 and 1994, the num ber of prescriptions and the prescription costs for lipid lowering drugs de creased compared to the values of the last six months of 1992. A global dec rease in prescription use of drugs without proven efficacy observed in the first six months of 1993, did not persist. Conclusion: The data show, that the drug budget had no relevant long term i mpact on drug prescribing by internists and general practioners for diabeti c patients.