[Medical problems and risks of switching drugs according to legal requirements of drug discount contracts in Germany]

Greek Physicians' Perceptions on Generic Drugs in the Era of Austerity

Purpose. To assess the beliefs and preferences of Greek physicians, regarding generic drugs, in the years of financial crisis. Setting. Multicentered, nationwide survey. Material and Methods. A custom questionnaire based on former similar studies was developed and administered to Greek physicians. The variable "perception on generics" was constructed after an exploratory study and the instrument was validated by conventional and Rasch analysis methods. 22 items formed 5 subscales that constructed the variable in question. Results. 908 physicians successfully participated in the study (response rate: 80%). Mean total scores to the instrument were 60.63 ± 12.12 for men and significantly less (58.24 ± 11.73) for women (p = 0.04). Greek physicians were not persuaded on the potential economic gain (45.79 ± 10.53); moreover they identified that Greek authorities cannot address the increased pharmacovigilance mandates. Physicians working in Athens and those working in surgical units demonstrated significantly worse scores than their colleagues from the rest of Greece and those working in Internal Medicine wards (p = 0.03).  Conclusion. Our results suggest an overall poor acceptance of the national initiative on generic drugs by Greek physicians. This trial is registered with Clinicaltrials.gov identifier: NCT01855802.

Effectiveness, safety and cost of drug substitution in hypertension

Cost-containment measures in healthcare provision include the implementation of therapeutic and generic drug substitution strategies in patients whose condition is already well controlled with pharmacotherapy. Treatment for hypertension is frequently targeted for such measures. However, drug acquisition costs are only part of the cost-effectiveness equation, and a variety of other factors need to be taken into account when assessing the impact of switching antihypertensives. From the clinical perspective, considerations include maintenance of an appropriate medication dose during the switching process; drug equivalence in terms of clinical effectiveness; and safety issues, including the diverse adverse-event profiles of available alternative drugs, differences in the 'inactive' components of drug formulations and the quality of generic formulations. Patients' adherence to and persistence with therapy may be negatively influenced by switching, which will also impact on treatment effectiveness. From the economic perspective, the costs that are likely to be incurred by switching antihypertensives include those for additional clinic visits and laboratory tests, and for hospitalization if required to address problems arising from adverse events or poorly controlled hypertension. Indirect costs and the impact on patients' quality of life also require assessment. Substitution strategies for antihypertensives have not been tested in large outcome trials and there is little available clinical or economic evidence on which to base decisions to switch drugs. Although the cost of treatment should always be considered, careful assessment of the human and economic costs and benefits of antihypertensive drug substitution is required before this practice is recommended.

[Drug therapy in primary care in the light of discount contracts to health insurers--a patient survey]

BACKGROUND

Since April 1, 2007 pharmacists in Germany are obligated by law to dispense products from particular manufacturers with whom the health insurance funds have entered into discount agreements. Only by ticking the relevant tick box ("Aut Idem") on the prescription form can the prescriber insist on a drug of a specific company.

METHODOLOGY

A standardized questionnaire was designed and piloted in a small group and adapted accordingly. By means of this questionnaire patients were asked about their experiences with drug discount contracts.

RESULTS

226 patients participated in this study. 75% of the participants had knowledge of these contracts. 64.6% of the patients were concerned about substitute drugs. 32.1% took no longer the drugs regularly, and 21.2% indicated that they were confused by the changed packaging of medicinal drugs. 79.5% of the participants wanted to keep their old, familiar drug, and 53.7% of the participants insisted on receiving their familiar medication against the prescriber's prescription.

DISCUSSION

The survey shows that patients feel irritated by their medication and that medication errors occur. In addition, GPs and pharmacists must inform patients about the discount contracts (substitution). Many participants wanted to keep or insist on their familiar medication and compliance and physician-patient-relationship could be compromised.

CONCLUSION

This intervention by the health insurance funds interferes with the medical treatment of patients. Such far-reaching changes in medication might lead to life-threatening situations.