{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T10:19:21Z","timestamp":1778321961954,"version":"3.51.4"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,5,8]],"date-time":"2019-05-08T00:00:00Z","timestamp":1557273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"German Ministry of Health","award":["II A5-2513DSM228"],"award-info":[{"award-number":["II A5-2513DSM228"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In Germany, almost 50% of prescriptions for benzodiazepines and drugs as Zolpidem and Zopiclone are as out-of-pocket (OOP) prescriptions\u2014requiring patients to buy the drug at their own expense\u2014although almost 90% of the population has statutory health insurance covering medication costs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Knowing the significant medical risks and insecurity about regulations makes GPs wish to avoid hypnotics and sedatives. They achieve this by \u2018Creating a barrier\u2019 (central phenomenon) and employing the strategy \u2018Using an out-of-pocket prescription\u2019, which not only generates costs for the patient but also reduces the physicians\u00b4 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 \u2018uncomplicated\u2019 insomnia are more likely to receive an OOP prescription. Patients with any psychiatric diagnosis will likely receive a statutory health insurance prescription.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Current regulations do not provide guidance to GPs regarding hypnotics and sedatives. A clear regulatory framework and guidelines could possibly reduce physicians\u2019 defensive attitudes about these drugs and their use of OOP prescriptions. The approach to use OOP prescriptions as a barrier to reduce patients\u2019 medication use lacks evidence regarding effectiveness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/fampra\/cmz018","type":"journal-article","created":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T19:45:50Z","timestamp":1555530350000},"page":"785-790","source":"Crossref","is-referenced-by-count":4,"title":["General practitioners\u2019 concepts on issuing out-of-pocket prescriptions for hypnotics and sedatives in Germany"],"prefix":"10.1093","volume":"36","author":[{"given":"Katharina","family":"Schmalstieg-Bahr","sequence":"first","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane A","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Hummers","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,5,8]]},"reference":[{"issue":"2","key":"2019111806102243600_CIT0001","first-page":"80","article-title":"Benzodiazepin-Sucht, unsere iatrogene Seuche--157 F\u00e4lle von Benzodiazepin-Abh\u00e4ngigkeit","volume":"46","author":"Binder","year":"1984","journal-title":"Offentl Gesundheitswes"},{"key":"2019111806102243600_CIT0002","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1055\/s-2007-1017140","article-title":"Prescription and misuse of benzodiazepines in the Federal Republic of 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