Apps on prescription: AOK survey reveals potential for improvement

Digital health applications (DiGAs) are viewed positively overall, but around half of users consider them dispensable. These are the central results of a nationwide online survey of more than 2,600 AOK insured people who had received an “app on prescription”. The aim of the survey was to evaluate acceptance and actual usage behavior two years after the DiGAs were included in the statutory health insurance service catalogue. 58 percent of those surveyed rated the use of DiGA as a useful addition to their therapy. The biggest advantage users saw was that they could flexibly schedule treatment with a DiGA (70 percent). At least 40 percent of those surveyed said that the application helped them to get their illness better under control. However, DiGAs were rarely used to bridge waiting times until therapy began (15 percent); this was only the case slightly more often with DiGAs for the treatment of mental illnesses (21 percent).

Around one in five people have problems implementing digital therapy content

“Despite the overall quite high level of satisfaction with the prescription apps, we see a certain reluctance to assess the benefits experienced in the results,” says Dr. Carola Reimann, Chairwoman of the AOK Federal Association. Only 26 percent of those surveyed described the prescribed DiGA as “indispensable” for them; for a good half of the participants, this statement “not really” or “not at all” applies. Users are also reserved when it comes to recommendations: Only 38 percent of those surveyed would be very likely to recommend the DiGA they use to friends or acquaintances with a comparable diagnosis. Almost a fifth of those surveyed had problems implementing the digital therapy content, and a further 28 percent said they had had some problems. For at least 15 percent of those insured, the content did not fit their individual illness situation. “The results reflect that the DiGAs used do not always correspond to the needs and needs of the insured. Conventional on-site therapies such as physiotherapy for back problems are in many cases the better choice - and cost less for those paying contributions than a DiGA regulation," says AOK board member Reimann. The average price per DiGA is around 500 euros for 90 days of use.

Reimann: Integration into treatment can be improved

The majority of the insured persons surveyed (in 68 percent of cases) were informed by their doctor about the possibility of a DiGA prescription. Almost a third became aware of it through their own research, advertising or recommendations from third parties. “The survey results still show potential for improvement when it comes to integrating DiGAs into medical treatment,” emphasizes AOK board member Carola Reimann: More than a third of those surveyed (37 percent) were not informed about the functions of the DiGA used. Although the vast majority (94 percent) stated that they had received the application through a prescription from a doctor or therapist, only 38 percent had discussed their usage behavior and the results of the DiGA application with their doctor or therapist.

The “apps on prescription” were mainly used by the insured over a longer period of time. However, 5 percent of those surveyed also stated that they had only used their DiGA for a few days to a week. This was more common among people who had previously described themselves as having little digital savvy or had reported poor health: around 12 percent of those surveyed in poor health stated that they had only used the prescribed application for a few days to a week. Almost one in four (23 percent) stated that they had used the DIGA for a shorter time than intended. In the group of respondents with poor health, this even affected 30 percent. “In these cases, the GKV has to pay the full price for the applications, even though the insured do not use them fully and terminate the therapy prematurely. It would therefore make sense to introduce mandatory test periods in which the application can be tried out before the actual prescription is issued,” says Reimann.

The field period of the survey, which was carried out by the market research institute “Product + Market”, ran from September 24th to October 24th, 2022. During this period, 2,624 of a total of 20,879 AOK insured persons who were contacted by post took part in the survey. These insured persons had received and redeemed an activation code from the AOK for activating a digital health application two to twelve months before the survey, after they had previously received a corresponding doctor's prescription or had applied for the DiGA themselves from the health insurance company. The average age of those surveyed was 49 years, and 68 percent of those surveyed were women. The respondents' information on the prescribed "apps on prescription" correspond to the ranking of the DiGAs that have been most frequently prescribed and have been available for prescription for the longest time: The most frequently used were the obesity DiGA "zanadio", the tinnitus application "Kalmeda", the back DiGA " Vivira”, the depression application “deprexis”, the application “somnio” against sleep disorders and the migraine application “M-Sense”, which is no longer included in the DiGA directory.

There are currently 40 applications available

Since September 2020, those with statutory health insurance have been entitled to access to digital health applications. The basis for this is the Digital Supply Act, which came into force in December 2019. There are currently 40 applications listed in the DiGA directory of the Federal Institute for Drugs and Medical Devices (BfArM) that can be prescribed by a doctor for certain illnesses or applied for directly from the health insurance company. From September 2020 to December 2022, the eleven AOKs approved DiGAs worth 21.7 million euros.