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Chen X, Feng Z, Luo Q, Li H, Shao S, Du J. Factors affecting the essential medicine prescribing behavior among general practitioners in Beijing, China: a cross-sectional study with structural equation model. BMC PRIMARY CARE 2024; 25:293. [PMID: 39127640 PMCID: PMC11316370 DOI: 10.1186/s12875-024-02556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The aim of this study is to explore the influence of GPs'information, motivation and behavior skills on EM prescribing behavior in urban and suburban districts. METHOD A cross-sectional study was conducted from June to November 2022 cross 3 urban districts and 4 suburban districts in Beijing. The structural equation model was used to analyze the factors influencing the essential medicine prescription behavior among general practitioners in urban and suburban districts. RESULTS A total of 511 valid questionnaires were collected. There was a statistically significant difference in mean scores for personal motivation and behavioral skills between urban GPs and suburban GPs. For urban GPs, the path analysis revealed that the social motivation had a direct effect on the essential medicine prescribing behavior (β = 0.225, p < 0.05). In contrast, for suburban GPs, both social motivation and personal motivation had a direct effect on the essential medicine prescribing behavior, respectively (β = 0.175, p < 0.05; β = 0.193, p < 0.01). CONCLUSION Social motivation of urban GPs were positively and significantly associated with essential medicine prescribing behavior. Social motivation and personal motivation of suburban GPs were positively and significantly associated with essential medicine prescribing behavior. Therefore, various corresponding policies and measures should be developed to promote the National Essential Medicines Policy in China.
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Affiliation(s)
- Xiaolei Chen
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, China
- Department of General Practice, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Zhengwen Feng
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, China
| | - Qi Luo
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, China
| | - Hui Li
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, China
| | - Shuang Shao
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, China.
| | - Juan Du
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, China.
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Alsufyani MH, Alghoribi MH, Bin Salman TO, Alrabie AF, Alotaibi IS, Kharbosh AM, Alsheikh MY, Alshahrani AM, Fathelrahman AI. Generic Substitutions and Therapeutic Interchanges in Hospital Pharmacies: A Qualitative Study from Western Saudi Arabia. Healthcare (Basel) 2023; 11:1893. [PMID: 37444727 DOI: 10.3390/healthcare11131893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Background: The aim of the present study was to understand hospital pharmacists' views and practices regarding generic substitution and therapeutic interchange. Method: This was a qualitative study involving pharmacists from three Western Saudi governorates: Taif, Makkah, and Jeddah. It included respondents from the Ministry of Health (MoH), military and private hospitals. Pharmacists were selected using a convenient sampling technique and data were collected using a structured face-to-face interview. Results: Fifty-seven pharmacists agreed to participate in this study. In MoH and private hospitals, generic substitution is a pharmacist-initiated act, while therapeutic interchange requires physician approval. Medication unavailability, side effects, patient characteristics, outcomes, and economic status justified most substitution decisions. In military hospitals, both types of substitutions are controlled by an auto-switch policy and physicians should be informed. In all hospitals, there are policies regulating substitution. Medications eligible for interchange mentioned by pharmacists from different hospitals were comparable to some extent. Pharmacists from the private sector considered substitution a supportive economic measure for both hospitals and patients. Most pharmacists highlighted that patient convenience and physician approval are the most challenging situations in substitution practice. Conclusions: An enhanced understanding of substitution and knowledge about medications included in the hospital formulary will be valuable support to the implementation of substitution practice which responds to the patients' needs to improve their outcomes.
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Affiliation(s)
| | | | | | | | | | - Abdullah Mosa Kharbosh
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Mona Yaser Alsheikh
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Ali Mofleh Alshahrani
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
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Qu J, Zuo W, Took RL, Schafermeyer KW, Lukas S, Wang S, Du L, Liu X, Gao Y, Li J, Pan H, Du X, Mei D, Zhang B. A nationwide survey exploring physicians’ and pharmacists’ knowledge, awareness and perceptions regarding generic medicines in China. BMC Health Serv Res 2022; 22:1069. [PMID: 35987631 PMCID: PMC9392939 DOI: 10.1186/s12913-022-08438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Generic medicines substitution is an important means to control rapid growth of pharmaceutical expenditures for the healthcare system in China. Acceptance and utilization of generic medicines is highly influenced by healthcare providers’ perceptions. This study aimed to compare the knowledge, awareness and perceptions of generic medicines between physicians and pharmacists in China. Methods We used an online, cross-sectional survey across China. The questionnaire explored four sections: demographic characteristics, assessment of the participants’ knowledge and awareness of generic medicines, perceptions of generic medicines and generic substitution practices. Chi-square or Mann–Whitney-U tests were applied to compare differences between physicians and pharmacists. P-values < 0.05 were considered significant. Results A total of 1644 physicians and 4187 pharmacists participated. Most physicians (82.8%, n = 1362) and pharmacists (89.8%, n = 3760) correctly identified the definition of generic medicines. A similar percentage of physicians and pharmacists agreed that approved generic medicines are as effective (64.1% vs 68.2%) or safe (63.8% vs 69.1%) as brand-name medicines. Most physicians and pharmacists (67.6% vs 71.0%) supported the policy of generic substitution. In practice, 79.4% (n = 1305) of physicians reported that they had prescribed generic medicines. More than 78% of respondents reported an obvious increase in the number of generic medicines prescribed in their medical institutions. The majority of physicians and pharmacists identified lack of trust regarding efficacy and safety of generic medicines and the difficulty of changing patients’ preference as top challenges in generic substitution. Conclusions Both physicians and pharmacists surveyed had adequate knowledge of generic medicines, and hold positive attitude towards generics and generic substitution. Efficacy and safety are key factors related to prescribing or dispensing generic medicines. Various policies and regulations should be taken to encourage successful generic substitution. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08438-9.
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Lavtepatil S, Ghosh S. Improving access to medicines by popularising generics: a study of 'India's People's Medicine' scheme in two districts of Maharashtra. BMC Health Serv Res 2022; 22:643. [PMID: 35562697 PMCID: PMC9107149 DOI: 10.1186/s12913-022-08022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background In spite of being the ‘pharmacy of the world’, access to essential medicines for a large majority of Indians is constrained by both physical and financial reasons. According to an estimate, medicines account for 69% of household out-of-pocket spending on health care. To make quality generic medicine affordable, India’s People’s Medicine Scheme (Jan Aushadhi) was launched in 2008 and then revamped and rebranded as Pradhan Mantri Bhartiya Jan Ausadhi Pariyojana (PMBJP) in 2015. The current study focuses on the availability, affordability and acceptability aspects of PMBJP essential medicines. Methods We have used a mixed-methods approach, with the survey-based quantitative component supplemented by a qualitative component consisting of in-depth interviews (IDIs). The survey was conducted in 11 PMBJP pharmacies in Mumbai and Palghar. Data were gathered on the availability, stock-outs, price and affordability of 35 essential medicines and 2 consumables. Results Apart from the limited coverage of essential medicines and the significant presence of Fixed dose combinations (FDCs) in the PMBJP medicine list, the availability of surveyed essential drugs was also found to be low (47%) in PMBJP outlets. Across Mumbai and Palghar districts, around 50% and 42% of medicines were found to be out of stock for the period of 3–6 months respectively. The cost of generic medicines of PMBJP outlets for treating various conditions range from 0.01 days’ wages to 0.47 days’ wages for the lowest paid unskilled worker in Maharashtra. Conclusions The study findings show that PMBJP’s unbranded generics offer great opportunities for substantial cost savings. But, in order to fully realise the potential of this scheme, some policy actions are urgently required. First, the PMBJP drug list must include all essential drugs that feature in NLEM. Second, BPPI should procure only those drugs that pass the bioequivalence test. Third, compulsory de-branding of generics should be done in a phased manner. Fourth, PMBJP’s medicine procurement and distribution policies must be reviewed to address the supply chain issues. Moreover, there is a need for major pharmaceutical policy reforms to promote generic medicines in a big way. Regulations to support mandatory generic prescribing and generic substitution by pharmacists are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08022-1.
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Affiliation(s)
- Sonam Lavtepatil
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Soumitra Ghosh
- Centre for Health Policy, Planning and Management, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
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Qu J, Zuo W, Wang S, Du L, Liu X, Gao Y, Li J, Pan H, Du X, Mei D, Took RL, Schafermeyer KW, Lukas S, Zhang B. Knowledge, perceptions and practices of pharmacists regarding generic substitution in China: a cross-sectional study. BMJ Open 2021; 11:e051277. [PMID: 34663661 PMCID: PMC8524276 DOI: 10.1136/bmjopen-2021-051277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate pharmacists' knowledge, perceptions and practices towards generic substitution in the 11 pilot locations in China. DESIGN An online cross-sectional survey using questionnaires was conducted. A convenience sampling technique was implemented to recruit pharmacists. SETTING AND PARTICIPANTS The study took place in medical institutions of 11 pilot locations that participated in the pilot national centralised procurement programme in 2019. Two thousand two hundred and ninety-one pharmacists including hospital pharmacists or community pharmacists based on health-systems or clinics participated in the study. RESULTS Most of the participants had the good knowledge of requirements for evaluating the quality and efficacy of generic drugs (n=2118; 92.4%), and the definition of generic drugs (n=2078; 90.7%). In terms of perceptions, 67.3% of respondents were of the opinion that generic drugs are equally as effective as the brand-name drugs, and 69.0% of respondents were of the opinion that generic drugs are as safe as brand equivalents. A high percentage of participants supported the policy of generic substitution (n=1634; 71.4%). A significant positive correlation was demonstrated between total knowledge score and total perception score (ρ=0.267; p<0.001). Efficacy, safety and the direction of national policies and hospital regulations were the main factors affecting pharmacists' willingness to dispense generic drugs. CONCLUSIONS The study identified gaps in respondents' knowledge and perceptions of generic substitution. Pharmacists who are more knowledgeable in generic drugs tend to hold a more supportive attitude towards generic substitution. Although it appeared that pharmacists in China have largely accepted generic substitution, they still have concerns regarding the reliability and quality of generic drugs. The current issues need to be addressed for the realisation of the true value of generic drugs as part of the country's healthcare cost-containment strategy as well as the implementation of generic substitution policy in China.
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Affiliation(s)
- Jinghan Qu
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Wei Zuo
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Shaohong Wang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Liping Du
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xin Liu
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Yang Gao
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Jiantao Li
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Hui Pan
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xiaoli Du
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Dan Mei
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Roxane L Took
- Department of Pharmacy Practice, St. Louis College of Pharmacy, St Louis, Missouri, USA
| | - Kenneth W Schafermeyer
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, St Louis, Missouri, USA
| | - Stephanie Lukas
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, St Louis, Missouri, USA
| | - Bo Zhang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
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Pizetta B, Raggi LG, Rocha KSS, Cerqueira-Santos S, de Lyra-Jr DP, dos Santos Júnior GA. Does drug dispensing improve the health outcomes of patients attending community pharmacies? A systematic review. BMC Health Serv Res 2021; 21:764. [PMID: 34340700 PMCID: PMC8330087 DOI: 10.1186/s12913-021-06770-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Drug dispensing is a clinical pharmacy service that promotes access to medicines and their rational use. However, there is a lack of evidence for the impact of drug dispensing on patients' health outcomes. Thus, the purpose of this study was to assess the influence of drug dispensing on the clinical, humanistic, and economic outcomes of patients attending community pharmacies. METHODS A systematic literature search was performed in April 2021 using PubMed, Web of Science, Cochrane Library, LILACS, and Open Thesis. Two reviewers screened titles, abstracts, and full-text articles according to the eligibility criteria. Methodological quality was assessed using tools from the Joanna Briggs Institute, and the literature was synthesized narratively. RESULTS We retrieved 3,685 articles and included nine studies that presented 13 different outcomes. Regarding the design, they were cross-sectional (n = 4), randomized clinical trials (n = 4), and quasi-experimental (n = 1). A positive influence of drug dispensing on health outcomes was demonstrated through six clinical, four humanistic and three economic outcomes. Eight studies (88,9 %) used intermediate outcomes. The assessment of methodological quality was characterized by a lack of clarity and/or lack of information in primary studies. CONCLUSIONS Most articles included in this review reported a positive influence of drug dispensing performed by community pharmacists on patients' health outcomes. The findings of this study may be of interest to patients, pharmacists, decision makers, and healthcare systems, since they may contribute to evidence-based decision-making, strengthening the contribution of community pharmacists to health care. TRIAL REGISTRATION Registration: PROSPERO CRD42020191701 .
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Affiliation(s)
- Bárbara Pizetta
- Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, ES Alegre, Brazil
| | - Lívia Gonçalves Raggi
- Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, ES Alegre, Brazil
| | - Kérilin Stancine Santos Rocha
- Health Sciences Graduate Program, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, SE São Cristóvão, Brazil
| | - Sabrina Cerqueira-Santos
- Health Sciences Graduate Program, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, SE São Cristóvão, Brazil
| | - Divaldo Pereira de Lyra-Jr
- Health Sciences Graduate Program, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, SE São Cristóvão, Brazil
| | - Genival Araujo dos Santos Júnior
- Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, ES Alegre, Brazil
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Bayram D, Aydin V, Gelal A, Aksoy M, Akici A. Generic drug prescribing in primary care: A nationwide analysis. Int J Clin Pract 2021; 75:e14284. [PMID: 33914404 DOI: 10.1111/ijcp.14284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dissemination of generic drug (GD) use could provide significant savings on drug expenditures and contribute to the long-term sustainability of healthcare. We aimed to exhibit the nationwide trend of GD use in primary care and investigate potentially relevant drug and patient factors. METHODS Prescriptions written by primary care physicians in Turkey between 2013 and 2016 were analysed using the National Prescribing Information System. We determined the ratio of GD prescriptions with all prescriptions in terms of quantity and cost. In addition, we analysed the use of GD in terms of demographic characteristics of the patients, the most frequently prescribed preparations and frequent indications. RESULTS In the 4-year period, we identified 518,335,821 prescriptions, those with at least one GD constituted 54.0% (n = 786,972,813) with a total cost-share of 36.9%-37.8%. GD use was the highest in 2016 (54.4%) and lowest in 2014 (53.6%). GD prescribing was higher in women than men every year (P < .001 for each), with the highest difference in 2016 as 54.7% vs 54.0%. GD utilisation decreased as the age group increased, which was 64.0%-64.5% in <18-year-old group and 46.0%-47.1% in ≥75-year-old group. Among the top ten encountered indications, the highest and lowest GD prescribing was detected in acute tonsillitis (68.1%) and hypertension (33.9%). Metformin had the highest percentage of GD prescribing (96.1%-97.7%), whereas esomeprazole showed the lowest GD prescribing (4.5%-14.8%) among the most frequently used preparations in primary care. CONCLUSION This study shows a modest upward trend of GD utilisation in primary care, though its share appears to be lower than expected. GD use revealed a consistent reduction towards older age groups. GDs were more likely to be prescribed for acute conditions, particularly infectious diseases.
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Affiliation(s)
- Dilara Bayram
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Aydin
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Gelal
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara, Turkey
| | - Ahmet Akici
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
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Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study. Antibiotics (Basel) 2021; 10:antibiotics10010047. [PMID: 33466476 PMCID: PMC7824809 DOI: 10.3390/antibiotics10010047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/23/2022] Open
Abstract
Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.
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Saha SK, Kong DCM, Thursky K, Mazza D. Antimicrobial stewardship by Australian community pharmacists: Uptake, collaboration, challenges, and needs. J Am Pharm Assoc (2003) 2020; 61:158-168.e7. [PMID: 33187894 DOI: 10.1016/j.japh.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess community pharmacists' (CPs') awareness and uptake of evidence-based antimicrobial stewardship (AMS) strategies, attitudes toward collaboration with general practitioners (GPs), and needs to improve AMS practices. METHODS A nationwide survey of randomly sampled community pharmacies across Australia was conducted in April-October 2019. RESULTS The response rate of CPs was 30.7% (613 of 2000) and 592 participating CPs (96.5%) described the key barriers to and facilitators of improving AMS. CPs (447 of 613, 72.9%) were familiar with AMS but felt that they would require training (468 of 612, 76.5%) and access to AMS practice guidelines (566 of 605, 93.6%). Respondents perceived that AMS programs could reduce the inappropriate use of antimicrobials (409 of 612, 66.8%) and the costs of treating infection (508 of 612, 83.0%). CPs often counseled patients (591 of 609, 97.0%) and reviewed drug interactions or allergies (569 of 607, 93.8%) before dispensing antimicrobials. Respondents less often used the national Therapeutic Guidelines: Antibiotic (274 of 602, 45.5%) or assessed guideline-compliance of prescribed antimicrobials (231 of 609, 37.9%). CPs were less likely to communicate with GPs (254 of 609, 41.8%) when an antimicrobial prescription was believed to be suboptimal and perceived that GPs are not receptive to their intervention regarding the antimicrobial choice (500 of 606, 82.6%) and dosage (416 of 606, 68.6%). Point-of-care tests (114 of 596, 19.1%) and patient information leaflets (149 of 608, 24.5%) were used uncommonly. Most respondents supported policies that could foster GP-pharmacist collaboration (560 of 606, 92.4%), limit accessibility of selected antimicrobials (420 of 604, 74.4%), and reduce repeat-dispensing of antimicrobial prescriptions (448 of 604, 74.2%). CPs faced interpersonal, interactional, structural, and resource-level barriers to collaborate with GPs for practicing AMS. CONCLUSIONS CPs are aware of the importance of sensible use of antimicrobials but have had limited training and resources to conduct AMS activities. Improving GPs' receptiveness and system structures for increased GP-CP collaboration seem to be a priority to accelerate CP-led AMS implementation. Further study is required to understand the views of stakeholders about the feasibility of implementing evidence-based GP-CP collaborative AMS approaches.
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Mathews A, Ming LC, Che Rose FZ, Abbas SA. Cross-sectional Study on the Impact of Discount Pricing and Price Competition on Community Pharmacy Practice. Cureus 2020; 12:e9903. [PMID: 32839684 PMCID: PMC7440992 DOI: 10.7759/cureus.9903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Without stipulated legislation, a free pricing policy can lead to a disparity in prices among private healthcare setups. Competition is especially rampant among community pharmacies, especially in the Sabah state of Malaysia, where the recent years have witnessed the steady growth of pharmacy players from Peninsular Malaysia. Thus, this study aimed to examine the impact of price competition and discount pricing on the practice of community pharmacy in Sabah, Malaysia. Methods This was a cross-sectional study using an online questionnaire. Survey participants included community pharmacists practicing in Sabah. The validated and pilot-tested questionnaire consisted of three parts: background information of the pharmacy, attitudes and perception toward medicine prices, and practice of discount pricing. All required data were collected from community pharmacists practicing only in Sabah. Data were then analyzed by using descriptive, Chi-Square, and Kendall's tau-b tests. Results Of the 150 community pharmacists contacted, only 70 responded, providing a response rate of 47%. In terms of pharmacy type, 71% of the respondents were pharmacist-owned independent pharmacies, while 19% were pharmacy chains owned by community pharmacists. The remaining were pharmacies owned by non-pharmacists (10%). Sixty percent of the community pharmacies had been in existence for more than 10 years, with 12% in existence for less than two years, and 28% in existence for three to 10 years. More than 80% of the respondents stated that the business aspect of community pharmacy had overwhelmed the professional practice aspects and that community pharmacists have become providers of products instead of providers of care. In terms of professionalism, 87% also noted that they are being perceived as profiteering in the medicine business at the expense of patients. Conclusions The free market situation in Malaysia for medicine pricing has brought a detrimental consequence for community pharmacists with each one trying to undercut prices. Differing pricing mechanisms of medicines based on the quantity ordered contribute to the problem of discount pricing and price competition. Most community pharmacists, as indicated by this study, want the problem to be addressed.
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Affiliation(s)
- Allan Mathews
- Faculty of Pharmacy, Quest International University Perak, Ipoh, MYS
| | - Long C Ming
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, BRN
| | - Farid Z Che Rose
- Faculty of Science and Technology, Quest International University Perak, Ipoh, MYS
| | - Syed A Abbas
- Faculty of Pharmacy, Quest International University Perak, Ipoh, MYS
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Husnain SZ, Bukhari NI, Hussain K, Babar ZUD, Hashmi FK, Saleem Z, Salman M, Curley L. Cross verification of prescribing trends through loop evaluation of physicians, patients and medical store personnel. BMC Health Serv Res 2019; 19:328. [PMID: 31118096 PMCID: PMC6532124 DOI: 10.1186/s12913-019-4145-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription connects physician, patient and community pharmacy personnel who can help in understanding prescribing pattern. The present study was aimed to get an insight of viewpoints of all members involved in progression of events from prescription to drug purchase, i.e., physician, patient and medical-store personals regarding the prescription pattern in Pakistan. METHODS Therefore, a cross-sectional study was conducted in four provinces and capital territory (Islamabad) of Pakistan to evaluate the perception of physicians, patients and medical stores/pharmacy personnel of the prescribing trends in Pakistan. RESULTS Response rate was higher from Punjab and lower in Sindh. Responses of 981 walk-in patients with 393 physicians and 618 medical stores/pharmacies were received and statistically evaluated. The majority of physicians, patients and pharmacists/medical store personnel considered the medicines of multinational manufacturers as more effective. Physicians considered their prescribing cost-effective. However, majority of patients as well as pharmacists/medical store personnel strongly disagreed or disagreed with this notion that physicians prescribe cheap medicines. Furthermore, physicians and patients reported that medicines of local companies were not as effective as the medicines of multinational manufacturers, which were contrary to what pharmacists thought. Majority of physicians disagreed that their prescribing was under the influence of medical stores in their vicinity. The response of most of the patients (40.5%) was in line with that of physicians whereas 32% pharmacist/medical store personnel agreed. Nearly half of the physicians strongly agreed or agreed that patients demand medicines of multinational companies. Contrarily, a majority of patients and medical store personnel denied that patients demand for the medicines of multinational manufacturers. CONCLUSION The study highlighted that there was a need to develop policy guidelines at the level of Federal Government and Drug Regulatory Authority of Pakistan in connection with prescribing practices to reduce the variation in perception of key stakholders involved in drug use process.
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Affiliation(s)
- Syed Zia Husnain
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Nadeem Irfan Bukhari
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan.
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Zikria Saleem
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Muhammad Salman
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Louise Curley
- School of Pharmacy, Faculty of medical and health sciences, University of Auckland, Auckland, New Zealand
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Krentz HB, Campbell S, Lahl M, Gill MJ. De-simplifying single-tablet antiretroviral treatments: uptake, risks and cost savings. HIV Med 2019; 20:214-221. [PMID: 30632660 DOI: 10.1111/hiv.12701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES As more HIV-positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De-simplifying a single-tablet co-formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de-simplification of one STF could be utilized as a cost-saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. METHODS Patients stable on the most commonly used STF (Triumeq® ) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay® . No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. RESULTS Of 626 patients receiving Triumeq® , 321 were approached; 177 (55.1%) agreed to de-simplify. Of patients initiating ART, 62.7% chose the generic co-formulation. Patients switching to or starting on the generic co-formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV-experienced, and to have more comorbidities (all P < 0.05). Preference for STF was cited for declining de-simplification. No concern about generic ARVs was expressed. The rate of viral load > 500 HIV-1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. CONCLUSIONS Reliance on altruism, while respecting patient autonomy, achieved de-simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M Lahl
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Beauvais V, Marque A, Ferté G, Chrusciel J, Souille J, Nazeyrollas P, Sanchez S. Factors influencing the use of the "not for generic substitution" mention for prescriptions in primary care: a survey with general practitioners. BMC Health Serv Res 2018; 18:850. [PMID: 30419890 PMCID: PMC6233580 DOI: 10.1186/s12913-018-3652-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generic drug substitution is a public health policy challenge with high economic potential. Generic drugs are generally cheaper than brand-name drugs. Drugs are a significant part of the total health expenditure, especially in ambulatory care. We conducted a cross-sectional study with general practitioners in the Champagne-Ardenne region to determine physician-related factors and beliefs causing doctors to use the Not for Generic Substitution (NGS) mention. METHODS Questionnaires were sent to General Practitioners (GPs) practicing in Champagne-Ardenne via 3 shipments, from January 2015 to May 2015. Prescriber characteristics and beliefs influencing the use of the NGS mention were assessed for frequent (≥ 5%) and less frequent (< 5%) users of the NGS mention. RESULTS Factors associated with above average NGS mention use in bivariate analysis included patient comorbidity, polypharmacy, a concern that generic and brand-name drugs are not bioequivalent and belief in higher efficacy of the brand name drug. The use of an e-prescribing system (EPS) and medical practice in rural areas appeared to be associated with lower use of NGS mention in bivariate analysis but not in multivariable analysis. In multivariable analysis, patient request was associated with a higher use of the NGS mention (NGS ≥ 5%, adjusted Odds Ratio (aOR) = 2.52; 95% CI = [1.46-4.35]; p = 0.001), which was also linked to patient age over 65 (NGS ≥ 5%, aOR = 2.33; 95% CI = [1.03-5.30]; p = 0.04). The NGS mention was often used for drugs where substitution is debated in the literature (thyroid hormones, antiepileptic drugs). CONCLUSION This work highlights the involvement of the doctor-patient pair for the use of the NGS mention. Patient request was the major reason for using the NGS mention, even though it was not always endorsed by prescribers. Further studies are needed to assess patient views on generic drugs and drug substitution, accounting for their health status and socio-economic condition, to help improve the relevance of the information available to them.
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Affiliation(s)
| | - Annabelle Marque
- Emergency Department, Centre Hospitalier de Troyes, 10000, Troyes, France
| | | | - Jan Chrusciel
- Medical Information Department, Centre Hospitalier de Troyes, 10000, Troyes, France
| | - Julie Souille
- Emergency Department, Centre Hospitalier Universitaire de Reims, 51092, Reims, France
| | - Pierre Nazeyrollas
- Cardiology Department, Centre Hospitalier Universitaire de Reims, 51092, Reims, France
| | - Stéphane Sanchez
- Medical Information Department, Centre Hospitalier de Troyes, 10000, Troyes, France. .,, Troyes, France.
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15
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INN or brand name drug prescriptions: a multilevel, cross-sectional study in general practice. Eur J Clin Pharmacol 2018; 75:275-283. [PMID: 30368571 DOI: 10.1007/s00228-018-2580-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The prescription in International Nonproprietary Names (INN) is a legal obligation for all physicians in France since January 2015. The objective of this study was to analyze the frequency and main factors of INN drug prescribing in general practice. METHODS Multicenter cross-sectional study conducted with 11 interns acting as observers of 23 GP trainers between November 2015 and January 2016. Two evaluators analyzed all GPs' drug prescriptions to identify INN or brand name prescriptions. RESULTS The database included 4957 drugs prescribed during 1647 visits. Of these, 1462 (29.5% [95% CI 28.2-30.8%]) were prescribed only in INN. According to the multivariate analyses, the factors favoring INN prescribing were as follows: at the drug level, its initial prescribing (OR = 1.4), a nonspecific prescribing objective (OR = 1.6), its listing in the generic drug index with (OR = 7.7) or without (OR = 2.9) efficiency objective included in the payment for public health objectives (PPHO) program, and the oral route of administration (OR from 0.4 for the percutaneous route to 0.2 for the pulmonary route); at the patient level, the male gender (OR = 1.3), the age of 15 years or more (OR = 1.9), and the absence of a long-term condition (OR = 1.3); at the physician level, the reception of a public healthcare insurance representative (OR = 4.1), the nonreception of pharmaceutical sales representatives (OR = 3.0), and the urban practice environment (OR = 2.8). CONCLUSIONS In 2015, less than one third of drugs were prescribed in INN only in general practice. The use of various incentives and regulatory measures is likely to favor the prescription of INNs by practitioners.
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Mondelo-García C, Mendoza E, Movilla-Fernández MJ, Coronado C. Perceptions of pharmacists and physicians on generic substitution in a financial crisis context in Northwestern Spain: A qualitative study. Health Policy 2018; 122:1316-1325. [PMID: 30201184 DOI: 10.1016/j.healthpol.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/14/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022]
Abstract
In Spain, the use of generics has considerably evolved in a short period of time through different anti-crisis legislation changes. Before the financial crisis the proposal of generics was an option for patients. Nowadays its use is actively enforced by Health authorities. OBJECTIVE To explore the perceptions of pharmacists and physicians regarding the generic substitution driven by new Spanish drugs policies as well as their adaptive strategies intended to lessen the impact of changes to their patients' treatment. METHODS Pharmacists (16) and physicians (13) from Ferrol and A Coruña participated in a qualitative study using semi-structured in-depth interviews. RESULTS Qualitative analysis allowed identification of nine key components in the substitution process: Enabling factors: 'Adequate information to patients', 'Acute treatments', 'Bioappearance', 'Prescription by Estate Official Denomination followed by laboratory name', 'Personalized dosage systems'. Obstructing factors: 'Generics/Authorities distrust', 'Lack of time', 'Patient characteristics', 'Pharmacy financial management'. CONCLUSIONS Pharmacists and physicians in our economic crisis context perceive different barriers resulting in difficulties in the generic substitution process. They have implemented strategies to capitalize on the enablers and overcome the additional budget-cut barriers imposed by the Administration that had prevented them from maintaining their patient's treatment preferences. Spanish health authorities could improve current legislation either by reducing the number of new laboratories of authorized generic manufacturers or by extending the pharmacist capability for equivalent drugs substitution.
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Affiliation(s)
- Cristina Mondelo-García
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - Elvia Mendoza
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - Carmen Coronado
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain.
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Babar ZUD, Gammie T, Seyfoddin A, Hasan SS, Curley LE. Patient access to medicines in two countries with similar health systems and differing medicines policies: Implications from a comprehensive literature review. Res Social Adm Pharm 2018; 15:231-243. [PMID: 29678413 DOI: 10.1016/j.sapharm.2018.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Countries with similar health systems but different medicines policies might result in substantial medicines usage differences and resultant outcomes. The literature is sparse in this area. OBJECTIVE To review pharmaceutical policy research in New Zealand and Australia and discuss differences between the two countries and the impact these differences may have on subsequent medicine access. METHODS A review of the literature (2008-2016) was performed to identify relevant, peer-reviewed articles. Systematic searches were conducted across the six databases MEDLINE, PubMed, Science Direct, Springer Links, Scopus and Google Scholar. A further search of journals of high relevance was also conducted. Using content analysis, a narrative synthesis of pharmaceutical policy research influencing access to medicines in Australia and New Zealand was conducted. The results were critically assessed in the context of policy material available via grey literature from the respective countries. RESULTS Key elements regarding pharmaceutical policy were identified from the 35 research papers identified for this review. Through a content analysis, three broad categories of pharmaceutical policy were found, which potentially could influence patient access to medicines in each country; the national health system, pricing and reimbursement. Within these three categories, 9 subcategories were identified: national health policy, pharmacy system, marketing authorization and regulation, prescription to non-prescription medicine switch, orphan drug policies, generic medicine substitution, national pharmaceutical schedule and health technology assessment, patient co-payment and managed entry agreements. CONCLUSIONS This review systematically evaluated the current literature and identified key areas of difference in policy between Australia and NZ. Australia appears to cover and reimburse a greater number of medicines, while New Zealand achieves much lower prices for medicines than their Australian counterparts and has been more successful in controlling national pharmaceutical expenditure. Delays in patient access to new therapies in New Zealand have considerable implications for overall patient access to medicines; however, higher patient co-payments and relative pharmaceutical expenditure in Australia and its effect upon patient access to medicines must also be considered.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, West Yorkshire, HD1 3DH, United Kingdom; School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Todd Gammie
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ali Seyfoddin
- Auckland University of Technology (AUT), Auckland, New Zealand
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, West Yorkshire, HD1 3DH, United Kingdom
| | - Louise E Curley
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Krentz HB, Campbell S, Gill VC, Gill MJ. Patient perspectives on de-simplifying their single-tablet co-formulated antiretroviral therapy for societal cost savings. HIV Med 2018; 19:290-298. [PMID: 29368401 DOI: 10.1111/hiv.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The incremental costs of expanding antiretroviral (ARV) drug treatment to all HIV-infected patients are substantial, so cost-saving initiatives are important. Our objectives were to determine the acceptability and financial impact of de-simplifying (i.e. switching) more expensive single-tablet formulations (STFs) to less expensive generic-based multi-tablet components. We determined physician and patient perceptions and acceptance of STF de-simplification within the context of a publicly funded ARV budget. METHODS Programme costs were calculated for patients on ARVs followed at the Southern Alberta Clinic, Canada during 2016 (Cdn$). We focused on patients receiving Triumeq® and determined the savings if patients de-simplified to eligible generic co-formulations. We surveyed all prescribing physicians and a convenience sample of patients taking Triumeq® to see if, for budgetary purposes, they felt that de-simplification would be acceptable. RESULTS Of 1780 patients receiving ARVs, 62% (n = 1038) were on STF; 58% (n = 607) of patients on STF were on Triumeq®. The total annual cost of ARVs was $26 222 760. The cost for Triumeq® was $8 292 600. If every patient on Triumeq® switched to generic abacavir/lamivudine and Tivicay® (dolutegravir), total costs would decrease by $4 325 040. All physicians (n = 13) felt that de-simplifying could be safely achieved. Forty-eight per cent of 221 patients surveyed were agreeable to de-simplifying for altruistic reasons, 27% said no, and 25% said maybe. CONCLUSIONS De-simplifying Triumeq® generates large cost savings. Additional savings could be achieved by de-simplifying other STFs. Both physicians and patients agreed that selective de-simplification was acceptable; however, it may not be acceptable to every patient. Monitoring the medical and cost impacts of de-simplification strategies seems warranted.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - V C Gill
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Ferreira P, Barbosa H. Choice of mandatory prescribed drugs in Portugal: a consumers’ perspective. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-07-2016-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to contribute to the understanding of what influences consumers’ choice of mandatory prescribed drugs, by looking with more detail to the substitution of branded drugs by generics. Specifically, this research looks at three factors that can influence this decision, namely, participative decision-making, perceived risk and price consciousness, within the recent changes introduced in the Portuguese pharmaceutical market by new legislation.
Design/methodology/approach
A cross-sectional study was conducted, using a self-administered questionnaire, to survey a sample of consumers/patients that visited a doctor and were prescribed some kind of drug. Data were treated using factor analysis for dimensionality reduction purposes and regression analysis to test the main hypothesis.
Findings
The results show that participative decision-making has no impact on purchase decision of generics, while perceived risk and price consciousness show a predictive power regarding purchase intention of generic drugs.
Research limitations/implications
Although the results are only applicable to the Portuguese context, it draws important conclusions regarding consumers’ behaviour when choosing between branded and generic drugs.
Practical implications
Knowing what influences consumers’ choices of generic drugs contributes to tune marketing strategies and actions. For public institutions, this paper offers insights on how to adapt public policies.
Originality/value
This paper is valuable because it is the first to look at the Portuguese pharmaceutical market from a consumer behaviour perspective since new legislation was set up.
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20
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Perceptions and behaviors of patients and pharmacists towards generic drug substitution in Lebanon. Int J Clin Pharm 2017; 39:1101-1109. [DOI: 10.1007/s11096-017-0509-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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El-Jardali F, Fadlallah R, Morsi RZ, Hemadi N, Al-Gibbawi M, Haj M, Khalil S, Saklawi Y, Jamal D, Akl EA. Pharmacists' views and reported practices in relation to a new generic drug substitution policy in Lebanon: a mixed methods study. Implement Sci 2017; 12:23. [PMID: 28212657 PMCID: PMC5316154 DOI: 10.1186/s13012-017-0556-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/14/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Governments in both developed and developing countries have adopted generic drug substitution policies to decrease pharmaceutical expenditures and improve access to medicine. In August 2015, the Ministry of Public Health (MOPH) in Lebanon introduced generic drug substitution and a unified medical prescription form as policy instruments to promote generic drug use. The objective of this exploratory study was to examine the attitudes of community pharmacists and the reported practices in relation to the implementation of the new generic drug substitution policy. METHODS We used a cross-sectional mixed methods approach composed of self-administered questionnaires and semi-structured interviews. The study population consisted of community pharmacists in Lebanon. We randomly approached one pharmacy personnel from each selected community pharmacy. We conducted descriptive analyses to assess responses to questionnaire and regression analyses to understand associations between responses and respondent demographics. We analyzed qualitative data thematically. RESULTS Out of 204 invited community pharmacies, 153 pharmacies participated (75% response rate). The majority of respondents (64%) were in favor of generic drug substitution; however, less than half (40%) indicated they have substituted brand drugs for generic equivalents. Moreover, 57% indicated that the existing pricing system discourages them from performing generic drug substitution. Most respondents indicated that physicians are overusing the "non-substitutable" option (84%) and that there are technical problems with processing the new prescription form (78%). Less than half (47%) reported that the MOPH is performing regular audits on the forms collected by the pharmacy. While 45% of the respondents indicated that consumers have accepted most of the generic substitutions, 21% perceived the increase in generic drug dispensing to be significant. Findings suggested a potentially significant association between being informed about generic drugs and respondents' support of the policy. Suggested strategies to address implementation challenges included strengthening stewardship function of MOPH, securing full commitment of health care providers, conducting educational and awareness campaigns about generic drugs and generic drug substitution, and aligning incentive systems of the key stakeholders. CONCLUSIONS The majority of community pharmacists were supportive of generic drug substitution in general but not of the current implementation of the policy in Lebanon. Findings revealed implementation challenges at the provider, patient, and system level which are hindering attainment of the policy objectives. The key lessons derived from this study can be used for continuous improvement of the policy and its implementation.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Rami Z. Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nour Hemadi
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | | | - Magda Haj
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Suzan Khalil
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Youssef Saklawi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Diana Jamal
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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McMillan SS, Kelly F, Sav A, Kendall E, King MA, Whitty JA, Wheeler AJ. Consumers and Carers Versus Pharmacy Staff: Do Their Priorities for Australian Pharmacy Services Align? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:411-22. [PMID: 25512020 DOI: 10.1007/s40271-014-0105-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Health professionals, including pharmacists, are encouraged to meet the needs of their consumers in an efficient and patient-centred manner. Yet, there is limited information as to what consumers with chronic conditions need from pharmacy as a healthcare destination or how well pharmacy staff understand these needs. OBJECTIVE The aim of this study was to identify service user priorities for ideal community pharmacy services for consumers with chronic conditions and their carers, and compare these priorities with what pharmacy staff think these groups want. METHODS The nominal group technique was undertaken with pharmacist, pharmacy support staff, consumer and carer groups in four Australian regions between December 2012 and April 2013. Participant ideas and priorities for ideal services or care were identified, and contextual insight was obtained by thematic analysis. RESULTS Twenty-one nominal group sessions are accepted, including 15 consumer and carer, four pharmacist and two pharmacy support staff groups. Pharmacy staff views generally aligned with consumer priorities, such as access, affordability, patient-centred care and continuity and coordinated care, yet diverged with respect to consumer information or education on medication and services. Fundamentally, consumers and carers sought streamlined access to information and medication, in a coordinated, patient-centred approach. Alleviating financial burden was a key consumer priority, with a call for the continuation and extension of medication subsidies. CONCLUSION Overall, pharmacy staff had a reasonable understanding of what consumers would prioritise, but further emphasis on the importance, delivery, or both, of consumer information is needed. Greater consideration is needed from policy makers regarding the financial barriers to accessing medication for consumers with chronic conditions.
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Affiliation(s)
- Sara S McMillan
- Population and Social Health Research Program, Griffith Health Institute, Griffith University, University drive, Meadowbrook, QLD, 4131, Australia.
| | - Fiona Kelly
- Population and Social Health Research Program, Griffith Health Institute, Griffith University, University drive, Meadowbrook, QLD, 4131, Australia.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adem Sav
- Population and Social Health Research Program, Griffith Health Institute, Griffith University, University drive, Meadowbrook, QLD, 4131, Australia.,School of Allied Health, Australian Catholic University, Banyo, QLD, Australia
| | - Elizabeth Kendall
- Population and Social Health Research Program, Griffith Health Institute, Griffith University, University drive, Meadowbrook, QLD, 4131, Australia
| | - Michelle A King
- School of Pharmacy, Griffith Health Institute, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4215, Australia
| | - Jennifer A Whitty
- Population and Social Health Research Program, Griffith Health Institute, Griffith University, University drive, Meadowbrook, QLD, 4131, Australia.,School of Pharmacy, University of Queensland, Cornwall Street, Wooloongabba, QLD, 4102, Australia
| | - Amanda J Wheeler
- Population and Social Health Research Program, Griffith Health Institute, Griffith University, University drive, Meadowbrook, QLD, 4131, Australia.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Dunne SS. What Do Users of Generic Medicines Think of Them? A Systematic Review of Consumers’ and Patients’ Perceptions of, and Experiences with, Generic Medicines. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:499-510. [DOI: 10.1007/s40271-016-0176-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsaprantzi AV, Kostagiolas P, Platis C, Aggelidis VP, Niakas D. The Impact of Information on Doctors' Attitudes Toward Generic Drugs. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 53:53/0/0046958016637791. [PMID: 27033564 PMCID: PMC5798745 DOI: 10.1177/0046958016637791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
The objective of this study is to assess the impact of information on doctors' attitudes and perceptions toward generics. A cross-sectional survey based on a specially designed 21-item questionnaire was conducted. The survey involved doctors of different specialties working in a public hospital in Greece. The analysis includes descriptive and inferential statistics, reliability and validity tests, as well as structural equation modeling to evaluate the causal model. Statistical analysis was accomplished by using SPSS 20 and Amos 20. A total of 134 questionnaires out of 162 were received, providing a response rate of 82.71%. A number of significant associations were found between information and perceptions about generic medicines with demographic characteristics. It seems that the provision of quality information on generic drugs influences doctors' attitudes and prescription practices toward generic drugs. This is not a static process but a rather dynamic issue involving information provision policies for strengthening the proper doctors' attitudes toward generic drugs.
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Dispensing behaviour of pharmacies in prescription drug markets. Health Policy 2016; 120:190-7. [DOI: 10.1016/j.healthpol.2016.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 11/17/2022]
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Drozdowska A, Hermanowski T. Exploring factors underlying the attitude of community pharmacists to generic substitution: a nationwide study from Poland. Int J Clin Pharm 2015; 38:162-70. [PMID: 26620450 PMCID: PMC4733132 DOI: 10.1007/s11096-015-0227-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Generic uptake will increasingly be promoted by governments in the face of increasing healthcare costs and global economic uncertainties. OBJECTIVE The purpose of this study was to investigate attitudes towards generic substitution among community pharmacists, with a focus on the perception of the efficacy, knowledge of the generics characteristics, as well as the willingness to recommend generic substitution. SETTING Community pharmacies in Poland. METHOD The survey was conducted in 2013 by telephone interviews with 802 holders of an MSc degree in pharmacy working as community pharmacists. Stratified sampling was implemented to make the study representative in geographic terms. MAIN OUTCOME MEASURE Pharmacists' attitudes towards generics drugs. RESULTS The study showed that only 40 % of pharmacists always inform patients about their right to choose a generic substitute. It was also shown that the less time a pharmacist has been practising, the less likely they are to invite consumers to choose between generic and innovator products. The likelihood of informing was not affected by pharmacist's sex or age, or by pharmacy location or status (chain vs. independent pharmacy) (p > 0.05). Pharmacists varied in their approach to their statutory obligation to inform about a generic; a more or less equal share of respondents were either in favour or against it. Approximately 60 % pharmacists were shown to be familiar with the definition of a generic medicine. Pharmacists with shorter time of practice proved to know more about generics. However, more than 30 % respondents failed to choose the correct statement on generic versus reference medicine dosage. The majority of respondents (67 %) believed there are no differences in efficacy between generics and innovator drugs, whereas 31 % claimed that original brands could be more effective. A significant correlation was demonstrated between the views of pharmacists on the therapeutic efficacy and their willingness to substitute for generics whenever permitted by a physician. CONCLUSION It is important to address all concerns pharmacists may have over generics, for example by implementing comprehensive awareness-raising campaigns. Also, pharmacotherapy monitoring systems (i.e. provided in a framework of pharmaceutical care) could be considered to identify any safety or quality concerns that may arise.
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Affiliation(s)
- Aleksandra Drozdowska
- Department of Pharmacoeconomics, Medical University of Warsaw, ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland.
| | - Tomasz Hermanowski
- Department of Pharmacoeconomics, InterQuality Project Leader (7FP), The President of the Polish Society of Health Economic, Medical University of Warsaw, ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
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Toverud EL, Hartmann K, Håkonsen H. A Systematic Review of Physicians' and Pharmacists' Perspectives on Generic Drug Use: What are the Global Challenges? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13 Suppl 1:S35-S45. [PMID: 25963230 PMCID: PMC4519583 DOI: 10.1007/s40258-014-0145-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Generic substitution has been introduced in most countries in order to reduce costs and improve access to drugs. However, regulations and the generic drugs available vary between countries. It is the prescriber or dispenser of the drug who is the final decision maker. Nevertheless, physicians' and pharmacists' perceptions of generic drug use are not well documented to date. This study presents a systematic review of physicians' and pharmacists' perspectives on generic drug use worldwide. METHODS A systematic literature search was performed to retrieve all articles published between 2002 and 2012 regarding physicians' and/or pharmacists' experiences with generic drugs and generic substitution. RESULTS Of 1322 publications initially identified, 24 were eligible for inclusion. Overall, the studies revealed that physicians and pharmacists were aware of the cost-saving function of generic drugs and their role in improving global access to drugs. Nevertheless, marked differences were observed between countries when studying physicians' and pharmacists' perceptions of the available generic drugs. In less mature healthcare systems, large variations regarding, for example, control routines, bioequivalence requirements, and manufacturer standards were reported. A lack of reliable information and mistrust in the efficacy and quality were also mentioned by these participants. In the most developed healthcare systems, the participants trusted the quality of the generic drugs and did not hesitate to offer them to all patients regardless of socioeconomic status. In general, pharmacists seemed to have better knowledge of the concept of bioequivalence and generic drug aspects than physicians. CONCLUSIONS The present study indicates that physicians and pharmacists are aware of the role of generic drugs in the improvement of global access to drugs. However, there are marked differences regarding how these health professionals view the quality of generic drugs depending on the maturity of their country's healthcare system. This can be attributed to the fact that developed healthcare systems have more reliable public control routines for drugs in general as well as better bioequivalence requirements concerning generics in particular.
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Affiliation(s)
- Else-Lydia Toverud
- Department of Social Pharmacy, School of Pharmacy, University of Oslo, P.O. Box 1068, Blindern, 0316, Oslo, Norway,
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Ibrahim R, McKinnon RA, Ngo SNT. Knowledge and Perceptions of Community Patients about Generic Medicines. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2012.tb00189.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rafie Ibrahim
- School of Animal and Veterinary Sciences; The University of Adelaide
| | - Ross A McKinnon
- Flinders Centre for Innovation in Cancer, School of Medicine; Flinders University
| | - Suong NT Ngo
- School of Animal and Veterinary Sciences; The University of Adelaide; Roseworthy South Australia
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Takizawa O, Urushihara H, Tanaka S, Kawakami K. Price difference as a predictor of the selection between brand name and generic statins in Japan. Health Policy 2015; 119:612-9. [PMID: 25697888 DOI: 10.1016/j.healthpol.2015.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to explore the predictors of the selection between brand name drug (BR) and generic drug (GE) and to clarify the quantitative relationship about selection. METHODS We identified "incident users" who dispensed statins between April 2008 and June 2011 in commercially databases consisted of dispensing claims databases (DCD) of out-of-hospital pharmacies and hospital claims databases (HCD) of in-house pharmacies in Japan. Predictors of the selection between BR and GE, including price difference (PD), the price of BR, their interaction and percent change of the price of GE relative to BR were explored by logistic regression using DCD and HCD separately. RESULTS We extracted records of 670 patients who have opportunity for selection both BR and GE. Logistic regression analysis demonstrated that PD, the price of BR, interaction between them, and prescriber affiliation were factors significantly associated with the selection in the DCD; logit (p)=9.735-0.251×PD-0.071×the price of BR+0.002×PD×the price of BR-1.816×affiliation+0.220×gender-0.008×age+0.038×monthly medical fee. PD was inversely proportional to BR choice in DCD and lead to the opposite result in HCD. Numerical simulation of selection revealed that the quantitative relationships heavily depend on situations. CONCLUSIONS PD and the price of BR are predictors of the selection between BR and GE interactively in out-of-hospital pharmacies, but not in in-house pharmacies of medical facilities. Results may support policies which increase the power of out-of-hospital pharmacies for selection.
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Affiliation(s)
- Osamu Takizawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Hisashi Urushihara
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Consumers' perception of generic substitution in Iran. Int J Clin Pharm 2015; 37:497-503. [PMID: 25697840 DOI: 10.1007/s11096-015-0085-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The growth of pharmaceutical expenditure and patients' out of pocket has motivated policy makers to encourage patients to substitution of brands medicines with their generic alternatives called generic substitution. OBJECTIVES As the patients are final decision makers to accept generic substitution, the aim of this study is to evaluate the patient perception about generic medicines and underlying factors which can promote the generic acceptance. SETTING The study was done in community pharmacies in Tehran, the capital city of Iran. METHOD A cross-sectional descriptive study inviting people purchasing their drug at community pharmacies were per-formed using a self-administrated anonymous questionnaire (N=1309). MAIN OUTCOMES MEASURES Besides the demographic section, 16 items of developed questionnaire were categorized to five main factors including: patients' perception about efficiency, safety and cost of generic medicines, patient trust on physicians and pharmacists' advice. RESULTS Findings of completed questionnaires showed among the aforementioned factors the physician has the first priority to encourage patients to use of generics medicines which followed respectively by pharmacist's role, cost of medicines, efficacy, and safety concerns. CONCLUSION In conclusion, the trust of Iranian's society on the physicians and pharmacists advice would create a credible opportunity to reduce pharmaceutical expenditures as well as patients' out of pocket by promotion of generic substitution.
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Jacomet C, Allavena C, Peyrol F, Pereira B, Joubert LM, Bagheri H, Cotte L, Garaffo R, Gerbaud L, Dellamonica P. Perception of antiretroviral generic medicines: one-day survey of HIV-infected patients and their physicians in France. PLoS One 2015; 10:e0117214. [PMID: 25658627 PMCID: PMC4320025 DOI: 10.1371/journal.pone.0117214] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the interest of cost effectiveness, switching antiretroviral brand name medications to generics is recommended in France since 2013. The study objective was to evaluate the perception of generics per se and antiretroviral generics in HIV-infected patients and their hospital physicians. METHODS AND FINDINGS 556 out of 703 (79%) adult HIV+ outpatients and 116 physicians in 33 clinics were included in a multicentric cross-sectional survey performed in September 2013. Patients completed a self-questionnaire on their perception and acceptability of generics. Physicians completed a questionnaire on their acceptability of switching antiretroviral to generic. Socio-demographic data, medical history and HIV history were collected. Among the 556 patients with a median HIV duration of 13 years, 77% were France native, 59% in active employment, 100% covered by social insurance, 95% on antiretroviral therapy. Seventy-six percent of the patients accepted generics and 55% trusted them overall. Antiretroviral generics were accepted by 44% of them but only by 17% if the pill burden was going to increase. The factor significantly associated with acceptability of antiretroviral generics was acceptance of generics per se (p<0.001). Among the 116 physicians following a median of 100 HIV-patients/year, 75% would prescribe generics, dropping to 26% if the combo had to be broken. Factors significantly associated with willingness to prescribe antiretroviral generics were the absence of concern regarding the chemical entity (OR = 0.33), being aware that the patient would accept generics for other pathologies (OR = 2.04) and would accept antiretroviral generics (OR = 1.94). No factor related to sociodemographic conditions, HIV status or comorbidities was associated with the acceptability of antiretroviral generics. CONCLUSIONS Acceptability of antiretroviral generics in this French population was mostly dictated by the patient's and physician's knowledge and use of generics overall. It should be improved with an efficient information of both patients and physicians.
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Affiliation(s)
- Christine Jacomet
- Service des Maladies infectieuses et tropicales, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Clotilde Allavena
- Service des Maladies infectieuses et tropicales, CHU Hôtel-Dieu, Nantes, France
| | - Fleur Peyrol
- Santé Publique, EA 4681 PEPRADE, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Service de Biostatistiques, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Haleh Bagheri
- Pharmacologie Médicale et Clinique, INSERM U1027, CHU Toulouse, Toulouse, France
| | - Laurent Cotte
- Service des Maladies infectieuses et tropicales, INSERM U1052, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Gerbaud
- Santé Publique, EA 4681 PEPRADE, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Dellamonica
- Service des Maladies infectieuses et tropicales, CHU de l'Archet, Nice, France
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Mansfield SJ. Generic drug prices and policy in Australia: room for improvement? a comparative analysis with England. AUST HEALTH REV 2014; 38:6-15. [PMID: 24480618 DOI: 10.1071/ah12009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 11/11/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the degree to which reimbursement prices in Australia and England differ for a range of generic drugs, and to analyse the supply- and demand-side factors that may contribute to these differences. METHODS Australian and English reimbursement prices were compared for a range of generic drugs using pricing information obtained from government websites. Next, a literature review was conducted to identify supply- and demand-side factors that could affect generic prices in Australia and England. Various search topics were identified addressing potential supply-side (e.g. market approval, intellectual property protection of patented drugs, generic pricing policy, market size, generic supply chain and discounting practices) and demand-side (consumers, prescribers and pharmacists) factors. Related terms were searched in academic databases, official government websites, national statistical databases and internet search engines. RESULTS Analysis of drug reimbursement prices for 15 generic molecules (representing 45 different drug presentations) demonstrated that Australian prices were on average over 7-fold higher than in England. Significant supply-side differences included aspects of pricing policy, the relative size of the generics markets and the use of clawback policies. Major differences in demand-side policies related to generic prescribing, pharmacist substitution and consumer incentives. CONCLUSIONS Despite recent reforms, the Australian Government continues to pay higher prices than its English counterpart for many generic medications. The results suggest that particular policy areas may benefit from review in Australia, including the length of the price-setting process, the frequency of subsequent price adjustments, the extent of price competition between originators and generics, medical professionals' knowledge about generic medicines and incentives for generic prescribing. WHAT IS KNOWN ABOUT THE TOPIC? Prices of generic drugs have been the subject of much scrutiny over recent years. From 2005 to 2010 the Australian Government responded to observations that Pharmaceutical Benefits Scheme prices for many generics were higher than in numerous comparable countries by instituting several reforms aimed at reducing the prices of generics. Despite this, several studies have demonstrated that prices for generic statins (one class of cholesterol-lowering drug) are higher in Australia compared with England and many other developed countries, and prices of numerous other generics remain higher than in the USA and New Zealand. Recently there has been increasing interest in why these differences exist. WHAT DOES THIS PAPER ADD? By including a much larger range of commonly used and costly generic drugs, this paper builds significantly on the limited previous investigations of generic drug prices in Australia and England. Additionally, this is the first comprehensive investigation of multiple supply- and, in particular, demand-side factors that may explain any price differences between these countries. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners may contribute to the higher prices of generic medications in Australia compared with England through relatively low rates of generic prescribing. There are also significant implications for health policy makers, as this paper demonstrates that if Australia achieved the same prices as England for many generic drugs there could be substantial savings for the Pharmaceutical Benefits Scheme.
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Affiliation(s)
- Sarah J Mansfield
- Department of General Practice, Deakin University, 2-18 Colac Road, Belmont, Vic. 3216, Australia.
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Impact of generic substitution practice on care of diabetic patients. Int J Clin Pharm 2014; 36:623-9. [PMID: 24718947 DOI: 10.1007/s11096-014-9946-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 03/31/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients with chronic diseases like type II diabetes mellitus often have their prescriptions substituted with generic medicines in the course of care to save costs of medicines and to improve access. There is need to assess impact of this practice on patient care. OBJECTIVE To assess patient's knowledge of generic substitution practice and its impact on patient care. SETTING An outpatient diabetic clinic of a tertiary hospital in Nigeria. METHOD The study is a cross sectional survey of patients attending a diabetic clinic. A structured questionnaire was used to interview willing patients. A total of 120 patients were enrolled for the study, but only 102 responded (85 % overall response rate). MAIN OUTCOME MEASURES Patients' knowledge of generic substitution practice, patients' report of abstaining from drug use, experiences of more side effects and patients' confusion. RESULTS Over half (57.8 %) of surveyed patients (n = 59) had noticed brand switches, out of which, 30.5 % experienced brand switches more than 3 times within a year. More than a third of the respondents (38.6 %) did not know when pharmacists actually substituted their medicines. About one in five (19.6 %) patients did not use their medicines after substitution because they were not sure of the brand supplied but 35.6 % have rejected substitution at one time and insisted on doctors' prescription. Respondents (14.9 %) agreed that brand substitution resulted in confusion while 24 % reported receiving brands that resulted in more side effects. More respondents (58.6 %) indicated that they never had a discussion with their pharmacists about the reasons for generic substitution and switches. CONCLUSION Generic substitution without adequate information resulted in confusion and subsequent lack of adherence. There is the vital need for appropriate policy and guidelines for generic substitution in Nigeria.
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Knowledge, attitudes, and practices of community pharmacists on generic medicines in Qatar. Int J Clin Pharm 2014; 36:394-404. [PMID: 24532363 DOI: 10.1007/s11096-013-9909-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The practice of generic medicines prescribing, dispensing and substitution in developing countries has been controversial among healthcare professionals, particularly due to issues on quality, safety and efficacy. These controversies are as a result of inter-country differences in policies and laws as well as individualized knowledge and attitudes of pharmacists pertaining to generic medicines. OBJECTIVE This study primarily aims to assess the knowledge, attitudes, and practices of community pharmacists in Qatar towards generic medicines. SETTING Community pharmacy settings throughout the State of Qatar. METHOD A cross-sectional study using a pretested paper-based survey was conducted among a random sample of community pharmacists in Qatar. The data were analyzed using IBM-SPSS(®) version 20. Both descriptive and inferential statistical analyses were applied. MAIN OUTCOME MEASURE Knowledge, attitudes, and practices of generic medicines pertaining to regulatory standards, safety, efficacy, quality, and future policies. Results A total of 160 surveys were distributed to community pharmacists of which 118 were returned (response rate, 74 %). The mean total score of generic medicines knowledge among the pharmacists was 6.8 ± 1.6 (maximum possible score was 10). Years of practice as well as place of obtaining academic degree did not influence knowledge score. Approximately 72 % of the pharmacists supported generic substitution for brand name drugs in all cases where a generic medicine is available and the majority (93 %) agreed that pharmacists should be given generic substitution right. Nearly 61 % of the pharmacists considered lack of proven bioequivalence to original brands as an important barrier for selecting generic medicines and 55 % rated "lack of policy for directing the practice of generic medicine" as an important barrier. CONCLUSION In order to enhance the quality use of and to promote the practice of generic medicines in Qatar, an educational program should be implemented. A national generic medicine policy and guidelines are warranted in the State of Qatar.
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Dylst P, Vulto A, Simoens S. Demand-side policies to encourage the use of generic medicines: an overview. Expert Rev Pharmacoecon Outcomes Res 2014; 13:59-72. [DOI: 10.1586/erp.12.83] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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McMillan SS, Kelly F, Sav A, King MA, Whitty JA, Wheeler AJ. Consumer and carer views of Australian community pharmacy practice: awareness, experiences and expectations. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sara S. McMillan
- Griffith Health Institute; School of Human Services and Social Work; Griffith University; Logan Queensland Australia
| | - Fiona Kelly
- School of Human Services and Social Work; Griffith University; Logan Queensland Australia
- Centre for Applied Health Economics; Griffith Health Institute; Griffith University; Logan Queensland Australia
| | - Adem Sav
- Griffith Health Institute; School of Human Services and Social Work; Griffith University; Logan Queensland Australia
| | - Michelle A. King
- School of Pharmacy; Griffith University; Gold Coast Queensland Australia
| | - Jennifer A. Whitty
- School of Pharmacy, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Amanda J. Wheeler
- Griffith Health Institute; School of Human Services and Social Work; Griffith University; Logan Queensland Australia
- Centre for Applied Health Economics; Griffith Health Institute; Griffith University; Logan Queensland Australia
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Zeng W. A price and use comparison of generic versus originator cardiovascular medicines: a hospital study in Chongqing, China. BMC Health Serv Res 2013; 13:390. [PMID: 24093493 PMCID: PMC3851002 DOI: 10.1186/1472-6963-13-390] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 10/01/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Developed countries use generic competition to contain pharmaceutical expenditure. China, as a developing and transitional country, has not yet deemed an increase in the use of generic products as important; otherwise, much effort has been made to decrease the drug prices. This paper aims to explore dynamically the price and use comparison of generic and originator drugs in China, and estimate the potential savings of patients from switching originator drugs to generics. METHODS A typical hospital in Chongqing, China, was selected to examine the price and use comparisons of 12 cardiovascular drugs from 2006 to 2011. RESULTS The market share of the 12 generic medicines studied in this paper was 34.37% for volume and 31.33% for value in the second half of 2011. The price ratio of generic to originator drugs was between 0.34 and 0.98, and the volume price index of originators to generics was 1.63. The potential savings of patients from switching originator drugs to generics is 65%. CONCLUSION The market share of the generics was lowering and the weighted mean price kept increasing in face of the strict price control. Under the background of hospitals both prescribing and dispensing medicines, China's comprehensive healthcare policy makers should take measures from supply and demand sides to promote the consumption of generic medicines.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No,66 Xuefu Road, Nan'an District, Chongqing 400074, China.
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Rathe J, Larsen P, Andersen M, Paulsen M, Jarbøl D, Thomsen J, Soendergaard J. Associations between generic substitution and patients' attitudes, beliefs and experiences. Eur J Clin Pharmacol 2013; 69:1827-36. [PMID: 23765409 DOI: 10.1007/s00228-013-1539-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Generic substitution has been implemented in many countries, but knowledge about patients' attitudes, beliefs and experiences is still sparse. AIM To assess associations between generic switching and patients' attitudes, beliefs and experiences with previous generic switching. DESIGN AND SETTING A cross-sectional study comprising questionnaire responses from 2,476 randomly selected patients aged 20 years or older and living in the Region of Southern Denmark, who had redeemed substitutable drugs. METHODS The questionnaire included items on beliefs about medicine, views on generic medicine and confidence in the healthcare system. Only prescriptions issued by the general practitioners were included. For each patient, we focused on one purchase of a generically substitutable drug (index drug). Patients were identified by means of a dispensing database. RESULTS Earlier generic switches within the index ATC code were statistically significantly associated with experience of a generic switch (adjusted OR 5.93; 95 % CI 4.70-7.49). Having had more than five earlier switches within other ATC codes and having negative views on generic medicines reduced the odds of experiencing a generic switch. No associations were found between generic substitution and gender, drug group, number of different drugs used by the patient, confidence in the health care system and beliefs about medicine in general. CONCLUSION Patients who had once experienced a generic switch were more likely to accept a future generic switch within the same ATC code. Negative views on generic medicines were negatively associated with switching, while beliefs about medicine and confidence in the healthcare system had no influence.
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Affiliation(s)
- Jette Rathe
- Institute of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark,
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El-Dahiyat F, Kayyali R. Evaluating patients' perceptions regarding generic medicines in Jordan. J Pharm Policy Pract 2013; 6:3. [PMID: 24764538 PMCID: PMC3987061 DOI: 10.1186/2052-3211-6-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 04/29/2013] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to explore Jordanian patients’ perceptions toward generic medicines and to evaluate their opinions regarding generic substitution. Method A cross-sectional descriptive study involving Jordanian patients was undertaken, using a self-administrated anonymous questionnaire. The response rate was 80% (n=400/500). Results The study showed that cost of medicines is high according to 83% of the patients. Most patients (92%) preferred to be prescribed the cheapest medicine. Majority of patients (79%) believed that cost should be considered before a drug is prescribed. Most patients (78%) accepted generic substitution and believed that it can provide significant saving. Surveyed patients (78%) agreed that they should have the option of choosing between generic and originator and 74% believed that physicians should give them that choice. These results showed a significant statistical correlation with the monthly income of the patient, percentage cost they pay and number of medicines prescribed (P<0.05). Conclusion The high cost of medicines in Jordan is believed to be the main driver for choosing generic medicines Furthermore; patients have positive attitudes towards generic medicines. The involvement of patients in the treatment decision would result in more adherence and improvement in health. The insights gained from patients in this study will be useful to health organisations and policy makers to design a robust generic policy to use medicines cost-effectively in Jordan.
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Affiliation(s)
- Faris El-Dahiyat
- Pharmacy Department, Kingston University, Penrhyn Road, Kingston upon Thames, KT1 2EE, United Kingdom
| | - Reem Kayyali
- Pharmacy Department, Kingston University, Penrhyn Road, Kingston upon Thames, KT1 2EE, United Kingdom
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Timonen J, Heikkilä R, Ahonen R. Generic substitution in Finland: lessons learned during 2003-2008. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Johanna Timonen
- School of Pharmacy/Social Pharmacy; Faculty of Health Sciences; Kuopio Campus; University of Eastern Finland; Kuopio Finland
| | - Reeta Heikkilä
- School of Pharmacy/Social Pharmacy; Faculty of Health Sciences; Kuopio Campus; University of Eastern Finland; Kuopio Finland
| | - Riitta Ahonen
- School of Pharmacy/Social Pharmacy; Faculty of Health Sciences; Kuopio Campus; University of Eastern Finland; Kuopio Finland
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Zaoui S, Hakkou F, Filali H, Khabal Y, Tazi I, Mahmal L. [Generic drug in Morocco: the point of view of the consumer]. Pan Afr Med J 2013; 15:18. [PMID: 24009794 PMCID: PMC3758848 DOI: 10.11604/pamj.2013.15.18.2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/16/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Le médicament générique est souvent une origine de préjugés négatifs et de méfiance chez les professionnels de santé et les patients. Ceci pourrait être dû à plusieurs facteurs entre autre le manque des connaissances du patient sur ces médicaments. Le but de notre étude était d’évaluer l'information du consommateur sur les médicaments génériques et apprécier leur utilisation de ces médicaments. Méthodes Il s'agit d'une étude transversale réalisée de Janvier à Mars 2010 auprès de 251 sujets. Un questionnaire comprenant dix questions fermées a été utilisé. Les questions concernaient l’évaluation des connaissances sur les médicaments génériques, les sources d'information, le degré de confiance et d'information des patients sur ces médicaments. Une analyse descriptive simple des différentes variables a été réalisée. Résultats Dans notre étude, 126 sujets (50,2%) ont répondu connaître les médicaments génériques. Parmi eux, 52,3% les utilisaient et 67,4% estimaient qu'ils étaient insuffisamment informés sur ces médicaments. Les cadres supérieurs et les étudiants ont représenté la catégorie qui utilisait le plus les médicaments génériques (respectivement dans 40,9% et 25,7%) et qui était la mieux informée (respectivement dans 61,9% et 23,81%). Le faible coût a été la principale motivation d'utilisation du médicament générique (93,9%). Les médias ont représenté la première source d'information (59,5%). Après sensibilisation, 88,8% des sujets qui ne connaissaient pas le médicament générique ont été favorable à son utilisation. Conclusion Une promotion efficace par une politique d'information soutenue auprès des consommateurs et par des mesures incitatrices à la prescription et à la délivrance du générique par les médecins et les pharmaciens, pourront améliorer l'utilisation de ces médicaments dans notre pays.
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Affiliation(s)
- Sanaa Zaoui
- Laboratoire de Pharmacologie et de Toxicologie, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, Marrakech, Maroc
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Liou WS, Hsieh SC, Chang WY, Wu GHM, Huang HS, Lee C. Brand name or generic? What are the health professionals prescribed for treating diabetes? A longitudinal analysis of the National Health Insurance reimbursement database. Pharmacoepidemiol Drug Saf 2013; 22:752-9. [PMID: 23625864 DOI: 10.1002/pds.3445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/13/2013] [Accepted: 03/06/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to explore whether physicians prescribe more brand-name oral hypoglycemic agents (OHA) for diabetic patients with medical training background (MP) than for general patients (GP). RESEARCH DESIGN AND METHODS A longitudinal analysis of 1,000,000 National Health Insurance cohorts of 1998-2008 was conducted. Univariate and multivariate models were performed to assess the associations of the outcome (the ratio of brand-name/generic odds in the MP group to that in the GP group) and the covariates, including patient medical training background, characteristics of patient, prescriber, and medical settings, and market competition. A generalized estimating equation method was used to control the dependency of longitudinal data. RESULTS A total of 46,850 diabetic patients were prescribed with 2,703,149 OHA prescriptions during the study period. Compared with GP, MP had 1.37 times greater odds of being prescribed with brand-name instead of generic OHA, among whom pharmacists and physicians had the highest odds ratios of 2.78 (95%CI, 1.05-7.36) and 1.68 (95%CI, 0.99-2.85), respectively. Patients' diabetes severity, prescribers' level of experience, medical settings that were publicly owned, had a higher accreditation level, and were located in a higher urbanized area, lower market competition, and earlier dates of prescription were positively associated with brand-name prescription. Among all medical sub-specialties, cardiologists were more likely to prescribe brand-name OHA. CONCLUSIONS This study is the first to demonstrate how a patients' medical training background, in addition to the characteristics of patients, prescribers, and medical settings, and market competition might influence physicians' prescribing choice of brand-name or generic OHA.
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Affiliation(s)
- Wen-Shyong Liou
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
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Underuse of generic medicines in Portugal: an empirical study on the perceptions and attitudes of patients and pharmacists. Health Policy 2011; 104:61-8. [PMID: 22024369 DOI: 10.1016/j.healthpol.2011.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 09/07/2011] [Accepted: 10/01/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objectives of this study were to identify: perceptions regarding underuse and characteristics of generic medicines; patients' attitudes towards drug substitution and pharmacists' attitudes towards substitution recommendation. METHODS Two questionnaires were designed and interviewer-administered - one to patients and another to pharmacists. A binary variable 'correct understanding' was created and multiple logistic regression analysis was used to identify factors associated with experience and willingness to accept generic medicine substitution. Statistical analyses were performed by SPSS version 19.0. RESULTS All of the 417 patients knew the term 'generic medicine'. Level of education, experience and discussion with doctor were significantly associated with correct understanding. 77.5% of respondents had consumed generic medicines and 88.7% (64.5%) were willing to accept drug substitution based on doctor's (pharmacist's) recommendation. Having at least one chronic condition, discussion with doctor and perception that generic drug substitution is cost-saving were significantly associated with experience. In addition to the last two, having correct understanding and having experience were significantly associated with willingness to accept generic drug substitution. 91.6% of pharmacists (95 respondents) said that drug substitution is recommended in their pharmacies. CONCLUSIONS More information should be given to patients preferably by doctors and pharmacists. Prescription should be encouraged and experience promoted.
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