[Drug therapy in primary care in the light of discount contracts to health insurers--a patient survey].
BACKGROUND
Since April 1, 2007 pharmacists in Germany are obligated by law to dispense products from particular manufacturers with whom the health insurance funds have entered into discount agreements. Only by ticking the relevant tick box ("Aut Idem") on the prescription form can the prescriber insist on a drug of a specific company.


METHODS
A standardized questionnaire was designed and piloted in a small group and adapted accordingly. By means of this questionnaire patients were asked about their experiences with drug discount contracts.


RESULTS
226 patients participated in this study. 75% of the participants had knowledge of these contracts. 64.6% of the patients were concerned about substitute drugs. 32.1% took no longer the drugs regularly, and 21.2% indicated that they were confused by the changed packaging of medicinal drugs. 79.5% of the participants wanted to keep their old, familiar drug, and 53.7% of the participants insisted on receiving their familiar medication against the prescriber's prescription.


CONCLUSIONS
The survey shows that patients feel irritated by their medication and that medication errors occur. In addition, GPs and pharmacists must inform patients about the discount contracts (substitution). Many participants wanted to keep or insist on their familiar medication and compliance and physician-patient-relationship could be compromised.


CONCLUSIONS
This intervention by the health insurance funds interferes with the medical treatment of patients. Such far-reaching changes in medication might lead to life-threatening situations.
Gröber-Grätz
Dagmar
D
Institut für Allgemeinmedizin, Universität Ulm, Helmholtzstrasse 20, 89069 Ulm. dagmar.groeber-graetz@uni-ulm.de
Gulich
Markus
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032982:Contracts / Q000191:economics*; D003625:Data Collection / Q000191:economics; D004358:Drug Therapy / Q000191:economics* / Q000592:standards; D004522:Educational Status; D005260:Female; D005858:Germany; D006801:Humans; D007343:Insurance Carriers / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D055815:Young Adult