Prescriber's Preferences for Digital Health Applications in Mental Health Care: Cross-Sectional Best-Worst Scaling Study of General Practitioners and Psychotherapists in Germany.

BACKGROUND

Mental disorders affect nearly one-third of adults in Germany, with a 12-month prevalence of approximately 28%. Following Germany's 2019 Digital Care Act, digital health applications (Digitale Gesundheitsanwendungen [DiGA]) became reimbursable interventions by the statutory health insurance for mental health conditions. However, adoption remains uneven. General practitioners (GPs) issue most mental health DiGA prescriptions, while psychotherapists or psychiatrists prescribe far fewer, even though most DiGA target mental health. Existing studies imply profession-specific barriers but lack quantitative evidence on preference drivers or remain descriptive. Whether and how these preferences differ across professional groups has not been systematically quantified.

OBJECTIVE

This study aimed to quantify and compare GPs' and psychotherapists' or psychiatrists' preferences for factors associated with DiGA prescription decisions using best-worst scaling (BWS).

METHODS

A cross-sectional BWS study was conducted among outpatient GPs and psychotherapists or psychiatrists. Eleven DiGA objects were evaluated using a balanced incomplete block design. Preferences were analyzed using conditional logit regression. Likelihood ratio tests assessed differences between professional groups, with stratified models estimating group-specific odds ratios (OR) and 95% CIs.

RESULTS

Of 484 respondents (244 GPs and 240 psychotherapists or psychiatrists), 408 completed the BWS experiment. Group-specific ORs ranged from 0.47 to 1.72 (likelihood ratio test: χ210=328.76; P<.001), suggesting that GPs and psychotherapists or psychiatrists operate within a broadly shared evaluative space but assign different relative emphasis to specific factors influencing DiGA prescription decisions. Relative to the reference object (intuitive usability for patients), GPs most strongly preferred scientific recommendations (OR 1.72, 95% CI 1.42-2.09) and patients' interest in DiGA (OR 1.70, 95% CI 1.40-2.06) while significantly showing lower preferences for cross-device availability (OR 0.57, 95% CI 0.47-0.69) and access to patient-entered data (OR 0.47, 95% CI 0.39-0.57). Psychotherapists or psychiatrists showed different preference patterns, most strongly preferring device availability (OR 1.47, 95% CI 1.22-1.76) and contact points for technical support (OR 1.36, 95% CI 1.13-1.64) while showing significantly lower preference for alignment with scientific recommendations (OR 0.75, 95% CI 0.62-0.90).

CONCLUSIONS

Professional role is a source of preference heterogeneity for factors associated with DiGA prescription decisions. GPs assigned comparatively greater weight to evidence-based recommendations and patient interest, while psychotherapists or psychiatrists emphasized technical integration feasibility and peer experience. These structured differences in priority gradients indicate that uniform implementation approaches may not adequately reflect the evaluative frameworks of both professional groups.