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Wang Z, Wang R, Li X, Bai L, Fan P, Tang Y, Li X, Huang Y, Nie X, Han S, Shi L, Chen J. Influencing Factors of Generic Prescribing Behavior of Physicians: A Structural Equation Model Based on the Theory of Planned Behavior. Risk Manag Healthc Policy 2024; 17:1375-1385. [PMID: 38813068 PMCID: PMC11135567 DOI: 10.2147/rmhp.s446743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Background Although affordable generics could probably contribute to the solution of rapidly increasing pharmaceutical expenditure, those drugs are prescribed at a lower rate in China. Physicians' perception and knowledge of generics have a great influence on their prescribing behavior. Objective This study aimed to identify factors that affect physicians' generic prescribing behavior based on the theory of planned behaviors (TPB). Methods Data were collected by both electronic and paper-based surveys from 1297 Chinese physicians, and 1047 surveys were retained. The structural equation model (SEM) was employed to investigate the relationship between four behavioral constructs, namely, attitudes, subjective norms, perceived control of behaviors, and intentions. Results About 50% of Chinese physicians had a positive attitude towards generic drugs that had passed the "Consistency Evaluation of Quality and Efficacy of Generic Drugs" (high-quality generic drugs), but their knowledge of generic drugs was relatively inadequate. The path coefficients for the effect of attitudes, subjective norms, and perceived behavioral control on behavioral intention were 0.285, 0.366, and 0.322 respectively. The path coefficients for the effect of behavioral intention and perceived behavioral control on prescribing behavior were 0.009 and 0.410 respectively. Conclusion Physicians' attitudes, subjective norms, and perceived behavioral control were significant positive correlation predictors of behavioral intention. Subjective norms and perceived behavior control had a greater impact than attitude on physicians' prescribing intention. However, the generic prescribing behavior is not under the volitional control of Chinese physicians. Physicians' prescribing practice is likely affected by perceived strong control over prescribing generic drugs.
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Affiliation(s)
- Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Ruilin Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Xiaoyu Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Pingan Fan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Yuanyuan Tang
- Bidding Management Office, Suqian First Hospital, Suqian, Jiangsu, People’s Republic of China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yangmu Huang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Sheng Han
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Jing Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
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Bergmann F, Nussbaumer-Pröll A, Wulkersdorfer B, Eberl S, Ruppitsch W, Lepuschitz S, Zeitlinger M. Antimicrobial activity and pathogen mutation prevention of originator and generics of cefepime, linezolid and piperacillin/tazobactam against clinical isolates of Staphylococcus aureus. J Glob Antimicrob Resist 2023; 34:179-185. [PMID: 37473915 DOI: 10.1016/j.jgar.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Although generic medicinal products are required to have the same qualitative and quantitative composition of the active substance as their reference originator product, patients and health care professionals express concerns about their interchangeability and safety. Therefore, the present study investigated the antimicrobial activity and pathogen mutation prevention of original and generic cefepime, linezolid and piperacillin/tazobactam against Staphylococcus aureus. METHODS Two generic formulations of cefepime, linezolid and piperacillin/tazobactam were tested against their respective originator products. Susceptibility testing was performed with twenty-one clinical isolates of S. aureus and ATCC-29213 using broth microdilution. Time kill curves (TKC) were performed with ATCC-29213 at drug concentrations above and below the respective minimum inhibitory concentrations (MIC). Mutation prevention concentration was determined for each drug formulation against ATCC-29213. All experiments were performed in triplicate. Mutant colonies from mutation prevention concentration (MPC) experiments were genotypically tested by sequence analysis. RESULTS MIC ratios between contiguous originator and generic drugs were similar for each isolate. No visual differences were observed in TKCs between originator and generic substances. The MPC did not differ between different formulations of the same substance. Although sequence analysis of mutant colonies revealed genomic differences compared with the original ATCC-29213, no differences in mutation frequencies were observed between clinical isolates and ATCC-29213 treated with originator or generic substances. CONCLUSIONS Similar antimicrobial activity and pathogen mutation prevention was observed between contiguous substances. These results support the interchangeability of generic and originator drug formulations with the same active ingredient.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria; Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria
| | | | | | - Sabine Eberl
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - Werner Ruppitsch
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Sarah Lepuschitz
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria.
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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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Lungfiel G, Mandlmeier F, Kunow C, Langer B. Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin. J Pharm Policy Pract 2023; 16:68. [PMID: 37237301 DOI: 10.1186/s40545-023-00565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling. METHODS Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne®, citing a contraceptive failure one day ago as the reason. RESULTS Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139). CONCLUSIONS Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone.
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Affiliation(s)
- Gwenda Lungfiel
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Franca Mandlmeier
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany.
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Selam MN, Mengstu AT, Fentie AM, Gebretekle GB, Ali EE, Belete A. Health professionals' perceptions on local production and bioequivalence study of generic medicines: A cross-sectional survey of physicians and pharmacy professionals in Addis Ababa, Ethiopia. PLoS One 2023; 18:e0281665. [PMID: 36972261 PMCID: PMC10042336 DOI: 10.1371/journal.pone.0281665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/29/2023] [Indexed: 03/29/2023] Open
Abstract
Local production of generic medicines in developing countries has a critical role to meet public health needs by ensuring the availability of essential medicines and providing patients' relief from the burden of unaffordable medical bills. Compliance with bioequivalence (BE) requirements increase the quality and competitiveness of generic drugs regardless of the source. In this regard, a regional BE center has been established in Addis Ababa, Ethiopia to serve the needs of Ethiopia and neighbouring countries. The present study aimed to assess the knowledge and perceptions of health professionals working in Addis Ababa regarding local production and BE studies of generic medicines. A cross-sectional survey was employed and physician participants working at public hospitals and pharmacists from various practice settings were selected using convenient sampling technique. Data was collected using self-administered structured questionnaire. Descriptive statistics was used to summarize the data and multinomial logistic regression analyses was used to assess predictors of health professionals' perception towards the source of drugs. Statistically significant association was declared at p-value < 0.05. A total of 416 participants responded and 272 (65.4%) of them were male. Nearly half of the study participants (n = 194) preferred the imported products. Compared to physicians, participants with diploma (AOR = 0.40; 95%CI: 0.18-0.91, p = 0.028) and bachelor degree and above holders (AOR = 0.32; 95%CI: 0.15-0.68, p = 0.003) in pharmacy were more likely to prefer locally produced products. Participants who practiced in pharmaceutical industries (AOR = 0.40, 95%CI: 0.22-0.77, p = 0.006) preferred locally manufactured products as compared to those practicing in the hospital. While a majority (321, 77.2%) believed in the advantages of doing BE studies locally, only 106 (25.5%) recognized that local pharmaceutical manufacturers did not implement BE studies for their generic products and lack of enforcement by the national regulatory body was raised as a reason for not conducting BE studies by most of the participants (67.9%). The present study revealed a modest preference by physicians and pharmacy professionals towards locally produced products. Majority of participants supported the idea of doing BE studies locally. However, manufacturers and regulators should devise ways to increase health professionals' confidence in local products. Strengthening local BE study capacity is also highly recommended.
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Affiliation(s)
- Muluken Nigatu Selam
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abrham Temesgen Mengstu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gebremedhin Beedemariam Gebretekle
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Eskinder Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anteneh Belete
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Merchant HA, Babar ZUD, Hussain IM. A leap towards enforcing medicines prescribing by generic names in low- and middle-income countries (LMICs): pitfalls, limitations, and recommendations for local drug regulatory agencies. J Pharm Policy Pract 2022; 15:104. [PMID: 36550588 PMCID: PMC9773520 DOI: 10.1186/s40545-022-00501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Drug Regulatory Authority of Pakistan (DRAP) in response to the public outcry on increasing medicines prices in the country issued notifications to direct healthcare professionals to prescribe medicines with their generic names. Like DRAP, many regulators in the low- and middle-income countries (LMICs) are also inspiring from the west to legally enforce generic prescribing in a bid to reduce the out-of-pocket public expenditures. However, there are pitfalls in the LMICs drug regulatory framework, which if left unaddressed can severely jeopardise the foreseen benefits of medicines prescribing by generic names. This article critically appraises the impact of prescribing by generic names regulations in LMICs and highlights the key considerations that are vital to address before legally enforcing generic prescribing. The ethics, regulatory compliance, and good governance are the key to success; better generics for a better tomorrow.
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Affiliation(s)
- Hamid A. Merchant
- grid.15751.370000 0001 0719 6059Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH UK ,grid.413930.c0000 0004 0606 8575Health Services Academy, Park Road, Chak Shahzad, Islamabad, 44000 Pakistan
| | - Zaheer-Ud-Din Babar
- grid.15751.370000 0001 0719 6059Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH UK
| | - Izhar M. Hussain
- grid.412080.f0000 0000 9363 9292Institute of Business and Health Management (IBHM), Dow University of Health Sciences (DUHS), SUPARCO Road, Karachi, 74200 Pakistan
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Alemu S, Tadesse N, Mulugeta T, Assefa D. Generic substitution for prescribed brand medicines in Ethiopia: knowledge, attitude and practice among pharmacy professionals in community drug retail outlets. BMC Health Serv Res 2022; 22:926. [PMID: 35854313 PMCID: PMC9295362 DOI: 10.1186/s12913-022-08330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
Background Generic substitution is a good approach to reduce pharmaceutical expenses without compromising healthcare quality. Yet, the practice of generic substitution has been contentious due to concerns on quality and efficacy. Objective This study was aimed to assess knowledge, attitude and practice among pharmacy professionals toward generic substitution in community drug retail outlets in Jimma town, Southwest Ethiopia. Methods A descriptive cross-sectional study was conducted among pharmacy professionals working in community drug retail outlets. Data was collected using a self-administered questionnaire. Knowledge was tested using a 3-point response format consisting of “Yes,” “No” and “I am not sure.” Attitude was evaluated using the 5-point Likert scale ranging from 1(strong agreement) to 5 (strong disagreement). The practice was examined as never, seldom, sometimes, often, and always with scores ranging from 0 to 4. The influences of socio-demographic factors on knowledge, attitude, and practice were tested using the Mann–Whitney U and Kruskal–Wallis tests as appropriate. P ≤ 0.05 was considered statistically significant. Results The mean knowledge score of participants regarding generic medicines was 5.75 ± 1.79. Only 32 respondents (30.2%) of the participants were knowledgeable about the generic substitution. 54 (50.9%) of respondents had positive attitude toward generic substitution and 52 (49.1%) had practiced generic substitution. The year of experience had a significant effect on knowledge (X2 = 9.14, p = 0.01) and practice (X2 = 4.71, p = 0.03) of generic substitution. Conclusions Our study found that pharmacy professionals working in community drug retail outlets in Jimma town had lack of knowledge about generic substitution. Conversely, an enormous amount of participants had positive attitude toward generic substitution and nearly half of them had practiced generic substitution. The year of experience had a significant effect on knowledge and practice of generic substitution.
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Affiliation(s)
- Sintayehu Alemu
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Natnael Tadesse
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tidenek Mulugeta
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Desta Assefa
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Huang T, Bai L, Wushouer H, Wang Z, Yang M, Lin H, Shen P, Guan X, Shi L. Clinical Outcome and Medical Cost of Originator and Generic Antihypertensive Drugs: A Population-Based Study in Yinzhou, China. Front Pharmacol 2022; 13:757398. [PMID: 35295329 PMCID: PMC8920543 DOI: 10.3389/fphar.2022.757398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The substitution of generic drugs can effectively alleviate the rapid growth of drug costs; however, the clinical effectiveness and medical costs of originator products and generics were barely studied in China. Objectives: To compare the effectiveness of antihypertensive drugs and hypertension-related medical costs between originator and generic initiators in Yinzhou, China. Methods: We conducted a population-based retrospective cohort study using the Chinese Electronic Health Records Research in Yinzhou (CHERRY), from July 1, 2011, to December 31, 2018. Hypertension patients initiating with originator products were compared with patients initiating with generic counterparts. We used 1:1 propensity score matching to pair the two groups based on sociodemographic, clinical, and health service utilization variables. Cox proportional regression was adopted to compare the rate of hospitalization for hypertension-related cardiovascular disease between matched originator and generic initiators. Wilcoxon matched-pairs signed-rank test was used to compare annual hypertension-related medical costs. Results: Matched pairs (10,535) of patients were included in the comparative study of originator products and generics, corresponding to seven antihypertensive drugs including amlodipine, felodipine, nifedipine, irbesartan, losartan, valsartan, and metoprolol. The average age of patients included in the analysis was around 60 years (originator vs. generics initiators: from 59.0 vs. 59.1 years in losartan to 62.9 vs. 63.6 years in nifedipine). Higher hospitalization rates among originator initiators were observed for three calcium channel blockers (hazard ratio[95% CI]: amlodipine, 3.18[1.43, 7.11]; felodipine, 3.60[1.63, 7.98]; and nifedipine, 3.86[1.26, 11.81]; respectively). The remaining four out of seven drugs of the clinical endpoint estimates showed comparable outcomes between originator products and generics (hazard ratio[95% CI]: irbesartan, 1.19[0.50, 2.84]; losartan, 1.84[0.84, 4.07]; valsartan, 2.04[0.72, 5.78]; and metoprolol, 1.25[0.56, 2.80]; respectively). Higher median annual hypertension-related medical costs were observed in originator initiators (all p < 0.001), except for metoprolol (p = 0.646). Conclusion: We observed comparable or even better clinical outcomes and less medical cost associated with the use of antihypertensive generics compared to originator counterparts. This could help increase patient and provider confidence in the efficacy of generic medicines to manage hypertension diseases.
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Affiliation(s)
- Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Mingchun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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Al-Arifi MN. Assessment of Knowledge, Attitudes, and Factors Influencing the Selection Student of Generic Medicine. Front Public Health 2021; 9:767128. [PMID: 34938706 PMCID: PMC8685314 DOI: 10.3389/fpubh.2021.767128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Generic replacements for branded medicines have become a typical practice among registered pharmacists all over the world. Therefore, this study was aimed to determine the influence of the knowledge and attitudes of PharmD students and other factors on the selection of unbranded medicines. Methods: A descriptive, cross-sectional study was conducted through Google Forms to collect data using self-reported questionnaires. The data was collected over a period of 3 months, from January to March 2021, among junior level pharmacy students who are currently undertaking a PharmD course at the King Saud University, College of Pharmacy, Riyadh, Saudi Arabia. Results: The mean age of the students was 21.05± (SD = 1.03), majority of students 70.2% (n = 134) were able to define the term generic medicine, and about 65% (n = 123) were able to correctly define bioequivalence. More than half of the students, 56.5% (n = 108) lacked knowledge about the pharmacokinetic parameters of generic products. Meanwhile, the majority, 85% (n = 122), supported generics over branded medicines, and about 66% (n = 99) agreed that wider use of generic medicines would lead to less money required for the research and development of new pharmaceuticals. Conclusion: Findings revealed that most pharmacy students possess sufficient knowledge of generic medicines, although knowledge in some aspects remains lacking.
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Affiliation(s)
- Mohamed N Al-Arifi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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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: 13] [Impact Index Per Article: 4.3] [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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11
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Kunow C, Langer B. Dispensing and Variabilities in Pricing of Headache OTC Medicines by Community Pharmacies in a German Big City: A Simulated Patient Approach. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:843-851. [PMID: 34588789 PMCID: PMC8476173 DOI: 10.2147/ceor.s320728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background In Germany, over-the-counter (OTC) medicines for self-medication may only be dispensed by community pharmacies (CPs). From the customer's point of view, "adequate" counseling includes not only the recommendation of medicines that meet guidelines, but ao the dispensing of low-priced medicines. This is all the more important in Germany against the background of free pricing and a lack of obligation to display prices. The aim was to analyze the dispensing and possible price variability of OTC medicines for headache. Methods The cross-sectional design of the study based on the simulated patient methodology (SPM) included all 42 CPs of the German big city Potsdam and used eight trained simulated patients (SPs). Between October and December 2020, four different SPs visited each CP four times with two almost identical scenarios with the demand for a medicine for headache. Results All 168 planned visits were successfully completed and ibuprofen (60.1%) was dispensed most frequently. Across all dispensed medicines, prices varied from €0.93 to €9.97 (∆ 972%; median €3.46 [interquartile range (IQR) €2.25]). For repeated dispensing of the same CPs, the price variability was a maximum of €8.77. In addition, packs with ≤10 tablets were dispensed in 47.6%, with 11 to 20 tablets in 50.6%, and with >20 tablets in 1.8% of visits. Conclusion Increasing price transparency and strengthening price competition could make it easier for customers to access OTC medicines according to their personal needs.
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Affiliation(s)
- Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
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12
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Li WJ, Xia MJ, Gong SW, Ding YF. Perceptions of Generic Drugs in the Pharmacists of Public Hospitals: A Cross-sectional Survey in Hubei Province of China. Curr Med Sci 2021; 41:987-995. [PMID: 34476663 DOI: 10.1007/s11596-021-2412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Generic drugs provide an opportunity for savings in drug expenditure since they are available at a lower cost and do not affect patients' health. A better understanding of pharmacists' knowledge, attitudes, and perception can promote the quality use of generic drugs. The objective of this study was to investigate the knowledge, attitudes, and perception of pharmacists from tertiary hospitals in China regarding generic drugs. METHODS A cross-sectional survey using a postal questionnaire was conducted, which was sent to 200 hospital pharmacists randomly selected from tertiary hospitals in Hubei Province. A total of 125 questionnaires out of 200 were received. Of the respondents, 80 were female and 45 were male. RESULTS The majority of respondents (87.2%) could clearly distinguish between original and generic drugs. Pharmacists agreed that generic drugs were less effective (52.8%) and produced more side effects (52%). Fortynine respondents thought that generic drug products were not adequately tested. Approximately 78% and 60% of the pharmacists indicated that generic substitution was not feasible for drugs with narrow therapeutic windows and drugs for critical diseases, respectively. Most of them supported the recommendation of generic drugs based on professional judgment. CONCLUSION Our study showed that a considerable portion of Chinese hospital pharmacists hold negative perceptions of generic drugs. Interventions to improve pharmacists' knowledge of generic drugs are needed.
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Affiliation(s)
- Wei-Jie Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mei-Jun Xia
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shi-Wei Gong
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Yu-Feng Ding
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Babar ZUD. Ten recommendations to improve pharmacy practice in low and middle-income countries (LMICs). J Pharm Policy Pract 2021; 14:6. [PMID: 33407945 PMCID: PMC7788796 DOI: 10.1186/s40545-020-00288-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Medicines are important health interventions and their appropriate use could improve health outcomes. Throughout the globe, pharmacists play a very important role to improve the use of medicines. Though high-income countries are debating on futuristic approaches, independent prescribing of pharmacists, clinical skills, and to expand pharmacy services; a large majority of low and middle-income countries still lag behind to strengthen pharmacy practice. This paper presents a key set of recommendations that can improve pharmacy practice in low and middle-income countries (LMICs). The ten recommendations include (1) Mandatory presence of graduate-level pharmacists at community pharmacies (2) Clear demarcation of the roles and responsibilities of different categories of pharmacists (3) Effective categorization and implementation of medicines into (a) prescription medicines (b) pharmacists only medicines (c) over the counter medicines (4) Enforcement of laws and regulations for the sale of medicines (5) Prohibiting doctors from dispensing medicines (the dispensing separation between pharmacists and doctors). (6) Involving pharmacies and pharmacists in Universal Health Coverage Schemes to improve the affordability of medicines (7) Strengthening national medicines regulatory authorities to improve the quality, safety, and effectiveness of medicines (8) Training of pharmacists in clinical skills, vaccination, and minor ailment schemes (9) Promoting independent medicines information for consumers and healthcare professionals by developing national medicines information strategy (10) Mandatory Continuing Professional Development (CPD) programs for the Pharmacists.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, Centre for Pharmaceutical Policy and Practice Research, University of Huddersfield, Queensgate, HD1 3DH, Huddersfield, UK.
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14
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Mohammed AS, Woldekidan NA, Mohammed FA. Knowledge, attitude, and practice of pharmacy professionals on generic medicines in Eastern Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0235205. [PMID: 32658918 PMCID: PMC7357759 DOI: 10.1371/journal.pone.0235205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/11/2020] [Indexed: 11/05/2022] Open
Abstract
Background Generic medicines are similar to innovator medicine in terms of safety, quality, efficacy, dosage form, strength, and route of administration. They have the same therapeutic use to innovator medicines and available at a far lower price. However, health professionals' poor knowledge and attitude may limit its utilization. The present study aimed at assessing the knowledge, attitude, and practice of pharmacy professionals towards generic medicines in Harar city, Eastern Ethiopia. Methods A cross-sectional survey was conducted among community pharmacists in Harar city. A self-administered thirty-three item questionnaire on Knowledge, attitude, and practice of community pharmacists was utilized. Logistic regression analysis was performed to predict the determinants of knowledge and attitude of pharmacists. An odds ratio at 95% confidence interval along with a p-value < 0.05 was considered significant. Results Among 80 community pharmacists’ approached, 74 completed the survey, providing a response rate of 92.5%. Sixty-seven percent of the respondents knew that generic drugs are bioequivalent to brand drugs and claimed generic medicines are cheaper (86.5%). Nearly half (48.6%) of participants believe that generic medicines are less effective and slower in the onset of action (58.1%). More than half (54.1%) of study participants revealed their lack of belief in generic medicine as a factor hindering the selection and dispensing of generic medicines. In multivariate logistic regression, experience in community pharmacy practice (Adjusted odds ratio (AOR = 2.18, 95%CI: 1.21–63.1) and Sex (AOR = 3.88, 95%CI: 2.12–39.62) were significantly associated with knowledge and attitude toward generic medicines, respectively. Conclusion The current study revealed that there is a gap in the knowledge and attitude of community pharmacists towards generic and brand drugs. More than averages of the respondents have known the concept of generic medicine including their right to perform generic substitution and had a positive attitude toward generics. Female pharmacists were more likely to have a positive attitude and the overall knowledge was higher in those who have more than 5 years of work experience.
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Affiliation(s)
- Ammas Siraj Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- * E-mail:
| | | | - Fuad Adem Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
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15
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Ahmed KK, Al-Jumaili AA, Mutlak SH, Hadi MK. Determinants of national drug products acceptance across patients, pharmacists, and manufacturers: A mixed method study. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/1741134320926625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction The national pharmaceutical industry is pivotal for both the health sector and the national economy. This study aims to identify determinants of national drug products acceptance. The objectives of this study were to quantitatively measure the level of patient and community pharmacist acceptance of national drug products available in community pharmacies and to qualitatively explore the barriers facing national pharmaceutical companies and investigate the suggested solutions. Methods This cross-sectional study used an explanatory mixed method design. It was conducted in Baghdad, Iraq from July through October 2018. The study included two surveys (one for pharmacy customers and another for pharmacists) and thereafter semi-structured interviews of national pharmaceutical company owners/managers. The interview guide was developed based on preliminary quantitative results. Thematic analysis was used to analyze the interview findings. Results We received 123 patient surveys and 125 usable pharmacist surveys. We conducted seven interviews and stopped when we reached saturation. Integrated qualitative and quantitative findings showed that the main determinants of national drug product acceptance are product characteristics (namely price, packaging, brand, and availability), healthcare providers effect on product promotion and perceived effectiveness, and regulations enforced by authorities mainly the Ministry of Health. Conclusions Product price was the number one modulating factor in patient decision-making when purchasing a drug product. It appears that physicians and pharmacists are playing negative or at least neutral role in promoting national drug products and sustaining patients trust in national drug products. Current policies appeared to slow national drug industry growth and limit manufacturers’ ability to expand their share in the market. Manufacturer marketing efforts can help in gaining physicians and pharmacists support of the national drug product. Reforms to current drug policy and regulations were proposed by manufacturers.
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Affiliation(s)
- Kawther Khalid Ahmed
- University of Baghdad College of Pharmacy, Baghdad, Iraq
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Ali Azeez Al-Jumaili
- University of Baghdad College of Pharmacy, Baghdad, Iraq
- University of Iowa College of Pharmacy, Iowa City, IA, USA
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Glerum PJ, Maliepaard M, de Valk V, Scholl JHG, van Hunsel FPAM, van Puijenbroek EP, Burger DM, Neef K. Quantification of Adverse Drug Reactions Related to Drug Switches in The Netherlands. Clin Transl Sci 2020; 13:599-607. [PMID: 32052597 PMCID: PMC7214643 DOI: 10.1111/cts.12746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 01/17/2023] Open
Abstract
We performed a retrospective cohort study in the Dutch patient population to identify active substances with a relatively high number of adverse drug reactions (ADRs) potentially related to drug switching. For this, we analyzed drug switches and reported ADRs related to switching between June 1, 2009, and December 31, 2016, for a selection of 20 active substances. We also compared pharmacovigilance analyses based on the absolute, switch-corrected, and user-corrected numbers of ADRs. In total, 1,348 reported ADRs and over 23.8 million drug switches were obtained from the National Health Care Institute in The Netherlands and from Lareb, which is The Netherlands Pharmacovigilance Centre. There was no correlation between the number of ADRs and the number of switches, but, on average, we found 5.7 reported ADRs per 100,000 switches. The number was relatively high for rivastigmine, levothyroxine, methylphenidate, and salbutamol, with 74.9, 50.9, 47.6, and 26.1 ADRs per 100,000 switches, respectively. When comparing analyses using the absolute number and the switch-corrected number of ADRs, we demonstrate that different active substances would be identified as having a relatively high number of ADRs, and different time periods of increased numbers of ADRs would be observed. We also demonstrate similar results when using the user-corrected number of ADRs instead of the switch-corrected number of ADRs, allowing for a more feasible approach in pharmacovigilance practice. This study demonstrates that pharmacovigilance analyses of switch-related ADRs leads to different results when the number of reported ADRs is corrected for the actual number of drug switches.
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Affiliation(s)
- Pieter J Glerum
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Joep H G Scholl
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | | | - Eugène P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands.,Pharmaco-Therapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Rainio R, Ahonen R, Timonen J. The content of patient counseling about interchangeable medicines and generic substitution in Finnish community pharmacies - a survey of dispensers. BMC Health Serv Res 2019; 19:956. [PMID: 31829174 PMCID: PMC6907127 DOI: 10.1186/s12913-019-4798-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Generic substitution aims to increase the use of more affordable generic preparations and restrain the growth of medicine expenditures. Pharmaceutical staff plays an important role in generic substitution by implementing substitution and counseling customers. The aim of this study was to explore how Finnish dispensers inform pharmacy customers about interchangeable medicines and generic substitution and what customers ask dispensers about generic substitution and the reference price system. Methods A questionnaire was sent to a random sample of dispensers (n = 1054) working in community pharmacies in spring 2018. The data was analyzed using frequencies, percentages and the Chi-square test and Fisher’s exact test. The open-ended questions were analyzed first using inductive content analysis and later with the quantitative methods mentioned above. Results The final study material consisted of 498 questionnaires (response rate 51%). The main topics dispensers always informed customers about were the physician’s record in the prescription not to substitute the medicine (69%) and that the prescribed or purchased interchangeable medicine did not belong in the reference price band (59%). Topics mentioned often by dispensers dealt with customer’s chance to choose their medicine from among several alternative products (68%) and the manufacturer of the interchangeable medicines (66%). Differences in appearance (33%) or in composition (28%) of interchangeable products were the most common topics mentioned only when the customer asked about them. Of the respondents 17.6% always and 51.4% often informed the customer about the least expensive interchangeable product at the point of dispensing. Customers’ questions about the generic substitution and reference price system most commonly (82.4%) concerned the similarity of interchangeable medicines. Conclusions Finnish dispensers provide customers with a wide range of information about different subjects when dispensing interchangeable medicines. Patient counseling generally meets the legislative requirements, except for price counseling. In future, information about generic substitution and interchangeable medicines should continuously be provided to customers both at pharmacies and elsewhere, e.g. through educational campaigns.
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Affiliation(s)
- Riikka Rainio
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland.
| | - Riitta Ahonen
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland
| | - Johanna Timonen
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland
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18
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Babar ZUD, Ramzan S, El-Dahiyat F, Tachmazidis I, Adebisi A, Hasan SS. The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries. Front Pharmacol 2019; 10:1375. [PMID: 31824316 PMCID: PMC6880243 DOI: 10.3389/fphar.2019.01375] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices, and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries. Methods: Data on affordability, availability, and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organization/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal, and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of innovator brand (IB) and lowest priced generic (LPG) of diabetes medicines by WHO regional groupings and by country level. Results: Lowest priced generic of metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure 1-month’s supply of IB of insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p = 0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of insulin 100 IU/ml and metformin 500 mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively. Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Sara Ramzan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Faris El-Dahiyat
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
| | - Ilias Tachmazidis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Adeola Adebisi
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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Al-Husseini A, Abu-Farha R, Van Hout MC, Wazaify M. Community pharmacists experience of pregabalin abuse and misuse: A quantitative study from Jordan. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1554716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Amneh Al-Husseini
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan (UJ), Amman, Jordan
| | - Rana Abu-Farha
- Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan
| | - Marie Claire Van Hout
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan (UJ), Amman, Jordan
| | - Mayyada Wazaify
- Department of Pharmacy, Faculty of Pharmacy and Medical Sciences, Amman Al-Ahliyya University, Amman, Jordan
- Public Health Institute, Liverpool John Moore’s University, Liverpool, UK
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Domeyer PJ, Katsari V, Sarafis P, Aletras V, Niakas D. Greek students' attitudes, perception and knowledge regarding generic medicines in times of economic crisis: a cross-sectional study. BMC MEDICAL EDUCATION 2018; 18:262. [PMID: 30442145 PMCID: PMC6238271 DOI: 10.1186/s12909-018-1379-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/02/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND The penetration of generic medicines in the pharmaceutical market is influenced, among others, by the consumer's attitude upon them. The attitude of students in health management and recent alumni is particularly important, as they constitute tomorrow's policymakers. The aim of our study was to assess their attitude, perception and knowledge towards generic medicines. METHODS A cross-sectional study was undertaken, involving students in Health Management and recent alumni. The ATtitude TOwards GENerics (ATTOGEN) validated questionnaire was used, which consists of 18 items, yielding 6 scales (trust, state audit, knowledge, drug quality, drug substitution and fiscal impact), with all item responses expressed on a 5-point Likert scale and higher scores denoting greater disagreement. Correlation coefficients were computed and independent sample tests were performed using non-parametrical statistical methods. RESULTS A total of 1402 students were interviewed, with a female predominance (62.88%). The mean (SD) scores for the six scales of the ATTOGEN questionnaire were: Trust: 2.877 (0.940), State audit: 3.251 (0.967), Knowledge: 1.537 (0.688), Drug quality: 2.708 (0.971), Drug substitution: 3.828 (1.127) and Fiscal impact: 2.299 (0.860). Trust over generics was statistically significantly associated with all ATTOGEN scales (all p < 0.001). In addition, the increased level of knowledge about generics was associated with recognition of the generic medicines' quality equivalence (p < 0.001) and positive fiscal impact (p = 0.018). Pharmacists declared having a superior knowledge of generic medicines, being more satisfied with the information they receive about them and strongly believing in drug substitution (p < 0.001). Comparatively to other professionals, pharmacists also indicated substantial differences between branded and generic medicines more often (p < 0.001). They also argued to a greater extent that generic medicines were invented and promoted to resolve the financial crisis of social security institutions at the expense of citizens (p < 0.001). CONCLUSIONS This study demonstrated a mixed attitude of students regarding generic medicines. Trust and knowledge emerged as key factors shaping the students' attitude towards generics. Among students, pharmacists exhibited a distinct response pattern. This study underlines the importance of addressing and correcting health management students' misbeliefs about generics' quality and utility.
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Affiliation(s)
| | - Vasiliki Katsari
- School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Pavlos Sarafis
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
| | - Vassilis Aletras
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | - Dimitris Niakas
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Μedical School, National and Kapodistrian University of Athens, Athens, Greece
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21
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Gebresillassie BM, Belachew SA, Tefera YG, Abebe TB, Mekuria AB, Haile KT, Erku DA. Evaluating patients', physicians' and pharmacy professionals' perception and concern regarding generic medicines in Gondar town, northwest Ethiopia: A multi-stakeholder, cross-sectional survey. PLoS One 2018; 13:e0204146. [PMID: 30403668 PMCID: PMC6221256 DOI: 10.1371/journal.pone.0204146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Generic medicine prescribing has become common practice in many countries. However, data regarding the perceptions of stakeholders (patients, prescribers and dispensers) regarding generic medicines in Ethiopia is scarce. The present survey aimed to investigate the perception of patients, physicians and pharmacy professionals regarding generic medicines in Ethiopia. METHODS A quantitative cross-sectional survey was conducted in Gondar town, Northwest Ethiopia between January 1 and February 1, 2017. The questionnaire, comprised of 5-point Likert scale items on perception and concerns regarding generic medicine, was administered to patients, physicians and pharmacy professionals working in the community drug retail outlets. Frequencies, percentages, and median were calculated using Statistical Package for the Social Sciences (SPSS) software version 21.0 for Windows to describe different variables. RESULTS The survey was completed by 612 participants. More than half of patients, 56% (n = 219) knew about the term brand and generic medicines and 38.7% (n = 151) of patients agreed/strongly agreed that brand medicines are more effective. Nearly half, 47% (n = 184) of patients agreed that they should have the option of choosing between generic and brand medicines and 61.4% (n = 240) of patients believed that cost should be considered before a medicineis prescribed. The majority of physicians 70.6% (n = 101) indicated a very low generic medicine prescription rate. 56% (n = 130) of physicians and 87.2% (n = 68) of pharmacy professionals agreed that they need a standard guideline to both prescribers and pharmacists on brand substitution process. Furthermore, 39.9% (n = 57) of the physicians and 87.2% (n = 68) of pharmacy professionals agreed that drug advertisements by the manufacturers would influence their prescribing/dispensing practice. CONCLUSIONS Overall, our findings demonstrate a knowledge gap among patients towards the perception of generics, perceiving generics are less effective and inferior in quality compared to their branded equivalents. The majority of physicians reported a very low generic medicine prescribing rate and the majority pharmacy professionals' dispensing practice was influenced by drug advertisements. Hence, a customized educational program should be developed and implemented to patients, prescribers and dispensers so as to boost the acceptability of generic medicines and increase generic prescribing and/or substitution.
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Affiliation(s)
- Begashaw Melaku Gebresillassie
- Clinical Pharmacy Departments, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Sewunet Admasu Belachew
- Clinical Pharmacy Departments, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Clinical Pharmacy Departments, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tamrat Befekadu Abebe
- Clinical Pharmacy Departments, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Basazn Mekuria
- Pharmacology Department, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kaleab Taye Haile
- Pharmaceutics and Social Pharmacy Department, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- Clinical Pharmacy Departments, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ramzan S, Timmins P, Hasan SS, Babar ZUD. Cost analysis of type 2 diabetes mellitus treatment in economically developed countries. Expert Rev Pharmacoecon Outcomes Res 2018; 19:5-14. [DOI: 10.1080/14737167.2018.1513790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Sara Ramzan
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
| | - Peter Timmins
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
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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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Shraim NY, Al Taha TA, Qawasmeh RF, Jarrar HN, Shtaya MAN, Shayeb LA, Sweileh WM. Knowledge, attitudes and practices of community pharmacists on generic medicines in Palestine: a cross-sectional study. BMC Health Serv Res 2017; 17:847. [PMID: 29282055 PMCID: PMC5745619 DOI: 10.1186/s12913-017-2813-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Generic substitution in several countries has become a common practice. Besides, it is considered as a major cost minimizing strategy meant to contain pharmaceutical expenditure without compromising healthcare quality. However, the safety and quality issues of generic products are of top concerns of general practitioners and health work professionals. This study aimed to investigate community pharmacist’s knowledge, attitudes and practices toward generic medicines in Palestine. Methods This study was a cross-sectional observational study employing a self-administered questionnaire. The questionnaire was of four main sections: demographic and practice details of the participants, knowledge, attitudes and the influencing factors related to selection and dispensing of generic medicines. A convenience sampling technique was implemented in this study in which the data collection form was distributed in West Bank- Palestine among a set of practicing pharmacists. Mann-Whitney-U or Kruskal-Wallis tests were used to comparison of different issues as appropriate. P-values of <0.05 were considered significant. Results A total of 302 community pharmacists were interviewed, slightly more than half were males (52.3%). The mean knowledge score of participants regarding generic medicines was (5.91 ± 1.27) where the highest score was 8 of 10. Knowledge score was not significantly influenced by any of the socio-demographic characteristics. Our data showed that most of included pharmacists in the study (95.4%) agreed that health authorities should implement bioequivalence policies prior to marketing approval of generics, while 87.4% of participants agreed that they should be given the right to substitute generics and the majority (62.3%) support generic substitution for brand name drugs in all cases when a generic is available The main two factors affect pharmacists’ selection and dispensing of generic medicines are personal faith in the product (86.1%) and cost effectiveness of generic medicines (84.1%). Conclusions Generic medicines substitution among pharmacists is widespread and prevalent. Our data found that participant pharmacists in Palestine had basic knowledge with regards to generic medicine. However, their knowledge score pertaining the technical and regulatory aspects of bioequivalence and pharmacokinetic parameters in particular was insufficient. Electronic supplementary material The online version of this article (10.1186/s12913-017-2813-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naser Y Shraim
- Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Tasneem A Al Taha
- Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rawan F Qawasmeh
- Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hiba N Jarrar
- Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Maram A N Shtaya
- Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Lama A Shayeb
- Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Waleed M Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Domeyer PJ, Aletras V, Anagnostopoulos F, Katsari V, Niakas D. Development and validation of a tool to assess knowledge and attitudes towards generic medicines among students in Greece: The ATtitude TOwards GENerics (ATTOGEN) questionnaire. PLoS One 2017; 12:e0188484. [PMID: 29186163 PMCID: PMC5706728 DOI: 10.1371/journal.pone.0188484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/08/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The use of generic medicines is a cost-effective policy, often dictated by fiscal restraints. To our knowledge, no fully validated tool exploring the students' knowledge and attitudes towards generic medicines exists. The aim of our study was to develop and validate a questionnaire exploring the knowledge and attitudes of M.Sc. in Health Care Management students and recent alumni's towards generic drugs in Greece. MATERIALS AND METHODS The development of the questionnaire was a result of literature review and pilot-testing of its preliminary versions to researchers and students. The final version of the questionnaire contains 18 items measuring the respondents' knowledge and attitude towards generic medicines on a 5-point Likert scale. Given the ordinal nature of the data, ordinal alpha and polychoric correlations were computed. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales. Confirmatory factor analysis and Generalized Linear Latent and Mixed Model analysis (GLLAMM) with the use of the rating scale model were used in the second sample to assess goodness of fit. An assessment of internal consistency reliability, test-retest reliability, and construct validity was also performed. RESULTS Among 1402 persons contacted, 986 persons completed our questionnaire (response rate = 70.3%). Overall Cronbach's alpha was 0.871. The conjoint use of exploratory and confirmatory factor analysis resulted in a six-scale model, which seemed to fit the data well. Five of the six scales, namely trust, drug quality, state audit, fiscal impact and drug substitution were found to be valid and reliable, while the knowledge scale suffered only from low inter-scale correlations and a ceiling effect. However, the subsequent confirmatory factor and GLLAMM analyses indicated a good fit of the model to the data. CONCLUSIONS The ATTOGEN instrument proved to be a reliable and valid tool, suitable for assessing students' knowledge and attitudes towards generic medicines.
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Affiliation(s)
- Philip J. Domeyer
- School of Social Sciences, Hellenic Open University, Patras, Greece
- * E-mail:
| | - Vassilis Aletras
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | - Fotios Anagnostopoulos
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Panteion University of Social and Political Sciences, Kallithea, Athens, Greece
| | - Vasiliki Katsari
- Department of Social and Educational Policy, University of Peloponnese, Korinthos, Greece
| | - Dimitris Niakas
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Μedical School, National and Kapodistrian University of Athens, Athens, Greece
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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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Alkhuzaee FS, Almalki HM, Attar AY, Althubiani SI, Almuallim WA, Cheema E, Hadi MA. Evaluating community pharmacists’ perspectives and practices concerning generic medicines substitution in Saudi Arabia: A cross-sectional study. Health Policy 2016; 120:1412-1419. [PMID: 28228231 DOI: 10.1016/j.healthpol.2016.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 11/25/2022]
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Patel M, Slack M, Cooley J, Bhattacharjee S. A cross-sectional survey of pharmacists to understand their personal preference of brand and generic over-the-counter medications used to treat common health conditions. J Pharm Policy Pract 2016; 9:17. [PMID: 27103997 PMCID: PMC4839112 DOI: 10.1186/s40545-016-0066-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/11/2016] [Indexed: 11/21/2022] Open
Abstract
Background Consumers are hesitant in choosing generic medications as they are under the assumption that they are not as safe nor effective as brand medications. However, pharmacists do have the education and training to know that this is not the case. The aim of this study was to determine pharmacists’ preference of generic versus brand over-the-counter (OTC) medication for their personal use as self-treatment for various health symptoms. Methods A prospective, cross sectional study was conducted on 553 licensed pharmacists who were presumed to have expertise in the use of generic and brand name OTC medications. In a single Southwestern state in the United States, from December 2014 to January 2015, a web-based questionnaire was sent to pharmacists to explore their preference of brand and generic medications based on various health symptoms. Thirty-one brand-generic medication pairs were used to identify which medication type pharmacists preferred when asked about nine health symptoms. Frequency counts of pharmacists’ preference of a brand medication or a generic OTC medication overall and for each of the nine health symptoms were determined. Chi-squared analyses and one-way ANOVA were conducted to determine if there were any differences between the preferences of brand and generic OTC medications across each symptom. Results The study overall showed that pharmacists preferred generic OTC medications to brand OTC medications (62 to 5 %, respectively). Based on an 11-point rating scale, pharmacists were likely to take OTC generic medications (as their choice of self-treatment) when presented with health symptoms (mean = 7.32 ± 2.88). In addition, pharmacists chose generic OTC medications over brand medications regardless of health symptoms (p < 0.001). Conclusion Pharmacists who have expertise in medications were shown to prefer using generic OTC medications rather than brand name OTC medications for self-treating a variety of health symptoms. These study findings support the theory that expertise affects preference for generic versus brand name OTC medications. This information can be used to provide consumers the evidence needed to make well-informed choices when choosing between brand and generic medications.
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Affiliation(s)
- Mira Patel
- College of Pharmacy, The University of Arizona, Tucson, Arizona USA
| | - Marion Slack
- College of Pharmacy, The University of Arizona, Tucson, Arizona USA
| | - Janet Cooley
- College of Pharmacy, The University of Arizona, Tucson, Arizona USA
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Fadare JO, Adeoti AO, Desalu OO, Enwere OO, Makusidi AM, Ogunleye O, Sunmonu TA, Truter I, Akunne OO, Godman B. The prescribing of generic medicines in Nigeria: knowledge, perceptions and attitudes of physicians. Expert Rev Pharmacoecon Outcomes Res 2015; 16:639-650. [PMID: 26567041 DOI: 10.1586/14737167.2016.1120673] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Generic medicines have the same efficacy and safety as originators at lower prices; however, there are concerns with their utilization in Nigeria. Objective was to evaluate physicians' understanding and perception of generics. A questionnaire was administered among physicians working in tertiary healthcare facilities in four geo-political regions of Nigeria. Questionnaire response was 74.3% (191/257) among mainly males (85.9%). The mean knowledge score regarding generics was 5.3 (maximum of 9) with 36.6%, 36.1% and 27.2% having poor, average and good knowledge respectively. Cross-tabulation showed statistical significance (p = 0.047) with the duration of practice but not with position, subspecialty or sex. The majority of respondents did not believe that generic medicines are of lower quality than branded medicines. Therapeutic failure was a major concern in 82.7%, potentially discouraging the prescribing of generics, and a majority (63.9%) did not support generic substitution by pharmacists. Knowledge gaps were identified especially with the perception of generics, which need to be addressed.
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Affiliation(s)
- Joseph O Fadare
- a Department of Pharmacology , Ekiti State University , Ado-Ekiti , Nigeria
| | - Adekunle O Adeoti
- b Department of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | - Olufemi O Desalu
- c Department of Medicine , University of Ilorin , Ilorin , Nigeria
| | - Okezie O Enwere
- d Department of Medicine , Imo State University , Orlu , Imo State , Nigeria
| | - Aliyu M Makusidi
- e Department of Medicine , Usman Danfodiyo University , Sokoto , Nigeria
| | - Olayinka Ogunleye
- f Clinical Pharmacology Unit, Department of Medicine , Lagos State University Teaching Hospital , Ikeja , Lagos , Nigeria.,g Department of Pharmacology and Therapeutics , Lagos State University College of Medicine , Ikeja , Lagos , Nigeria
| | | | - Ilse Truter
- i Drug Utilization Research Unit (DURU), Department of Pharmacy , Nelson Mandela Metropolitan University , Port Elizabeth 6031 , South Africa
| | - Onyinye O Akunne
- j Department of Pharmacology and Therapeutics , University of Ibadan, Ibadan , Nigeria
| | - Brian Godman
- k Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , SE-141 86 , Stockholm , Sweden.,l Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
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Colgan S, Faasse K, Martin LR, Stephens MH, Grey A, Petrie KJ. Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review. BMJ Open 2015; 5:e008915. [PMID: 26671954 PMCID: PMC4679988 DOI: 10.1136/bmjopen-2015-008915] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate negative perceptions about generic medicines and evaluate the proportions of lay people, doctors and pharmacists who hold these perceptions. DESIGN A systematic review of observational studies. DATA SOURCES MEDLINE, EMBASE, PsycInfo and Scopus. ELIGIBILITY CRITERIA Quantitative data from cross-sectional and prospective studies published in English after 1980, using self-report measures to evaluate perceptions about generic medicines, presented as percentages of the total sample assessed. RESULTS After screening 2737 articles, 52 articles were included in the final analysis. A high proportion of doctors, pharmacists and lay people had negative perceptions of generics. Lay people were significantly more likely to view generics as less effective than branded medication (35.6%, 95% CI 34.8% to 36.4%) compared to doctors (28.7%, 27.5% to 29.9%) and pharmacists (23.6%, 21.2% to 26.2%), p<0.0001. Pharmacists (33.4%, 31.0% to 35.9%) were significantly more likely to believe generics were of inferior quality compared to branded medication than were doctors (28.0%, 26.3% to 29.9%), p=0.0006, and lay people (25.1%, 24.2% to 26.0%), p<0.0001. Doctors believed generics caused more side effects than branded medication (24.4%, 22.2% to 26.9%), compared to pharmacists (17.6%, 15.3% to 20.1%) and lay people (18.8%, 17.8% to 19.8%), p<0.0001. Doctors (28.5%, 26.9% to 30.2%) and pharmacists (25.4%, 21.4% to 29.9%) had significantly more safety concerns about generics than did lay people (18.0%, 17.0% to 19.0%), p ≤ 0.0002. A greater proportion of lay people felt negatively about generic substitution (34.0%, 33.2% to 34.9%), compared to doctors (24.1%, 22.0% to 26.4%) and pharmacists (11.0%, 9.6% to 12.7%), p<0.0001. Rates of negative perceptions of generics do not appear to have changed substantially over time in the general population or among physician groups, p ≥ 0.431, but such negative beliefs show a decreasing trend in pharmacists over the study period, p=0.034. CONCLUSIONS A significant proportion of doctors, pharmacists and lay people hold negative perceptions of generic medicines. It is likely these attitudes present barriers to the wider use of generics.
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Affiliation(s)
- Sarah Colgan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kate Faasse
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Leslie R Martin
- Department of Psychology, La Sierra University, Riverside, California, USA
| | - Melika H Stephens
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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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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Patients’ perceptions of generic drugs in Greece. Health Policy 2015; 119:1406-14. [DOI: 10.1016/j.healthpol.2015.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022]
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Lessing C, Ashton T, Davis P. New Zealand patients' understanding of brand substitution and opinions on copayment options for choice of medicine brand. AUST HEALTH REV 2015; 40:345-350. [PMID: 26363980 DOI: 10.1071/ah15004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022]
Abstract
Objective The aim of the present study was to better understand the views and experiences of New Zealand patients on switching between brands of prescription medicines and on alternative funding options for the provision of medicines, including an increase in copayments. Methods A self-administered questionnaire was offered to selected patients through participating community pharmacies. Pharmacies were stratified according to level of deprivation of the community served before random selection and invitation for involvement in the study. Patient understanding of and rationale for brand substitution was assessed. Preference for different copayment options was elicited, together with demographic and other explanatory information. Results In all, 194 patient-completed questionnaires were returned. Some gaps in patient knowledge and understanding of brand changes were evident. Most respondents indicated a preference for the existing subsidy arrangements with little desire expressed for alternatives. Around half were willing to contribute towards paying for a choice of brand other than the subsidised brand; however, the maximum contribution nominated was disproportionately lower than real cost differences between originator brand and generics. Conclusion The findings of the present study suggest that although most patients have experienced brand changes without any problems occurring, a lack of knowledge about substitution does persist. There may be some additional gain in ensuring New Zealanders are aware of the full cost of their medicines at the point of dispensing to reinforce the benefits of the Pharmaceutical Management Agency (PHARMAC) purchasing model. What is known about the topic? Generic reference pricing is used as a mechanism to make savings to pharmaceutical budgets; however, reticence to the use of generic medicines persists. What does this paper add? Most New Zealand patients experience brand changes without any problems occurring; however, a lack of knowledge about substitution does persist. The dollar value patients indicate they would contribute for brand choice is lower than the true cost difference between brands. What are the implications for practitioners? Opportunities exist for healthcare professionals to reinforce generic policies and there may be some additional gain in ensuring New Zealanders are aware of the full cost of their medicines at the point of dispensing.
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Affiliation(s)
- Charon Lessing
- Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Toni Ashton
- Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Peter Davis
- Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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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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Dunne SS, Dunne CP. What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs. BMC Med 2015; 13:173. [PMID: 26224091 PMCID: PMC4520280 DOI: 10.1186/s12916-015-0415-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considerable emphasis is presently being placed on usage of generic medicines by governments focussed on the potential economic benefits associated with their use. Concurrently, there is increasing discussion in the lay media of perceived doubts regarding the quality and equivalence of generic medicines. The objective of this paper is to report the outcomes of a systematic search for peer-reviewed, published studies that focus on physician, pharmacist and patient/consumer perspectives of generic medicines. METHODS Literature published between January 2003 and November 2014, which is indexed in PubMed and Scopus, on the topic of opinions of physicians, pharmacists and patients with respect to generic medicines was searched, and articles within the scope of this review were appraised. Search keywords used included perception, opinion, attitude and view, along with keywords specific to each cohort. RESULTS Following review of titles and abstracts to identify publications relevant to the scope, 16 papers on physician opinions, 11 papers on pharmacist opinions and 31 papers on patient/consumer opinions were included in this review. Quantitative studies (n = 37) were the most common approach adopted by researchers, generally in the form of self-administered questionnaires/surveys. Qualitative methodologies (n = 15) were also reported, albeit in fewer cases. In all three cohorts, opinions of generic medicines have improved but some mistrust remains, most particularly in the patient group where there appears to be a strongly held belief that less expensive equals lower quality. Acceptance of generics appears to be higher in consumers with higher levels of education while patients from lower socioeconomic demographic groups, hence generally having lower levels of education, tend to have greater mistrust of generics. CONCLUSIONS A key factor in improving confidence in generic products is the provision of information and education, particularly in the areas of equivalency, regulation and dispelling myths about generic medicines (such as the belief that they are counterfeits). Further, as patient trust in their physician often overrules their personal mistrust of generic medicines, enhancing the opinions of physicians regarding generics may have particular importance in strategies to promote usage and acceptance of generic medicines in the future.
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Affiliation(s)
- Suzanne S Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Lessing C, Ashton T, Davis P. An Evaluation of Health Service Impacts Consequent to Switching from Brand to Generic Venlafaxine in New Zealand under Conditions of Price Neutrality. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:646-654. [PMID: 26297093 DOI: 10.1016/j.jval.2015.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/24/2015] [Accepted: 02/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the health impact on adult New Zealand patients who switch from originator brand to generic venlafaxine. METHODS The national pharmacy database was used to select patients using venlafaxine for at least 6 months. Switchers and nonswitchers were identified, and switch behavior was compared for a 12-month follow-up period. Change in health service use following switching was also compared between switchers and nonswitchers including use of the emergency department, hospital, and specialist outpatient services over the same period. RESULTS Approximately 12% of all originator brand users switched to generic venlafaxine, at least half of whom continued to use the generic throughout the follow-up period to August 1, 2012. Almost 60% of new users of the generic venlafaxine, however, switched to using the originator brand. Aside from a slight reduction in the use of outpatient services among switchers, there were no significant differences in health services use between switchers and nonswitchers for either existing or new venlafaxine users. CONCLUSIONS Although both products remain fully subsidized and available, there is little incentive for prescribers, pharmacists, or patients to switch to the less expensive generic brand. If savings to the national New Zealand budget are to be realized, additional policy measures should be implemented to minimize incentives for multiple and reverse switching, and prescribers, as key opinion leaders, could take the lead in promoting generics to their patients.
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Affiliation(s)
- Charon Lessing
- Health Systems Section, School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Toni Ashton
- Health Systems Section, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Davis
- Health Systems Section, School of Population Health, University of Auckland, Auckland, New Zealand
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Bashaar M, Hassali MA, Saleem F. Community pharmacists' attitudes toward the quality and price of locally manufactured generic medicines in Kabul, Afghanistan. J Pharm Policy Pract 2015; 8:16. [PMID: 26078869 PMCID: PMC4467055 DOI: 10.1186/s40545-015-0037-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/17/2015] [Indexed: 11/13/2022] Open
Abstract
Objective To report the attitudes of community pharmacists in Kabul, Afghanistan, concerning the quality and price of locally manufactured medicines. Methods A cross-sectional descriptive study, involving a sample of 198 community pharmacists was conducted in Kabul city. Results With a response rate of 100%, most of the respondents 70.7% had 11–20 years experience working as a pharmacist. About 84.3% of the pharmacists dispensed imported generic medicines from Pakistan, Iran, India, and the UAE. Only 15.7% of pharmacists were dispensing locally produced generics from Ariana (i.e. a local pharmaceutical manufacturer). Exactly half of the pharmacists 50.0% reported that locally produced generics were equally safe and efficacious as the imported generics, while 70.7% of the respondents believed that the local manufacturers of generic products had reliable logistics and supply systems. However, 80.8% of respondents expressed concerns regarding their own credibility when stocking the medicines. Consequently, 80.3% of the sample only stocked well-advertised domestic generics, which were likely to be seen by consumers as more credible alternatives. Most of the respondents 82.8% were confident that the locally manufactured generics were cheaper than imported generics. Interestingly, 80.8% of the respondents favoured the establishment of a national brand substitution policy. Furthermore, 90.4% of the respondents believed that it was the responsibility of the Afghan regulatory authorities to educate pharmacists on the quality of domestic generics. Conclusion Although community pharmacists had a positive attitude towards the quality and affordability of locally manufactured medicines, due to lack of resources most of their medicines are imported. Despite their positivity towards the quality and price of generics, the community pharmacists only dispense them to a minimal degree, because of low local production levels among other reasons. The findings call for improvements in the local pharmaceutical industry in order to substitute imported medicines with local generics. The government must take firm steps to formulate and reinforce pharmaceutical pricing and brand substitution policies to help in controlling healthcare costs. Further research, especially a countrywide survey, is required.
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Affiliation(s)
- Mohammad Bashaar
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia
| | - Fahad Saleem
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia
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Factors influencing community pharmacist decision to dispense generic or branded medicines; Eastern Province, Alahsa, Saudi Arabia. Saudi Pharm J 2015; 23:143-6. [PMID: 25972733 PMCID: PMC4421022 DOI: 10.1016/j.jsps.2014.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/05/2014] [Indexed: 11/21/2022] Open
Abstract
Background Rising costs of medicines have increased the interest of policy makers in generic medicines. However, consumers’ and health care providers’ perception and attitude towards generic medicine act as a main barrier to the promotion of generic medicines. Objective To explore the factors community pharmacists consider while dispensing branded or generic medicines to consumers. Method A qualitative study was planned; twenty community pharmacists (ten hospital affiliated pharmacies and ten non-hospital affiliated pharmacies) were approached using a convenient sampling method. Interviews were recorded and later were coded into themes. Result Overall, it is seen that generic medicine stock was available for antibiotics, pain killers, cough syrups, antihistaminics and antacids. Pharmacists working in hospital affiliated pharmacies were more concerned about the quality of drug before dispensing it to the consumer and they believe that what is prescribed is best for them and substitution or switching is unnecessary while for pharmacists in the non-hospital affiliated pharmacies, appearance of the client was found to be the main factor influencing them to dispense generic (low cost) or branded (expensive) medicines. Conclusion Physical appearance of the consumer is revealed to be one of the main factors affecting the pharmacist decision to dispense generic or branded medicine. Pharmacists practising in hospital affiliated pharmacies were found to be influenced by physicians’ recommendation, and prefer to dispense good quality medicines.
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Lessing C, Ashton T, Davis P. Do users of risperidone who switch brands because of generic reference pricing fare better or worse than non-switchers? A New Zealand natural experiment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:695-703. [DOI: 10.1007/s10488-014-0606-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ndukwe HC, Tordoff JM, Wang T, Nishtala PS. Psychotropic Medicine Utilization in Older People in New Zealand from 2005 to 2013. Drugs Aging 2014; 31:755-68. [DOI: 10.1007/s40266-014-0205-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Babar ZUD, Kan SW, Scahill S. Interventions promoting the acceptance and uptake of generic medicines: a narrative review of the literature. Health Policy 2014; 117:285-96. [PMID: 24973926 DOI: 10.1016/j.healthpol.2014.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 03/23/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this paper was to undertake a narrative review of the literature regarding strategies and interventions promoting the acceptance and uptake of generic medicines. METHOD A literature search was performed between November 2011 and January 2012 to identify published full text original research articles documenting interventions to promote the use of generic medicines. Keywords used were: "generic medicine", "generic drug", "intervention", "promotion", "acceptance", "uptake", "generic/therapeutic substitution" and their related root words. The electronic databases comprised of Embase (1980 - present), Google, Google Scholar, Medline (1948 - present), PubMed, Science Direct, Scopus, Springer Link and The Cochrane Library. An interpretative narrative synthesis was undertaken and emergent themes analysed and reported. RESULTS Eighteen studies were included in the final analysis. There were seven main themes which including; education, financial incentives, advertising to promote generic medicines, free generic medicine trials, administrative forms and medicines use review (MUR). These themes were further classified into subthemes. Education was subdivided into consumer and physician education. Financial incentives included the influence of financial incentives on both consumers and physicians. The subthemes in the financial incentives category included the changes in co-payment for consumers, reward payment for physicians and fund-holding schemes. Advertising included the sub-themes of print media and the use of anthropomorphic images, while free generic medicines trial was made up of free vouchers for generic medicines and generic medicines sampling system. CONCLUSIONS The studies have mixed results; some interventions in some settings were useful, while others were not. Not all interventions consistently improved the uptake of generic medicines. There was limited literature available and further work is required to develop a range of interventions to support the uptake of generic medicines within and across different countries.
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Affiliation(s)
- Z U D Babar
- School of Pharmacy, University of Auckland, New Zealand.
| | - S W Kan
- School of Pharmacy, University of Auckland, New Zealand
| | - S Scahill
- School of Pharmacy, University of Auckland, New Zealand
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Abstract
OBJECTIVES To identify priority medicines policy issues for New Zealand. SETTING Stakeholders from a broad range of healthcare and policy institutions including primary, secondary and tertiary care. PARTICIPANTS Exploratory, semistructured interviews were conducted with 20 stakeholders throughout New Zealand. PRIMARY AND SECONDARY OUTCOME MEASURES The interviews were digitally recorded, transcribed and coded into INVIVO 10, then compared and grouped for similarity of theme. Perceptions, experiences and opinions regarding New Zealand's medicines policy issues were recorded. RESULTS A large proportion of stakeholders appeared to be unaware of New Zealand's (NZ) medicines policy. In general, the policy was considered to offer consistency to guide decision-making. In the context of Pharmaceutical Management Agency's (PHARMAC's) fixed budget for procuring and subsidising medicines, there was reasonable satisfaction with the range of medicines available-rare disorder medicines being the clear exception. Concerns raised were by whom and how decisions are made and whether desired health outcomes are being measured. Other concerns included inconsistencies in evidence and across health technologies. Despite attempts to improve the situation, lower socioeconomic groups (including rural residents) Māori and Pacific ethnicities and people with rare disorders face challenges with regards to accessing medicines. Other barriers include, convenience to and affordability of prescribers and the increase of prescription fees from NZ$3 to NZ$5. Concerns related to the PHARMAC of New Zealand included: a constraining budget; non-transparency of in-house analysis; lack of consistency in recommendations between the Pharmacology and Therapeutics Advisory Committee. Constraints and inefficiencies also exist in the submission process to access high-cost medicines. CONCLUSIONS The results suggest reasonable satisfaction with the availability of subsidised medicines. However, some of the major challenges include access to medicines in vulnerable groups, increasing costs and demand for new medicines, access to prescribers, budgetary constraints, cultural and health literacy, patient affordability and evidence requirement for gaining subsidy for medicines.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Faculty of Medical and Health Sciences, School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Susan Francis
- Faculty of Medical and Health Sciences, School of Pharmacy, University of Auckland, Auckland, New Zealand
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Exploring pharmacists' opinions regarding PHARMAC's interventions in promoting brand changes. Res Social Adm Pharm 2014; 11:96-110. [PMID: 24811426 DOI: 10.1016/j.sapharm.2014.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND In New Zealand, the use of generic medicines is advocated by the Pharmaceutical Management Agency of New Zealand (PHARMAC). Among other interventions, PHARMAC uses educational awareness campaigns to educate pharmacists to promote the uptake of generic medicines. However, the opinion of pharmacists regarding these interventions has not yet been evaluated. OBJECTIVES The objective of this study was to explore pharmacists' opinions regarding PHARMAC's interventions in promoting medicine brand changes. METHOD A cross-sectional study design was employed to explore pharmacists' opinions regarding brand changes. A questionnaire was sent to 500 randomly selected pharmacists in New Zealand. In second component of the study, five community pharmacies in the Auckland region were selected through convenience sampling, and a semi-structured interview was conducted with a pharmacist in each site. RESULTS One-hundred and eighty seven questionnaires were returned and analyzed (response rate of 37.4%). Sixty-eight percent of pharmacists supported brand changes and 98.4% mentioned that PHARMAC is responsible for informing them of brand changes. Over half (51.3%) of pharmacists found the current interventions effective, and 39.6% were satisfied with the current brand change information provided by PHARMAC. The majority (94.7%) of pharmacists currently receive faxed information but many indicated (70.8%) that they prefer email notifications. Cilazapril was considered the least difficult medicine to substitute in the past 10 years and omeprazole the most difficult. Patient acceptance and claims about effectiveness were the main factors in determining the difficulty of brand substitution. Fewer than half of the respondents felt that interventions were implemented with enough preparation time for a brand change. The ideal lead-in time was in the range of three to six months. Pharmacists expressed a number of concerns about brand changes such as the frequency at which they occur and the lack of generic stock availability when a brand change occurs. CONCLUSION Over one-third of respondents were satisfied with brand change information provided by PHARMAC. Cilazapril was the least difficult medicine to substitute, while omeprazole and salbutamol changes were the most difficult. Claims about effectiveness, quality and side effects were the main factors identified as barriers to generic substitution.
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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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Auta A, Bala ET, Shalkur D. Generic medicine substitution: a cross-sectional survey of the perception of pharmacists in North-Central, Nigeria. Med Princ Pract 2014; 23:53-8. [PMID: 24217185 PMCID: PMC5586836 DOI: 10.1159/000355473] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the views of pharmacists in North-Central Nigeria on generic medicines and generic substitution practices. SUBJECTS AND METHOD A cross-sectional survey was conducted in 4 cities in North-Central Nigeria from April to June 2012 among 330 pharmacists in hospital and community pharmacy settings, recruited through a convenience sampling strategy. Data were collected using a prevalidated self-administered questionnaire and entered into SPSS version 16.0 software to generate descriptive statistics. Binary logistic regression was conducted to determine the demographic predictors of preference for generic substitution among respondents. RESULTS The response rate was 46.7% (n = 154). Eighty-four (54.5%) respondents reported that generic medicines were not of equivalent quality to branded ones. There was no significant difference (p > 0.05) in the perception of respondents regarding the quality of imported generic medicines over locally manufactured ones. While 143 (92.9%) respondents supported generic substitution practices, 105 (68.2%) would prefer to recommend generic medicines over branded ones. Hospital pharmacists were more likely (OR = 2.6; 95% CI 1.2-5.8) than community pharmacists to recommend generic medicines. One hundred and fifty-three (99.4%) respondents would support the implementation of a future generic substitution right for pharmacists in Nigeria. CONCLUSION The present study showed a high support for generic substitution and future generic substitution rights for pharmacists in Nigeria.
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Affiliation(s)
- Asa Auta
- *Asa Auta, Department of Clinical Pharmacy, University of Jos, PMB 2084, Jos (Nigeria), E-Mail
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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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Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol 2013; 14:1. [PMID: 23289757 PMCID: PMC3579676 DOI: 10.1186/2050-6511-14-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 12/24/2012] [Indexed: 12/31/2022] Open
Abstract
Generic medicines are those where patent protection has expired, and which may be produced by manufacturers other than the innovator company. Use of generic medicines has been increasing in recent years, primarily as a cost saving measure in healthcare provision. Generic medicines are typically 20 to 90% cheaper than originator equivalents. Our objective is to provide a high-level description of what generic medicines are and how they differ, at a regulatory and legislative level, from originator medicines. We describe the current and historical regulation of medicines in the world's two main pharmaceutical markets, in addition to the similarities, as well as the differences, between generics and their originator equivalents including the reasons for the cost differences seen between originator and generic medicines. Ireland is currently poised to introduce generic substitution and reference pricing. This article refers to this situation as an exemplar of a national system on the cusp of significant health policy change, and specifically details Ireland's history with usage of generic medicines and how the proposed changes could affect healthcare provision.
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Affiliation(s)
- Suzanne Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Olsson E, Kälvemark Sporrong S. Pharmacists' experiences and attitudes regarding generic drugs and generic substitution: two sides of the coin. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 20:377-83. [PMID: 23134096 DOI: 10.1111/j.2042-7174.2012.00214.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 03/21/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Generic drug substitution reduces costs for medicines, but the downsides include unintentional double medication, confusion and anxiety among patients. Information from pharmacists affects patients' experiences of substitution with generic drugs. The aim of this study was to explore experiences and attitudes to generic substitution among Swedish community pharmacists. METHODS An interview guide was developed. Semi-structured interviews with community pharmacists were conducted and transcribed verbatim. Analysis was inductive; extracts from the transcripts were compared and combined to form themes and subcategories. Pharmacists from a heterogeneous convenience sample of pharmacies were interviewed until data saturation had been achieved. KEY FINDINGS Sixteen pharmacists were interviewed. Three main themes and twelve subcategories were identified, with the main themes being the role of the pharmacist, pharmacists' concerns regarding patients, and the generic drug. Pharmacists found it positive that generic substitution decreases the costs for pharmaceuticals but also emphasized that the switch can confuse and worry patients, which could result in less benefit from treatment. Respondents claimed that generic substitution has changed the focus in the pharmacist-patient meeting towards economics and regulations. CONCLUSION According to the interviewed pharmacists generic substitution is not primarily an issue of generic versus brand-name products, but concerns above all the challenges that the switch implies for patients and pharmacists. To prevent known confusion and concerns among patients it is important that community pharmacists acquire the necessary tools and knowledge to manage this situation; pharmacists themselves as well as pharmacy owners and authorities share responsibility for this.
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Affiliation(s)
- Erika Olsson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
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