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Tao J, Li S, Xu Q, Gong S, Zeng F. Patients' attitudes towards switching to national volume-based procurement (NVBP) Drugs-a qualitative investigation in Wuhan, China. BMC Health Serv Res 2023; 23:62. [PMID: 36670463 PMCID: PMC9862793 DOI: 10.1186/s12913-023-09077-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The implementation of the NVBP policy has generated considerable reductions in drug procurement prices and an increase in the market share of the NVBP drugs.This study aimed to investigate patients' attitudes towards switching to drugs of national volume-based procurement (NVBP) and identify their underlying influencing factors in Wuhan, China. METHODS A total of 21 eligible patients from the Wuhan Union Hospital who were switched to NVBP drugs between January 2022 and May 2022 were included in our study. Semi-structured face-to-face interviews were conducted to collect interview information and the interview data was analyzed by the Colaizzi seven-step method. RESULTS Twenty-one semi-structured face-to-face interviews were conducted. The duration of each interview was 25-35 min and three themes related to patients' attitudes and their influencing factors were extracted, including (1) Patients' perception of the NVBP drugs; (2) Family and social influence to patients; (3) Medication habits of patients. This study found: 1) 71.4% patients (15/21) showed a positive attitude towards switching to NVBP medicines; 2)80.9% patients (17/21) have felt a significant reduction in their medication cost after the implementation of the NVBP policy; 3)Advices from healthcare professionals and health insurance reimbursement policies showed great impacts on patients' attitude towards switching to NVBP drugs; 4)Attitudes towards switching to NVBP drugs varied considerably among patients with different severities of disease. CONCLUSION The implementation of the NVBP policy has significantly reduced the cost of healthcare for patients and has been supported by71.4% (15 of 21) patients. However, some issues have been identified in the implementation of the policy in this study. Health professionals in general need to contribute more efforts to improve patients' preconceptions about the NVBP drugs and boost their confidence in the NVBP drugs.
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Affiliation(s)
- Jinyi Tao
- grid.33199.310000 0004 0368 7223Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shihong Li
- grid.33199.310000 0004 0368 7223Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiling Xu
- grid.33199.310000 0004 0368 7223Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiwei Gong
- grid.33199.310000 0004 0368 7223School of Pharmacy, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Zeng
- grid.33199.310000 0004 0368 7223Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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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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Qu J, Zuo W, Took RL, Schafermeyer KW, Lukas S, Wang S, Du L, Liu X, Gao Y, Li J, Pan H, Du X, Mei D, Zhang B. A nationwide survey exploring physicians’ and pharmacists’ knowledge, awareness and perceptions regarding generic medicines in China. BMC Health Serv Res 2022; 22:1069. [PMID: 35987631 PMCID: PMC9392939 DOI: 10.1186/s12913-022-08438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Generic medicines substitution is an important means to control rapid growth of pharmaceutical expenditures for the healthcare system in China. Acceptance and utilization of generic medicines is highly influenced by healthcare providers’ perceptions. This study aimed to compare the knowledge, awareness and perceptions of generic medicines between physicians and pharmacists in China. Methods We used an online, cross-sectional survey across China. The questionnaire explored four sections: demographic characteristics, assessment of the participants’ knowledge and awareness of generic medicines, perceptions of generic medicines and generic substitution practices. Chi-square or Mann–Whitney-U tests were applied to compare differences between physicians and pharmacists. P-values < 0.05 were considered significant. Results A total of 1644 physicians and 4187 pharmacists participated. Most physicians (82.8%, n = 1362) and pharmacists (89.8%, n = 3760) correctly identified the definition of generic medicines. A similar percentage of physicians and pharmacists agreed that approved generic medicines are as effective (64.1% vs 68.2%) or safe (63.8% vs 69.1%) as brand-name medicines. Most physicians and pharmacists (67.6% vs 71.0%) supported the policy of generic substitution. In practice, 79.4% (n = 1305) of physicians reported that they had prescribed generic medicines. More than 78% of respondents reported an obvious increase in the number of generic medicines prescribed in their medical institutions. The majority of physicians and pharmacists identified lack of trust regarding efficacy and safety of generic medicines and the difficulty of changing patients’ preference as top challenges in generic substitution. Conclusions Both physicians and pharmacists surveyed had adequate knowledge of generic medicines, and hold positive attitude towards generics and generic substitution. Efficacy and safety are key factors related to prescribing or dispensing generic medicines. Various policies and regulations should be taken to encourage successful generic substitution. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08438-9.
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Alemayehu C, Mitchell G, Nikles J, Aseffa A, Clavarino A. Acceptability and barriers to implementation of N-of-1 tests in Ethiopia - a qualitative study. BMC Med Res Methodol 2019; 19:192. [PMID: 31615422 PMCID: PMC6794767 DOI: 10.1186/s12874-019-0832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Locally produced generic drugs offer a cost–effective alternative to imported drugs to treat patients in Ethiopia. However, due to a lack of bioequivalence testing, additional assurance tests are needed to build trust in cheaper, locally made drugs. By testing bioequivalence of local drugs to gold standard, N-of-1 tests have the potential to promote patient centred quality use of medicines. Method We sought to assess the acceptability of, and explore barriers to, conducting N-of-1 tests to evaluate local medicines in a resource limited clinical setting. We conducted a descriptive qualitative study, analysing four focus group discussions and five key informant interviews. Participants were senior drug regulatory authority members, institutional review board members, physicians and patients. All interviews were audio taped and transcribed verbatim. Patient interviews were conducted in Amharic and translated to English prior to analysis. Data analysis used an inductive, thematic process. Results Five major themes were identified; (1) Appropriateness of N-of-1 tests to determine the therapeutic equivalence of local drugs, (2) N-of-1 therapeutic equivalence tests: clinical care or research? (3) Ethical and regulatory requirements (IRB), (4) Potential barriers to implementing N-of-1 tests and (5) Possible solutions to identified challenges. The study demonstrated considerable support for using N-of-1 tests for clinical equivalence studies between local and imported medicines, but important impediments were very likely to impact the feasibility of conducting N-of-1 tests in Ethiopia. Key informants from the regulatory authority did not support additional tests of local drugs. There were also mixed opinions regarding ethical requirements for conducting N-of-1 tests. The Institutional Review Board (IRB) members believed that IRB approval was sufficient to conduct N-of-1 tests, however, the regulatory authority members considered that N-of-1 tests constituted a clinical trial, and required approval at the regulatory level. Conclusion This study showed that there were key uncertainties that could impact the feasiblity of using N-of-1 testing local drugs in Ethiopia. Therefore, a number of protocol amendments to address contextual threats and regulatory challenges, would be needed before progressing to conducting these tests.
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Affiliation(s)
- Chalachew Alemayehu
- Faculty of Medicine, The University of Queensland, P.O. Box: 78, Scott road, Brisbane, QLD, 4006, Australia.
| | - Geoff Mitchell
- Faculty of Medicine, The University of Queensland, P.O. Box: 78, Scott road, Brisbane, QLD, 4006, Australia
| | - Jane Nikles
- UQCCR, The University of Queensland, Brisbane, Australia
| | - Abraham Aseffa
- Armauer Hanson Research Institute, Addis Ababa, Ethiopia
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Capturing Patients' Perspectives on Medication Safety: The Development of a Patient-Centered Medication Safety Framework. J Patient Saf 2019; 16:e324-e339. [PMID: 30882613 PMCID: PMC7678656 DOI: 10.1097/pts.0000000000000583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text. Medication safety incidents are common in primary care and contributory factors frameworks can assist in our understanding of their causes. A framework that is positioned from the perspective of patients would be advantageous in practice when seeking patient insights into medication safety. The aim of this study was to develop a patient-centered contributory factors framework for examining medication safety incidents.
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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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Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. "No generics, Doctor!" The perspective of general practitioners in two French regions. BMC Health Serv Res 2017; 17:707. [PMID: 29121918 PMCID: PMC5680768 DOI: 10.1186/s12913-017-2682-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022] Open
Abstract
Background Generic medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs) toward generic medicines in two French regions with the lowest penetration rate of these products. Methods An observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74%) who were administered a structured questionnaire developed from the results of the first phase. Results Seventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%). The main drawbacks cited were the variability of their presentation (44%), the confusion that they caused for some patients (47%), frequent allegations of adverse side effects (37%) and a lack of efficacy (24%), and frequent refusal by patients (26%). Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand. Conclusion Most surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.
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Affiliation(s)
- Béatrice Riner
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Adèle Bussy
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Jeannie Hélène-Pelage
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Nycrees Moueza
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Sébastien Lamy
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.,Laboratory of Epidemiology and Analysis in Public Health, UMR1027 INSERM, University of Toulouse III Paul Sabatier, Toulouse, France
| | - Philippe Carrère
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France. .,Laboratory of Epidemiology and Analysis in Public Health, UMR1027 INSERM, University of Toulouse III Paul Sabatier, Toulouse, France. .,Département de Médecine Générale, Faculté de Médecine Hyacinthe Bastaraud, Campus Universitaire de Fouillole, Université des Antilles, 97157 Pointe-à-Pitre Cedex, Guadeloupe, BP 250, France.
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Labiris G, Fanariotis M, Kastanioti C, Alexias G, Protopapas A, Karampitsakos T, Niakas D. Greek Physicians' Perceptions on Generic Drugs in the Era of Austerity. SCIENTIFICA 2015; 2015:251792. [PMID: 26457225 PMCID: PMC4589622 DOI: 10.1155/2015/251792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/24/2015] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Georgios Labiris
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Michael Fanariotis
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | | | - Georgios Alexias
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Adonis Protopapas
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Theodoros Karampitsakos
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Dimitris Niakas
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
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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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Tobin MR, Laing R. Generic medicine: Boston University students’ perceptions and surprising lack of knowledge. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/1741134315596012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This project aims to compare knowledge, perceptions, and attitudes regarding generic medicines in an effort to illuminate the reasons for widely discrepant rates of generic utilization in different countries. While the United States has high rates of generic uptake (around 86%), and generic medicine utilization has saved the US healthcare system over $1 trillion in the past decade (2003–2014), similar figures are not seen in many other countries despite the opportunities for substantial cost savings. Therefore, it is in the interest of global policy makers and public health professionals to be aware of public perception of generic medicines. Using quantitative and qualitative methods, our study illuminated five major themes among Boston University students of various nationalities: origin, knowledge, important decision-making factors, perceptions of self/others, and information sources. The key finding of our study was that only 24% of participants reported accurate knowledge of generic medicines. This figure is alarming given the high rates of use in the United States and carries implications for generic promotion and uptake rates.
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Affiliation(s)
- Molly R Tobin
- Kilachand Honors College, Boston University, Boston, USA
| | - Richard Laing
- Department of Global Health, School of Public Health, Boston University, Boston, USA
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Yousefi N, Mehralian G, Peiravian F, Jahangiri S, Ahmadi R. Physicians’ perceptions of generic medicine in Iran. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khalil H, O'Leary K, Lu CY, Hassali MA, Shafie AA, Palaian S, Poudel A, Ibrahim MIM, Hall T, Marotti SB, Abarno AC, Khalil H, Chan EW, Larizza M. Letters to the Editor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2009.tb00485.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hanan Khalil
- Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Heath Sciences; Monash University; Moe Vic. 3825
| | - Karen O'Leary
- Society of Hospital Pharmacists of Australia; PO Box 1774 Collingwood Vic. 3066
| | - Christine Y Lu
- School of Pharmacy and Medical Sciences Sansom Institute; University of South Australia; Adelaide SA 5001
| | - Mohamed Azmi Hassali
- School of Pharmacy and Medical Sciences Sansom Institute; University of South Australia; Adelaide SA 5001
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Subish Palaian
- Deputy Dean, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Arjun Poudel
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Mohamed IM Ibrahim
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Tony Hall
- Federal Councillor Society of Hospital Pharmacists of Australia, and Senior Lecturer School of Pharmacy; Griffith University; Gold Coast Qld 4222
| | | | | | - Hanan Khalil
- Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences; Monash University; Moe Vic 3825
| | - Esther W Chan
- Department of Pharmacy Practice, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Vic. 3052
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Kumar R, Hassali MA, Saleem F, Alrasheedy AA, Kaur N, Wong ZY, Kader MASA. Knowledge and perceptions of physicians from private medical centres towards generic medicines: a nationwide survey from Malaysia. J Pharm Policy Pract 2015; 8:11. [PMID: 25861452 PMCID: PMC4376509 DOI: 10.1186/s40545-015-0031-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/25/2015] [Indexed: 11/15/2022] Open
Abstract
Objectives Generic medicine prescribing has become a common practice in public hospitals. However, the trend in private medical centres seems to be different. The objective of this study was to investigate knowledge, perceptions and behavior of physicians from private medical centres in Malaysia regarding generic medicines. Methods This study was a cross-sectional nationwide survey targeting physicians from private medical centres in Malaysia. The survey was conducted using questionnaire having (i) background and demographic data of the physicians, volume of prescription in a day, stock of generic medicines in their hospital pharmacy etc. (ii) their knowledge about bioequivalence (iii) prescribing behavior (iv) physicians’ knowledge of quality, safety and efficacy of generic medicines, and their cost (v) perceptions of physicians towards issues pertaining to generic medicines utilization. Results A total of 263 questionnaires out of 735 were received, giving a response rate of 35.8%. Of the respondents, 214 (81.4%) were male and 49 (18.6%) were females. The majority of the participants were in the age range of 41–50 years and comprised 49.0% of the respondents. Only 2.3% of physicians were aware of the regulatory limits of bioequivalence standards in Malaysia. Of the respondents, 23.2% agreed that they ‘always’ write their prescriptions using originator product name whereas 50.2% do it ‘usually’. A number of significant associations were found between their knowledge, perceptions about generic medicines and their demographic characteristics. Conclusions The majority of the physicians from private medical centres in Malaysia had negative perceptions about safety, quality and the efficacy of generic medicines. These negative perceptions could be the cause of the limited use of generic medicines in the private medical centres. Therefore, in order to facilitate their use, it is recommended that the physicians need to be reassured and educated about the drug regulatory authority approval system of generic medicines with regard to their bioequivalence, quality, efficacy and safety. Apart from the policy on generic substitution, it would also be recommended to have a national medicine pricing policy, which controls drug prices, in both the public and private sector. These efforts are worthwhile to reduce the drug expenditure and improve the medicine affordability in Malaysia.
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Affiliation(s)
- Rohit Kumar
- Discipline of Administrative and Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Administrative and Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Fahad Saleem
- Discipline of Administrative and Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Alian A Alrasheedy
- Pharmacy Practice Department, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Navneet Kaur
- Discipline of Physiology and Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800 Malaysia
| | - Zhi Yen Wong
- Pharmacy Department, Hospital Teluk, Intan, Perak Malaysia
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Hassali MA, Wong ZY, Alrasheedy AA, Saleem F, Mohamad Yahaya AH, Aljadhey H. Does educational intervention improve doctors' knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia. SAGE Open Med 2014; 2:2050312114555722. [PMID: 26770747 PMCID: PMC4607233 DOI: 10.1177/2050312114555722] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/18/2014] [Indexed: 11/16/2022] Open
Abstract
Objectives: To investigate the impact of an educational intervention on doctors’ knowledge and perceptions towards generic medicines and their generic (international non-proprietary name) prescribing practice. Methods: This is a single-cohort pre-/post-intervention pilot study. The study was conducted in a tertiary care hospital in Perak, Malaysia. All doctors from the internal medicine department were invited to participate in the educational intervention. The intervention consisted of an interactive lecture, an educational booklet and a drug list. Doctors’ knowledge and perceptions were assessed by using a validated questionnaire, while the international non-proprietary name prescribing practice was assessed by screening the prescription before and after the intervention. Results: The intervention was effective in improving doctors’ knowledge towards bioequivalence, similarity of generic medicines and safety standards required for generic medicine registration (p = 0.034, p = 0.034 and p = 0.022, respectively). In terms of perceptions towards generic medicines, no significant changes were noted (p > 0.05). Similarly, no impact on international non-proprietary name prescribing practice was observed after the intervention (p > 0.05). Conclusion: Doctors had inadequate knowledge and misconceptions about generic medicines before the intervention. Moreover, international non-proprietary name prescribing was not a common practice. However, the educational intervention was only effective in improving doctors’ knowledge of generic medicines.
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Affiliation(s)
- Mohamed Azmi Hassali
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, UniversitiSains Malaysia, Penang, Malaysia
| | - Zhi Yen Wong
- Pharmacy Department, Hospital TelukIntan, Perak, Malaysia
| | - Alian A Alrasheedy
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, UniversitiSains Malaysia, Penang, Malaysia
| | - Fahad Saleem
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, UniversitiSains Malaysia, Penang, Malaysia
| | | | - Hisham Aljadhey
- College of Pharmacy, KingSaudUniversity, Riyadh, Saudi Arabia
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Hassali MA, Wong ZY, Alrasheedy AA, Saleem F, Mohamad Yahaya AH, Aljadhey H. Perspectives of physicians practicing in low and middle income countries towards generic medicines: a narrative review. Health Policy 2014; 117:297-310. [PMID: 25129135 DOI: 10.1016/j.healthpol.2014.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/16/2014] [Accepted: 07/24/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This review was conducted to document published literature related to physicians' knowledge, attitudes, and perceptions of generic medicines in low- and middle-income countries (LMICs) and to compare the findings with high-income countries. METHODS A systematic search of articles published in peer-reviewed journals from January 2001 to February 2013 was performed. The search comprised nine electronic databases. The search strategy involved using Boolean operators for combinations of the following terms: generic medicines, generic medications, generic drugs, generic, generic substitution, generic prescribing, international non-proprietary, prescribers, doctors, general practitioners, physicians, and specialists. RESULTS Sixteen articles were included in this review. The majority (n=11) were from high income countries and five from LMICs. The main difference between high income countries and LMICs is that physicians from high income countries generally have positive views whereas those from LMICs tend to have mixed views regarding generic medicines. Few similarities were identified among different country income groups namely low level of physicians' knowledge of the basis of bioequivalence testing, cost of generic medicines as an encouraging factor for generic medicine prescribing, physicians' concerns towards safety and quality of generic medicines and effect of pharmaceutical sales representative on generic medicine prescribing. CONCLUSION The present literature review revealed that physicians from LMICs tend to have mixed views regarding generic medicines. This may be due to differences in the health care system and pharmaceutical funding system, medicine policies, the level of educational interventions, and drug information sources in countries of different income levels.
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Affiliation(s)
- Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | - Zhi Yen Wong
- Pharmacy Department, Hospital Teluk Intan, Jalan Changkat Jong, 36000 Teluk Intan, Perak, Malaysia.
| | - Alian A Alrasheedy
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | - Fahad Saleem
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | | | - Hisham Aljadhey
- College of Pharmacy, King Saud University, 11451 Riyadh, Saudi Arabia.
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Dunne SS, Shannon B, Cullen W, Dunne CP. Beliefs, perceptions and behaviours of GPs towards generic medicines. Fam Pract 2014; 31:467-74. [PMID: 24895136 DOI: 10.1093/fampra/cmu024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To benefit from cost-savings associated with generic medicine use; in June 2013, Ireland introduced generic substitution and reference pricing. The attitudes and behaviours of health care professionals may influence successful implementation of such changes. OBJECTIVES To assess perceptions of GPs in Ireland regarding generic medicines in the time leading up to the enactment of the new legislation and for the first time in at least the prior decade. METHODS Detailed one-to-one semi-structured interviews performed with a representative cohort of 34 urban- and rural-based GPs in Ireland. RESULTS Thirty of the participating 34 GPs prescribed generic medicines actively. Predominantly, participants believed that generics worked as effectively, and were of the same quality, as originator medicines. However, 32 GPs reported receiving patient complaints regarding generics; almost a third reported complaints of increased or altered side effects. Thirty-two GPs stated that they would take a generic medicine, although one in seven would choose the originator if offered a choice. A minority of GPs were of the view that generics are manufactured to a poorer quality than originators and may be a risk to patient safety. CONCLUSION This study of GPs' attitudes towards generic medicines in Ireland highlights that this key stakeholder group has generally positive attitudes towards both generic medicines and the new legislation. However, variable knowledge about generic medicines and concerns regarding patient experience, clinical effectiveness and manufacturing quality were identified. GPs' opinions could negatively influence patient opinions; enhancing such opinions may prove important in successfully implementing the new legislation.
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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.
| | - Bill Shannon
- Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- 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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Dunne S, Shannon B, Hannigan A, Dunne C, Cullen W. Physician and pharmacist perceptions of generic medicines: What they think and how they differ. Health Policy 2014; 116:214-23. [DOI: 10.1016/j.healthpol.2014.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 02/21/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
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Mansfield SJ. Generic drug prices and policy in Australia: room for improvement? a comparative analysis with England. AUST HEALTH REV 2014; 38:6-15. [PMID: 24480618 DOI: 10.1071/ah12009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 11/11/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the degree to which reimbursement prices in Australia and England differ for a range of generic drugs, and to analyse the supply- and demand-side factors that may contribute to these differences. METHODS Australian and English reimbursement prices were compared for a range of generic drugs using pricing information obtained from government websites. Next, a literature review was conducted to identify supply- and demand-side factors that could affect generic prices in Australia and England. Various search topics were identified addressing potential supply-side (e.g. market approval, intellectual property protection of patented drugs, generic pricing policy, market size, generic supply chain and discounting practices) and demand-side (consumers, prescribers and pharmacists) factors. Related terms were searched in academic databases, official government websites, national statistical databases and internet search engines. RESULTS Analysis of drug reimbursement prices for 15 generic molecules (representing 45 different drug presentations) demonstrated that Australian prices were on average over 7-fold higher than in England. Significant supply-side differences included aspects of pricing policy, the relative size of the generics markets and the use of clawback policies. Major differences in demand-side policies related to generic prescribing, pharmacist substitution and consumer incentives. CONCLUSIONS Despite recent reforms, the Australian Government continues to pay higher prices than its English counterpart for many generic medications. The results suggest that particular policy areas may benefit from review in Australia, including the length of the price-setting process, the frequency of subsequent price adjustments, the extent of price competition between originators and generics, medical professionals' knowledge about generic medicines and incentives for generic prescribing. WHAT IS KNOWN ABOUT THE TOPIC? Prices of generic drugs have been the subject of much scrutiny over recent years. From 2005 to 2010 the Australian Government responded to observations that Pharmaceutical Benefits Scheme prices for many generics were higher than in numerous comparable countries by instituting several reforms aimed at reducing the prices of generics. Despite this, several studies have demonstrated that prices for generic statins (one class of cholesterol-lowering drug) are higher in Australia compared with England and many other developed countries, and prices of numerous other generics remain higher than in the USA and New Zealand. Recently there has been increasing interest in why these differences exist. WHAT DOES THIS PAPER ADD? By including a much larger range of commonly used and costly generic drugs, this paper builds significantly on the limited previous investigations of generic drug prices in Australia and England. Additionally, this is the first comprehensive investigation of multiple supply- and, in particular, demand-side factors that may explain any price differences between these countries. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners may contribute to the higher prices of generic medications in Australia compared with England through relatively low rates of generic prescribing. There are also significant implications for health policy makers, as this paper demonstrates that if Australia achieved the same prices as England for many generic drugs there could be substantial savings for the Pharmaceutical Benefits Scheme.
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Affiliation(s)
- Sarah J Mansfield
- Department of General Practice, Deakin University, 2-18 Colac Road, Belmont, Vic. 3216, Australia.
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Fabiano V, Mameli C, Cattaneo D, Delle Fave A, Preziosa A, Mele G, Clementi E, Zuccotti GV. Perceptions and patterns of use of generic drugs among Italian family pediatricians: first round results of a web survey. Health Policy 2012; 104:247-52. [PMID: 22217861 DOI: 10.1016/j.healthpol.2011.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 11/26/2011] [Accepted: 12/11/2011] [Indexed: 10/14/2022]
Abstract
Prescription of generic medicines represents an efficacious healthcare cost containment strategy. In some European countries and in the US, generic medicines are largely prescribed. In Italy, generic drugs prescription rate is lower. General Practitioners and Family Pediatricians may be less confident in prescribing generic equivalents instead of "branded" medicines. There are currently no data about Italian Family Pediatricians' perceptions and patterns of use of generic drugs. This is a first nationwide web survey conducted with the aim to evaluate generic medicines knowledge and prescribing habits of Italian Family Pediatricians. 303 Family Pediatricians completed the online questionnaire. 37.2% and 32.6% of them declared to have a sufficient or fairly good knowledge of generic medicines, respectively, and the majority of them believed that efficacy of generic medicines was sufficient (33.6%) or good (45.2%). Nevertheless, Italian Family Pediatricians are still prone to prescribe trade medicines more frequently, since only 13.5% of them declared that more than a half of their patients were treated with generic medicines. Major issues related with generic medicines prescriptions by Italian Family Pediatricians seem to be represented by diffuse scepticism about reliability of bioequivalence tests and safety of switchability from branded to generic equivalents. More information about generic drugs and more research in the field of pediatric pharmacology are needed for increasing generic medicines prescription rate among Italian Family Pediatricians.
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Affiliation(s)
- Valentina Fabiano
- Department of Pediatrics, Università degli Studi di Milano, Luigi Sacco Hospital, via GB Grassi 74, Milan, Italy.
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Bulsara C, McKenzie A, Sanfilippo F, Holman CDJ, Emery JE. 'Not the full Monty': a qualitative study of seniors' perceptions of generic medicines in Western Australia. Aust J Prim Health 2010; 16:240-5. [PMID: 20815994 DOI: 10.1071/py10006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The study explored consumers' perspectives on generic medicine use in Australia. A qualitative methodology was used to explore the topic, including community participation in the form of forums, focus groups and a panel of seniors. Three consumer forums were held from which a seniors' panel was formed and a series of focus groups were conducted. Participants demonstrated considerable mistrust of generic medicines. Participants highlighted their uncertainty about the extent of pharmaceutical companies' influence on health professionals, the mistrust of foreign generic manufacturers and scepticism in their equivalence. In addition, the substitution of generic medicines and variability in packaging added to the overall concern and reported poor compliance. Altering consumers' beliefs and attitudes about generic medicines might require a more concerted effort to reduce consumer mistrust. Consumers' beliefs about generic medicines will strongly affect attempts to increase generic prescribing in Australia. Many seniors require multiple medications for a range of chronic conditions. Currently however, the lack of uniformity in information and packaging implies that closer monitoring, greater clarity of information and improved packaging of generic medicines is required. Otherwise, the widespread problems and lower uptake of generic medicines amongst seniors will remain.
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Affiliation(s)
- Caroline Bulsara
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Claremont, WA 6010, Australia.
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Gill L, Helkkula A, Cobelli N, White L. How do customers and pharmacists experience generic substitution? INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2010. [DOI: 10.1108/17506121011095218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ortiz M, Simons LA, Calcino G. Generic substitution of commonly used medications: Australia-wide experience, 2007-2008. Med J Aust 2010; 192:370-3. [PMID: 20367581 DOI: 10.5694/j.1326-5377.2010.tb03556.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 10/19/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the extent of brand substitution and switching in three commonly used classes of drugs available on the Pharmaceutical Benefits Scheme (PBS). DESIGN, SETTING AND PARTICIPANTS Assessment of PBS claim records for a 1-year period from 1 August 2007 to 31 July 2008 for long-term concession cardholders drawn from a 10% random sample of the Australian population. The target drug classes were: statins (pravastatin, simvastatin), calcium channel blockers (CCBs) (amlodipine, felodipine, nifedipine), and selective serotonin reuptake inhibitor (SSRI) antidepressants (fluoxetine, fluvoxamine, paroxetine, sertraline). MAIN OUTCOME MEASURES Proportion of patients who were non-switchers (single brand only) and multiple switchers (two or more brand switches). RESULTS We retrieved information relating to 935 334 prescriptions for 122 000 patients. Of those patients filling at least four prescriptions for a product, 41 174 patients received statins, 27 230 received CCBs and 21 342 received SSRIs. More than half the patients received only one brand during the study period: 57% for statins, 60% for CCBs, and 63% for SSRIs. Multiple switching was recorded for 24% of patients with statins, 19% with CCBs, and 21% with SSRIs, with smaller proportions receiving three or more brands: 14% for statins, 10% for CCBs, and 12% for SSRIs. Multiple switching was more common among younger patients for all drug classes (28% for those aged < 50 years v 18% for those aged >/= 80 years). CONCLUSION Generic substitution with multiple switches is occurring in a small proportion of patients being treated with statins, CCBs or SSRIs. The potential for patient confusion appears to be relatively small, but this may change with recent incentives included in pharmacy reimbursement arrangements.
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Abstract
Most countries are facing escalating health-care expenditures. A recent trend to control these staggering increases in costs is to encourage the use of generic medicines. Physicians are at the centerpiece of the medication use process as they are the dominant prescribers in all clinical settings. It is therefore prudent to examine what they perceive about generic medicines. The current study attempts to identify and review the literature on physicians' perceptions and practices on the use of generic medicines. Using subject-related keywords, an extensive literature search was undertaken through indexing services available in the authors' institution's library. Full text papers written in English language between 1980 and 2008 were retrieved and reviewed. Fourteen studies, majority ( n = 5) from the United States were reviewed and included. Most of the studies used quantitative methodology. Generally, physicians were neutral to slightly supportive on the use of generic medications. Most of the studies reviewed highlighted the factors that can influence physicians' views as policy-related issues, patient-related variables, drug characteristics and physician-related variables. Although physicians accept generic substitution under policy and economic pressures, they still have concerns about the overall quality and reliability of generic drugs as well as generic interchange of certain drug categories.
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Chua GN, Hassali MA, Shafie AA, Awaisu A. A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia. Health Policy 2009; 95:229-35. [PMID: 20044165 DOI: 10.1016/j.healthpol.2009.11.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 11/19/2009] [Accepted: 11/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the general practitioners' (GPs') knowledge and perceptions towards generic medicines in a northern state of Malaysia. METHOD A postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%). RESULTS The majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of "bioequivalence", "efficacy", "safety", and "manufacturing standards" of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine. CONCLUSION Although it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia.
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Affiliation(s)
- Gin Nie Chua
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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Tsiantou V, Zavras D, Kousoulakou H, Geitona M, Kyriopoulos J. Generic medicines: Greek physicians' perceptions and prescribing practices. J Clin Pharm Ther 2009; 34:547-54. [PMID: 19744010 DOI: 10.1111/j.1365-2710.2009.01037.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The penetration of generic drugs in the Greek pharmaceutical market is placed among the weakest in the EU. The Greek regulatory framework does not systematically support the development of this subsector and physicians are not provided with incentives for prescribing generics. The aim of this study was to investigate the prescribing profile of physicians in Greece with a focus on the factors that influence their decision on generics prescribing. METHODS A structured questionnaire was sent by mail to a random national sample of 1463 physicians, stratified by sex, specialty and geographical region. RESULTS AND DISCUSSION The response rate was 82.3%. Greek physicians have a positive view on generics but they prefer to prescribe the original products. According to our analysis, physician's age and their opinion on generics' efficacy and effectiveness are identified as important determinants of their prescribing decision. The primary reason that could make them change their prescribing habits is the appearance of side-effects. Patients' insurance coverage and income, as well as the drug cost are also referred as factors that influence their prescribing decision. Despite the fact that they do not usually prescribe generics in their clinical practice, they are willing to substitute an original drug by a generic product. CONCLUSIONS Our findings suggest that Greek physicians could be persuaded to prescribe generic medicines, if a generic promotion policy was introduced in the country. To develop such a policy, a set of supply side and demand-side measures should be implemented along with provision of information on generics to physicians during their education and clinical practice.
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Affiliation(s)
- V Tsiantou
- Department of Health Economics, National School of Public Health, Athens, Greece.
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Kalisch LM, Roughead EE, Gilbert AL. Pharmaceutical brand substitution in Australia - are there multiple switches per prescription? Aust N Z J Public Health 2007; 31:348-52. [PMID: 17725015 DOI: 10.1111/j.1753-6405.2007.00085.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In Australia, brand substitution by pharmacists has been possible since 1994. There is no limit to the number of substitutions per prescription. Doctors have expressed concern that patients may receive a different product each time their prescription repeats are dispensed, which has the potential to confuse patients. It is unknown how often multiple substitutions per prescription occur. OBJECTIVES We aimed to identify the number of switches per prescription for a range of medicines and to determine the number of different brand and generic products supplied on each prescription. METHODS Repatriation Pharmaceutical Benefits Scheme prescription claims between 1 January 2001 and 28 February 2006 were identified for atenolol, citalopram, enalapril, metformin, omeprazole, ramipril, and simvastatin. Original prescriptions with five repeats and all supplies dispensed were included. Switches were identified if a different product was supplied on consecutive repeat dispensings. RESULTS 533,279 original prescriptions were included. 488,735 (92%) had no switches on repeats and 37,513 (7%) had only one switch. Only 1% of all prescriptions had more than one switch identified on repeats, and in most cases only two different products were supplied. None of the prescriptions had a different product supplied on each dispensing. CONCLUSION AND IMPLICATIONS Multiple switches per prescription are uncommon and multiple different products are rarely supplied on repeats of the same prescription. The rules of the brand substitution policy appear to be adequate in allowing brand choice for patients, without leading to multiple switches per prescription.
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Affiliation(s)
- Lisa M Kalisch
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia.
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