Perspectives on digital therapeutic prescribing: a qualitative study among German psychological psychotherapists

Since 2020, psychological psychotherapists in Germany can issue CE-certified prescription digital therapeutics (German Digitale Gesundheitsanwendungen, DiGA) at the expense of statutory health insurance. Although DiGA must adhere to rigorous requirements (e.g., efficacy, data security) and are free of charge for statutorily insured patients, various barriers hinder their regular prescription in healthcare. However, little is known about facilitating and hindering factors influencing the acceptance and professional use of DiGA among psychological psychotherapists in Germany, who are authorized to issue prescriptions since the introduction of DiGA. This study thus aims to understand German psychological psychotherapists' perspectives toward prescribing DiGA.

A qualitative study design was used to explore prior knowledge of, experience with, and attitudes toward prescribing DiGA, as well as information needs and wishes. Two researchers conducted semi-structured interviews in July and August 2024 with 13 licensed German psychological psychotherapists. Audio recordings of the interviews were transcribed verbatim and analyzed using deductive and inductive coding according to qualitative content analysis.

Psychotherapists indicated moderate knowledge about DiGA, primarily gained through professional exchanges and driven by personal interest. While psychotherapists differed in their experience with prescribing DiGA, the reported need for more information on several aspects was a shared matter. Regarding the attitudes toward prescribing DiGA, perceived advantages included bridging waiting times, enhancing therapy support, and improving aftercare. Subjective barriers included a lack of established prescribing routines (unlike physicians) or skepticism about managing patients' crises effectively while using DiGA. Wishes pertaining to the informational content of DiGA included an evidence base, data privacy, or prescription guidelines. Psychotherapists varied broadly in their preferred methods of information delivery (e.g., in sources such as collegial exchange or media channels, such as online workshops).

The findings indicate that despite a positive mindset toward DiGA, the absence of routine practice hinders its widespread adoption among psychotherapists in Germany. Increasing knowledge about DiGA may lead to greater adoption of prescribing. This qualitative formative research will form the basis for further research to evaluate and optimize information strategies regarding digital therapeutics. Future research should focus on the influence of tailored information on actual prescriptions.