From awareness to integration: a qualitative interview study on the impact of digital therapeutics on physicians' practices in Germany

Abstract

Background: The integration of digital therapeutics (DTx) into the German statutory healthcare system marks a significant shift in medical practice through the introduction of innovative, reimbursable digital interventions for patient care. While DTx can bridge therapy gaps and enhance patient care, the number of prescriptions is increasing slowly. This study aims to explore the challenges physicians face when integrating DTx into their treatment options and the changes this integration entails for their medical workflows.

Methods: A qualitative approach was adopted, gathering data from semi-structured interviews with 46 physicians across Germany. Participants, sampled for diversity in specialty, experience, and region, were interviewed between June 2022 and August 2024. The interviews explored physicians' knowledge, experiences, and perspectives on DTx. Data were analyzed using qualitative content analysis, combining deductive and inductive coding.

Results: The introduction of DTx into physicians' workflows impacts their practice on multiple levels. First, physicians must become aware of the new regulations and therapeutic possibilities, requiring significant information intake and time to feel adequately prepared for prescribing DTx. Second, DTx add complexity to patient assessment, as physicians must evaluate factors such as digital literacy, motivation, and cognitive conditions, necessitating a deeper understanding of their patients. Third, the integration of DTx reshapes the physician‒patient relationship, as it alters interaction dynamics, redistributes responsibilities, and poses new communication challenges. Fourth, DTx expand therapeutic options, particularly by bridging therapy delays and enabling more personalized care. Finally, the integration of DTx has the potential to drive long-term changes in physicians' workflows and mindsets, fostering alignment with multimodal and patient-centered treatment approaches.

Conclusions: DTx offer opportunities for patient care but also pose challenges, such as the development of digital skills or familiarization with new regulations, that necessitate adjustments in physicians' workflows. Physicians are generally confronted with an innovation that demands time, reliable information on effectiveness, practical experience, and openness to adopting digital health tools as complementary treatment options. However, the reception and integration of DTx into treatment vary among physicians, reflecting individual preferences and approaches. Further research should explore these diverse adoption strategies and examine the long-term effects of DTx on care delivery and patient outcomes.

Keywords: Digital health; Digital therapeutics; German healthcare system; Medical practices; Physician roles; Qualitative research.