A new survey of 3800 German GPs sheds light on their opinions of DiGA digital healthcare apps, which have undergone rigorous evaluation under Germany’s new process
In 2020, Germany launched one of Europe’s first and most comprehensive evaluation programmes for digital health apps under the Digital Healthcare Act. It put in place a solid reimbursement pathway for digital health solutions.
Under the programme, solutions qualify for reimbursement after they meet technical, safety and patient outcome efficacy requirements, based on assessment by the German Federal Institute of Drugs and Medical Devices (BfArM).
For solutions that do not meet requirements, but demonstrate potential, a temporary coverage pathway is available, in exchange for real world evidence generation to address key uncertainties identified in the initial evaluation. They are then reassessed for permanent coverage based on these outcomes.
Since the Digital Healthcare Act was launched, 38 digital health apps have been enrolled into the DiGA directory- 13 have received confirmed coverage and 25 are in the temporary coverage pathway. Most apps focus on chronic disease management, with therapy areas ranging from diabetes to cancer.
But what do physicians on the ground really think? How much value do they add in medical practice? A recently published survey of 3,800 German GPs shed some light on this topic.
Key takeaways
1. A comprehensive assessment programme does not automatically lead to widespread adoption of approved digital apps, but physicians who adopted DiGA generally found them useful
Of 3,800 German GPs surveyed, most (67%) had confidence in BFARM’s evaluation process for the approval of DiGAs. These GPs assume that the DiGAs listed in the approved directory are reliable applications.
However, trust in the process does not mean automatic adoption in practice. In contrast to the 67% who trust the evaluation procedure, only 14% said they have already prescribed DiGA, while a further 13% plan to prescribe more DiGA. Notably 21 % of GPs surveyed said that they are unlikely to prescribe DiGA in future. Practical concerns such as inertia in medical practice may also influence adoption.
But on a positive note, of GPs with DiGA experience, 83% found them useful. Observed healthcare effects mainly related to the improvement of treatment compliance, mobility and the improvement of health education and awareness.
About 45% of physicians with experience in prescribing DiGA (246/546 GPs) also saw reductions in patient complications such as hypoglycaemia.
Source: Wrangler and Jansky (2022) What potential and added value does DiGA offer for general practitioners
2. Urban physicians are more likely to support DiGA and urban patients are more likely to ask for them
Unsurprisingly, physicians in urban environments perceive apps significantly more positively than their colleagues in rural areas (94% to 27%).
Physicians who have already been approached by patients about DiGA are mostly found in medium to large urban areas, much less so in small towns and rural communities (88 % vs 21 %).
3. Younger physicians were more likely to support DiGA use
Physicians below the average age (54 years old in sample) were more likely to be positive about DiGA (85 % vs 49 %).
4. Physicians would like to see further improvements in DiGA
These include methods to optimise use, provision of certified training courses on DiGA, more gamification elements and exclusion of liability risk for doctors.
An assessment process for digital health technologies is just the first in many steps towards digital health adoption for GPs and patients. It would take time to change medical practice, and synchronise thorough medical thinking with a fast-paced, agile technology world.
These lessons could nonetheless be useful for other healthcare systems such as France and Finland who are building their own digital healthcare assessment procedures.
The full survey of German GP opinions on DiGA is available here (article in German).