A pilot study on generic medicine substitution practices among community pharmacists in the State of Penang, Malaysia

Knowledge, attitudes, perceptions and practices of community pharmacists about generic medicine in Nigeria

Background

Although generic medicines are used extensively in Nigeria information from community pharmacists about these drugs are scanty and therefore inadequate. This is why this study has been designed to bridge the knowledge gap, attitudes, as well as the perception and practice of community pharmacists about generic medicines in Nigeria.

Method

A questionnaire-guided cross-sectional survey was used to collect data from 380 community pharmacists who were randomly selected from community pharmacies between April and June 2019 in Southwestern Nigeria. Data generated in the course of this study was analysed with the Statistical Package for Social Sciences version 18. Descriptive statistics were used to summarize data. Chi-square was used to test proportions and to determine associations between categorical variables. Pearson’s Correlation Coefficient was used to determine correlation between dependent variables.

Result

Mean knowledge score of community pharmacists about generic medicines(GM) was 5.6 ± 2.9 out of a total maximum score of 10. Results showed that 47.9% of respondents had poor knowledge, 27.6% average knowledge and 24.5% good knowledge about GM. Knowledge was significantly associated (p = .000) with all demographic characteristics except professional qualifications. A majority (89%) of the respondents were of the view that patients need more explanations when GMs are dispensed to them. In addition, 90.3% of the respondents were of the opinion that GM will improve access to medicine because they are cheaper and easily affordable. About 93% practice generic substitution without consulting prescribing physicians. Furthermore, 85% of the respondents claim they stock mainly GMs.

Conclusion

Community pharmacists in Nigeria had a positive attitude, perception and practice about GM, but exhibited sub-optimal knowledge in understanding issues concerning generic medicines. It is concluded that there is the need for continuous training and education to enhance professional knowledge of pharmacists in the area of GM substitution.

Community pharmacy and emerging public health initiatives in developing Southeast Asian countries: a systematic review

The development of health and healthcare systems in South-East Asia has influenced the practice of community pharmacy. Over the years, community pharmacy in the region has striven to expand services beyond dispensing to encompass more involvement in public health issues. Searches were conducted in Scopus, EMBASE, MEDLINE and PubMed for articles published between January 2000 and December 2014, with 21 studies in five countries meeting the inclusion criteria. The findings showed increasing interest in research into the delivery of pharmacy services and public health initiatives. Overall, the review found that provision of some health services in pharmacies was common; however, most public health initiatives appeared to be poorly implemented, had limited evidence and were not demonstrated to be sustainable across the sector. This indicates that the practice of community pharmacy in the region has not significantly changed over the past 14 years with respect to the scope and quality of pharmacy services provided, and fundamental policy changes are necessary to improve this situation.

The experiences of implementing generic medicine policy in eight countries: A review and recommendations for a successful promotion of generic medicine use

Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting the use of generic medicines in eight selected countries, namely the United States (US), the United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicine use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients.

Exploring community pharmacists' views on generic medicines: a nationwide study from Malaysia

OBJECTIVE

To evaluate the Malaysian community pharmacists' views on generic medicines.

SETTING

A sample of 1419 Malaysian community pharmacies with resident pharmacists.

METHOD

A cross-sectional nationwide survey using a self-completed mailing questionnaire.

MAIN OUTCOME MEASURE

Pharmacists' views on generic medicines including issues surrounding efficacy, safety, quality and bioequivalence.

RESULTS

Responses were received from 219 pharmacies (response rate 15.4%). Only 50.2% of the surveyed pharmacists agreed that all products that are approved as generic equivalents can be considered therapeutically equivalent with the innovator medicines. Around 76% of respondents indicated that generic substitution of narrow therapeutic index medicines is inappropriate. The majority of the pharmacists understood that a generic medicine must contain the same amount of active ingredient (84.5%) and must be in the same dosage form as the innovator brand (71.7%). About 21% of respondents though that generic medicines are of inferior quality compared to innovator medicines. Most of the pharmacists (61.6%) disagreed that generic medicines produce more side-effects than innovator brand. Pharmacists graduated from Malaysian universities, twinning program and overseas universities were not differed significantly in their views on generic medicines. Additionally, the respondents appeared to have difficulty in ascertaining the bioequivalent status of the marketed generic products in Malaysia.

CONCLUSION

The Malaysian pharmacists' have lack of information and/or trust in the generic manufacturing and/or approval system in Malaysia. This issue should be addressed by pharmacy educators and relevant government agencies.

Psychosocial factors associated with the prescription of generic drugs

OBJECTIVE

To evaluate factors associated with "Generic drug prescription" (GDP) behaviour in Spain using the ASE (Attitude, Social Influence, Self-Efficacy) Model.

METHODS

General Practitioners were sent a validated and anonymous questionnaire measuring the ASE and Motivation variables for GDP and their generic drug prescription percentage. Most (n=486; 61.98%) responded to this cross-sectional survey. The mean scores and the 95% confidence intervals (95% CI) were calculated. A binary logistic regression was used to identify the variables that best predict GDP behaviour.

RESULTS

The main advantages and motivations for GDP were "saving money" and "protecting professional ethics". The greatest social influences were "doctors' personal preferences" and "authorities' pressure". GDP accounted for a scarce 15% of the total prescription. ASE and Motivation items were the best predictors: they explain 25% of being a 'high prescriber'. The highest prescribers were paediatricians (OR=5.07), workers in rural settings (OR=3.68) and professionals with high Motivation (OR=1.17) and Attitude (OR=1.11) scores.

CONCLUSIONS

GDP percentage is very low compared with other countries. Interventions to modify the Attitudes of Primary Care doctors towards generic drugs should be implemented. Better informed patients, longer doctor appointment times and more varied dosage forms of generic drugs would also facilitate improvements in GDP.

Evaluating community pharmacists' perceptions of future generic substitution policy implementation: a national survey from Malaysia

OBJECTIVES

This study aims to provide baseline data to support the implementation of generic substitution policy in Malaysia by evaluating the community pharmacists' perceptions and opinions on generic substitution and current substitution practices.

METHODS

A cross-sectional descriptive study involving the entire population of Malaysian community pharmacies (n=1419) was undertaken using a self-completed anonymous mail questionnaire.

RESULTS

A total of 219 responses were received for a response rate of 15.4%. Majority of the respondents (93.6%) agreed that pharmacists should have generic substitution rights. Almost all pharmacists (96.8%) viewed Poison Class C (pharmacist only medicine) as most suitable class of controlled medicines for substitution. About half (51.6%) of the pharmacists preferred a policy which allowed substitution on any prescription. The pharmacists prefer to consult the physician when substituting narrow therapeutic index medicines (88.1%) and prescription only medicines (51.3%). Less than 25.0% of the pharmacists routinely keep the medication records and follow-up the patients who received substitution. Monitoring the efficacy (79.2%) and patient's satisfaction with the generic medicines (74.9%) were the main reasons for following-up the patient if substitution occurs.

CONCLUSIONS

Malaysian community pharmacists are generally in favour of generic substitution policy implementation.

Malaysian Pharmaceutical Industry: Opportunities and Challenges

A sound generic pharmaceutical industry is vital for any country in order to increase the access and affordability of pharmaceuticals to the society at large. In this context, the generic pharmaceutical industry in Malaysia is seen as one of the potential manufacturing sectors that contributes not only to the well-being of the population but also in terms of economic output to the nation. However, the viability of the generic pharmaceutical industry in Malaysia is not free from challenges. In this paper, an overview of the Malaysian pharmaceutical industry together with the opportunities and challenges facing the generic market will be discussed.

A pilot survey on perceptions and knowledge of generic medicines among consumers in Penang, Malaysia

Objective

To explore the consumers’ perceptions and knowledge towards issues surrounding generic medicines utilization in Penang, Malaysia.

Methods

A cross sectional survey was conducted with consumers who attended the annual University open day. Using convenience sampling, survey forms were distributed to the respective consumers via the help of a group of trained 1st year pharmacy students. For a period of 5 days, 400 respondents had participated in the survey. Analysis of the response from the collected forms yielded in 396 usable forms.

Results

Only 28.3% (n=112) of the respondents were familiar with the term “generic medicines”. More than 70% of the respondents do not know that generic medicines can be marketed under different names. About 34% (n=38) of consumers stated that they had been given information regarding generics by their pharmacists. In terms of side effects, about 32% (n=127) of the respondents felt that generic medicines may cause more side effects than branded medicines. Majority of the consumers surveyed (64%) understand that generic cost less compared to their branded counterparts.

Conclusion

This survey showed that there is a gap in consumers’ knowledge and understanding about generic medicines. The findings also suggest that direct patient education by the healthcare providers on issues relating to safety and efficacy of generic medicines could further enhance their uptake.

Current awareness: Pharmacoepidemiology and drug safety

In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

Pharmacists' Views on Generic Medicines: A Review of the Literature

The aims of this paper were to identify and review the literature on pharmacists' views and practices on the use of generic medicines. Using appropriate keywords pertaining to the subject matter, an extensive literature search was undertaken using indexing services available in the authors' institution library. These electronic databases were searched for full-text papers written in the English language during the period from 1980 until September 2007. Based on this search, 13 studies were identified. The majority of studies are from the United States, with few from Europe and Asia. All retrieved studies, except one, used quantitative methodology. Most of the studies showed that pharmacists' views and behaviours towards generic medicine utilisation were affected by economic considerations, quality and bioequivalency of generic medications, drug therapeutic class, and other actors (the physicians, the patients, and public health officials). This review suggests that although in general pharmacists were positively inclined towards generic medication use, they have some considerations that determine to what extent they will support generic medicine use. These are economic, scientific, and policy-related considerations that are likely to remain matters for discussion in the future among pharmacists and their professional organisations.