# Prescribing Experiences, Potentials, and Challenges of Digital Health Applications in the Field of Hormones and Metabolism: Cross-Sectional Survey Study of Health Care Providers in Germany

## TL;DR

This study explores how healthcare providers in Germany prescribe digital health apps for hormone and metabolism conditions, finding low adoption due to lack of experience and reimbursement issues.

## Contribution

The study provides novel insights into DiHA prescribing behavior and barriers among HCPs in Germany, offering policy recommendations to improve integration and adoption.

## Key findings

- Over half of surveyed healthcare providers had never prescribed a digital health application.
- Lack of experience and inadequate reimbursement were cited as the main barriers to DiHA adoption.
- Most prescribers focused on apps for obesity or diabetes, with perceived benefits including improved self-management and adherence.

## Abstract

In 2020, the global prevalence of overweight and obesity was approximately 42%. One of the most common associated conditions is type 2 diabetes mellitus, which had a global prevalence of around 10.5% in 2021. Digital health applications (DiHA), which can be prescribed as certified medical devices in Germany, have been shown to effectively support disease management in patients with overweight and diabetes mellitus. However, little is known about DiHA-prescribing behavior of health care providers (HCPs) specializing in hormones and metabolism or about potential barriers to prescribing these applications.

This study aimed to assess HCPs’ experience with and willingness to prescribe DiHA in the field of hormones and metabolism. In addition, it sought to examine the patient-relevant health care effects that HCPs perceive as potentially achievable or have already observed with DiHA use, as well as the barriers they perceive to prescribing these applications.

An online questionnaire was developed based on preliminary studies and a literature review consisting of 86 items covering 6 key areas: experience and willingness to prescribe, health care effects, barriers, scientific evidence, digital affinity, and sociodemographics. The anonymous survey was distributed via the German Diabetes Association to 6035 HCPs in Germany between August 2 and October 9, 2024. Descriptive analyses, as well as correlation and regression analyses, were conducted.

A total of 350 HCPs participated in the survey (response rate=5.8%). Although the low response rate may limit generalizability, the findings provide insights into prescribing behavior within this specialty. More than half (187/350, 53.4%) had never prescribed any of the 54 DiHA available at the time of the survey, with 47.6% (89/187) citing a lack of experience as the primary reason. Among those who had prescribed a DiHA (163/350, 46.6%), the majority (139/163, 85.3%) had prescribed 1 of the 8 DiHA available for obesity or diabetes mellitus. Looking ahead, 42.9% (149/348) of all surveyed HCPs stated that they were either very unlikely (83/348, 23.9%) or somewhat unlikely (66/348, 19%) to prescribe these DiHA in the next 12 months. The greatest perceived benefits of DiHA were improvements in self-management, health literacy, and adherence. The main barriers to prescribing DiHA in the field of hormones and metabolism included inadequate reimbursement for ancillary medical services, poor compatibility with existing practice software, and a lack of digital affinity or motivation among patients.

DiHA have not yet been fully integrated into standard health care. To improve prescribing, we recommend integrating DiHA into medical guidelines, ensuring proper reimbursement, and involving HCPs in the pricing and health-economic evaluation of DiHA. The recommendations outlined should be considered to maximize DiHA’s potential and improve HCPs' acceptance, providing valuable insights for health policy to enhance the integration, reimbursement, and use of DiHA.