Skip to main content

Advertisement

SpringerLink
Log in

INN or brand name drug prescriptions: a multilevel, cross-sectional study in general practice

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The prescription in International Nonproprietary Names (INN) is a legal obligation for all physicians in France since January 2015. The objective of this study was to analyze the frequency and main factors of INN drug prescribing in general practice.

Methods

Multicenter cross-sectional study conducted with 11 interns acting as observers of 23 GP trainers between November 2015 and January 2016. Two evaluators analyzed all GPs’ drug prescriptions to identify INN or brand name prescriptions.

Results

The database included 4957 drugs prescribed during 1647 visits. Of these, 1462 (29.5% [95% CI 28.2–30.8%]) were prescribed only in INN. According to the multivariate analyses, the factors favoring INN prescribing were as follows: at the drug level, its initial prescribing (OR = 1.4), a nonspecific prescribing objective (OR = 1.6), its listing in the generic drug index with (OR = 7.7) or without (OR = 2.9) efficiency objective included in the payment for public health objectives (PPHO) program, and the oral route of administration (OR from 0.4 for the percutaneous route to 0.2 for the pulmonary route); at the patient level, the male gender (OR = 1.3), the age of 15 years or more (OR = 1.9), and the absence of a long-term condition (OR = 1.3); at the physician level, the reception of a public healthcare insurance representative (OR = 4.1), the nonreception of pharmaceutical sales representatives (OR = 3.0), and the urban practice environment (OR = 2.8).

Conclusions

In 2015, less than one third of drugs were prescribed in INN only in general practice. The use of various incentives and regulatory measures is likely to favor the prescription of INNs by practitioners.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization (2017) Guidance on the use of international nonproprietary names (INNs) for pharmaceutical substances. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwjXxPP1ofrdAhUDZVAKHdQKDaQQFjAAegQICRAC&url=http%3A%2F%2Fwww.who.int%2Fmedicines%2Fservices%2Finn%2FFINAL_WHO_PHARM_S_NOM_1570_web.pdf&usg=AOvVaw3fFsY4eRnn6HwUj1upTolN. Accessed 21 Jun 2018

  2. Aronson JK (2004) Medication errors resulting from the confusion of drug names. Expert Opin Drug Saf 3:167–172. https://doi.org/10.1517/14740338.3.3.167

    Article  PubMed  Google Scholar 

  3. No author (2006) Think INN, prescribe INN, dispense INN. ISDB Newsletter 20:5–10

  4. Godman B, Bishop I, Finlayson AE, Campbell S, Kwon HY, Bennie M (2013) Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries. Expert Rev Pharmacoecon Outcomes Res 13:469–482. https://doi.org/10.1586/14737167.2013.820956

    Article  PubMed  Google Scholar 

  5. OECD (2010) Value for money in health spending (table 6.1). OECD health policy studies. https://read.oecd-ilibrary.org/social-issues-migration-health/value-for-money-in-health-spending_9789264088818-en#page176. Accessed 21 Jun 2018

  6. Pontén J, Rönnholm G, Skiöld P (2017) PPRI pharma profile, Sweden 2017 (page 46)7. WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwi6ju7QpfrdAhXLJVAKHeVNA6EQFjAAegQICRAC&url=http%3A%2F%2Fwhocc.goeg.at%2FLiteraturliste%2FDokumente%2FCountryInformationReports%2FPPRI_Pharma_Profile_Sweden_2017.pdf&usg=AOvVaw25A53fGDSn7HyUFSq30xZZ. Accessed 21 Jun 2018

  7. Mutualité Française (2011) La Dénomination commune internationale (p7). http://solidarites-sante.gouv.fr/IMG/pdf/La_denomination_commune_internationale_-_Mutualite_francaise.pdf. Accessed 21 Jun 2018

  8. Dunne S, Shannon B, Dunne D, Cullen W (2013) 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 14:1. https://doi.org/10.1186/2050-6511-14-1

  9. Décret n° 2014–1359 du 14 novembre 2014 relatif à l’obligation de certification des logiciels d’aide à la prescription médicale et des logiciels d’aide à la dispensation prévue à l’article L. 161–38 du code de la sécurité sociale. JORF 0264:19255. https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000029761800&categorieLien=id. Accessed 21 Jun 2018

  10. Ministère des affaires sociales de la santé et des droits des femmes (2015) Plan national d’action de promotion des médicaments génériques (p24). http://solidarites-sante.gouv.fr/IMG/pdf/Plan_national_medicaments_generiques_24mars2015.pdf. Accessed 21 Jun 2018

  11. No author (2006) INN use: proposals for improvement. ISDN Newsletter 20:11

    Google Scholar 

  12. HAS (2014) Précisions concernant la certification des Logiciels d’Aide à la Prescription de la HAS. https://www.has-sante.fr/portail/upload/docs/application/pdf/2008-06/precisions_certification_des_lap200608.pdf. Accessed 21 Jun 2018

  13. Simoens S, De Coster S (2006) Sustaining generic medicines markets in Europe. J Generic Med 3:257–268. https://doi.org/10.1057/palgrave.jgm.4940128

    Article  Google Scholar 

  14. Bernard L, Gueyffier F, Letrilliart L (2018) Drug prescription goals in primary care: a cross-sectional study (submitted)

  15. WHO (2003) International Classification of Primary Care, Second edition (ICPC-2). http://www.who.int/classifications/icd/adaptations/icpc2/en/. Accessed 21 Jun 2018

  16. Agence nationale de sécurité du médicament et des produits de santé (2016) Répertoire des médicaments génériques. https://ansm.sante.fr/var/ansm_site/storage/original/application/7ef02426c3ced1d9cfbb57e0b10971bc.pdf. Accessed 21 Jun 2018

  17. CNAMTS (2015) Note méthodologique du dispositif de rémunération sur objectifs de santé publique des médecins traitants. Les indicateurs portant sur la qualité de la pratique médicale (Table p14). https://www.ameli.fr/sites/default/files/Documents/5088/document/indicateurs-qualite-medecins_assurance-maladie.pdf. Accessed 21 Jun 2018

  18. Insee (2003) Professions et catégories socioprofessionnelles (PCS). https://www.insee.fr/fr/metadonnees/pcs2003/categorieSocioprofessionnelleAgregee/1?champRecherche=true. Accessed 21 Jun 2018

  19. Prometheus. http://promethe.org/. Accessed 21 Jun 2018

  20. Centre national hospitalier d’information sur le médicament. Banque de donnée sur les médicaments Thériaque. http://www.theriaque.org/apps/contenu/accueil.php. Accessed 21 Jun 2018

  21. World Health Organization (2011) Anatomical Therapeutic Chemical (ATC) classification system. https://www.whocc.no/atc/structure_and_principles/. Accessed 21 Jun 2018

  22. The comprehensive R archive network. R software version 3.1.0. https://pbil.univ-lyon1.fr/CRAN/. Accessed 21 Jun 2018

  23. Mutualité Française (2010) Point de repère: Prescription en DCI Eté 2010. http://solidarites-sante.gouv.fr/IMG/pdf/Mutualite_francaise_prescriptions_en_DCI.pdf. Accessed 21 Jun 2018

  24. UFC Que Choisir (2016) Enquête sur la prescription en DCI Un déni caractérisé de l’intérêt des patients. https://www.quechoisir.org/action-ufc-que-choisir-enquete-sur-la-prescription-en-dci-un-deni-caracterise-de-l-interet-des-patients-n11881/. Accessed 21 Jun 2018

  25. Health & Social Care Information Center (2013) Prescriptions dispensed in the community. Statistics for England, 2002-2012 (Table A5, p80). NHS Digit https://files.digital.nhs.uk/publicationimport/pub11xxx/pub11291/pres-disp-com-eng-2002-12-rep.pdf. Accessed 21 Jun 2018

  26. Davis JS, Barrett T, Harris L (2017) Knowledge of proprietary and generic drug names among hospital prescribers: time to mandate generic prescribing? Intern Med J 47:959–962. https://doi.org/10.1111/imj.13506

    Article  PubMed  Google Scholar 

  27. Boissel A, Fagnoni P, Guignard MH, Lazzarotti A, De Messières S, Sgro C (2014) Evaluation of the good prescribing practices at discharge in a University Hospital: what stakes for non-substitutable chronic treatment? Pharm Hosp Clin 49:95–101. https://doi.org/10.1016/j.phclin.2013.07.017

    Article  Google Scholar 

  28. Montastruc F, Moulis G, Palmaro A, Gardette V, Durrieu G, Montastruc JL (2014) Interactions between medical residents and drug companies: a national survey after the mediator® affair. PLoS One 9:e104828. https://doi.org/10.1371/journal.pone.0104828

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Darroch C, Kay AG (2008) Current and future trends in the use of generic medicines in the UK. Pharm J 281:507

    Google Scholar 

  30. Chhina HK, Bhole VM, Goldsmith C, Hall W, Kaczorowski J, Lacaille D (2013) Effectiveness of academic detailing to optimize medication prescribing behaviour of family physicians. J Pharm Pharm Sci 16:511–529. https://doi.org/10.18433/J3KK6C

    Article  PubMed  Google Scholar 

  31. Mastura I, Teng CL (2008) Effect of “group detailing” on drug prescribing in primary care. Med J Malaysia 63:315–318 https://doi-org.docelec.univ-lyon1.fr/10.1016/0895-4356(94)00221-B

    CAS  PubMed  Google Scholar 

  32. Reynaud C, Goffe D, Robert-Tissot C (2017) La rémunération sur objectifs de santé publique-Bilan à 5 ans et présentation du nouveau dispositif (Table p18). Assurance maladie. https://www.ameli.fr/fileadmin/user_upload/documents/DP_bilan_ROSP_2016_du_21_avril_def.pdf. Accessed 21 Jun 2018

  33. Fickweiler F, Fickweiler W, Urbach E (2017) Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open 7:e016408. https://doi.org/10.1136/bmjopen-2017-016408

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yeh JS, Franklin JM, Avorn J, Landon J, Kesselheim AS (2016) Association of industry payments to physicians with the prescribing of brand-name statins in Massachusetts. JAMA Intern Med 176:763–768. https://doi.org/10.1001/jamainternmed.2016.1709

    Article  PubMed  Google Scholar 

  35. McCarthy M (2016) Now there’s proof: docs who get company cash tend to prescribe more brand-name meds. ProPublica 352:i1645. https://doi.org/10.1136/bmj.i1645

    Article  Google Scholar 

  36. Van Bever E, Wirtz VJ, Azermai M, De Loof G, Christiaens T, Nicolas L, Van Bortel L, Vander Stichele R (2014) Operational rules for the implementation of INN prescribing. Int J Med Inf 83:47–56. https://doi.org/10.1016/j.ijmedinf.2013.09.004

    Article  Google Scholar 

  37. Stenner SP, Chen Q, Johnson KB (2010) Impact of generic substitution decision support on electronic prescribing behavior. JAMIA 17:681–688. https://doi.org/10.1136/jamia.2009.002568

    Article  PubMed  Google Scholar 

  38. Chong CP, March G, Clark A, Gilbert A, Hassali MA, Bahari MB (2011) A nationwide study on generic medicines substitution practices of Australian community pharmacists and patient acceptance. Health Policy 99:139–148. https://doi.org/10.1016/j.healthpol.2010.08.002

    Article  PubMed  Google Scholar 

  39. Qian J, Hansen RA, Surry D, Howard J, Kiptanui Z, Harris I (2017) Disclosure of industry payments to prescribers: industry payments might be a factor impacting generic drug prescribing. Pharmacoepidemiol Drug Saf 26:819–826. https://doi.org/10.1002/pds.4224

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kirchhoff AC, Hart G, Campbell EG (2014) Rural and urban primary care physician professional beliefs and quality improvement behaviors. J Rural Health 30:235–243. https://doi.org/10.1111/jrh.12067

    Article  PubMed  Google Scholar 

  41. Gopalakrishnan S, Ganeshkumar P, Katta A (2013) Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu. Indian J Pharmacol 45:252–257. https://doi.org/10.4103/0253-7613.111931

    Article  PubMed  PubMed Central  Google Scholar 

  42. Fabiano V, Mameli C, Cattaneo D, Delle Fave A, Preziosa A, Mele G, Clementi E, Zuccotti GV (2012) Perceptions and patterns of use of generic drugs among Italian family pediatricians: first round results of a web survey. Health Policy 104:247–252. https://doi.org/10.1016/j.healthpol.2011.12.005

    Article  PubMed  Google Scholar 

  43. El-chaar GM, Mardy G, Wehlou K, Rubin LG (1996) Randomized, double blind comparison of brand and generic antibiotic suspensions: II. A study of taste and compliance in children. Pediatr Infect Dis J 15:18–22. https://doi.org/10.1097/00006454-199601000-00004

    Article  CAS  PubMed  Google Scholar 

  44. Hedenrud T, Hjelmqvist H, Sundell KA (2014) Do people regard generic drugs as good as original brand-named drugs, and are there age or gender differences? Res Soc Adm Pharm 10:e19. https://doi.org/10.1016/j.sapharm.2014.07.054

    Article  Google Scholar 

  45. Heikkilä R, Mäntyselkä P, Ahonen R (2011) Do people regard cheaper medicines effective? Population survey on public opinion of generic substitution in Finland. Pharmacoepidemiol Drug Saf 20:185–191. https://doi.org/10.1002/pds.2084

    Article  PubMed  Google Scholar 

  46. Letrilliart L, Rigault-Fossier P, Fossier B, Kellou N, Paumier F, Bois C, Polazzi S, Schott AM, Zerbib Y (2016) Comparison of French training and non-training general practices: a cross-sectional study. BMC Med Educ 16:126. https://doi.org/10.1186/s12909-016-0649-6

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to thank Louis Bernard who supervised the data collection, and the interns who collected the data: Morgane Aillet, Sofien Amraoui, François Drogou, Florent Debruyne, Aurélie Fleurentin, Laura Laperriere, Thomas Lecocq, Lucile Moracchini, Allison Netboute, Arnaud Ponçon, and Manon Ubéra. We also thank their 23 GP trainers. We are indebted to Philippe Ameline, who developed the server for data entry and storage. We are grateful to Natane Reynaud for the English editing of the manuscript.

Author information

Author notes

  1. Florent De Bruyne and Arnaud Ponçon equally contributed to conducting the study and writing this article.

Authors and Affiliations

  1. Collège universitaire de médecine générale, Univ. Lyon, Université Claude Bernard Lyon 1, Université Saint-Etienne, F-42023, Saint-Etienne, France

    Florent De Bruyne, Arnaud Ponçon & Laurent Letrilliart

  2. Université Lyon 1, F-69622, Villeurbanne, France

    Joris Giai & Cyrille Colin

  3. Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR5558, F-69622, Villeurbanne, France

    Joris Giai

  4. Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France

    Joris Giai

  5. Département de Pharmacie, Hospices Civils de Lyon, Lyon, France

    Xavier Dode

  6. Département d’Enseignement et de Recherche en Médecine Générale, Université de Nice Sophia-Antipolis, Nice, France

    David Darmon

  7. UMR 912 Sesstim Inserm, Marseille, France

    David Darmon

  8. Health Services and Performance Research, HESPER EA 7425, Lyon Cedex 3, France

    Cyrille Colin & Laurent Letrilliart

  9. Pôle IMER des Hospices Civils de Lyon, Lyon, France

    Cyrille Colin

  10. Service de Pharmaco-Toxicologie, Hospices Civils de Lyon, 69000, Lyon, France

    François Gueyffier

  11. UMR 5558, CNRS & Université Claude Bernard Lyon 1, 69000, Lyon, France

    François Gueyffier

Authors
  1. Florent De Bruyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arnaud Ponçon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joris Giai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xavier Dode
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Darmon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cyrille Colin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. François Gueyffier
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Laurent Letrilliart
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LL conceived the study, and he designed it along with FB and AP. XD helped to use the Thériaque drug database. FB and AP managed the database, with the support of LL. JG performed the statistical analyses. XD, DD, CC, and FG contributed to the interpretation of the findings. FB, AP, and LL drafted the manuscript. All authors reviewed and approved the final version of the article.

Corresponding author

Correspondence to Laurent Letrilliart.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Hospices Civils de Lyon ethics committee has approved the OPREM study. A patient information poster was displayed in the offices of participating physicians. Data storage was covered by a statement made to the French Commission on Information Technology and Liberties (CNIL, No. 1549782).

Electronic supplementary material

ESM 1

(PDF 58.5 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Bruyne, F., Ponçon, A., Giai, J. et al. INN or brand name drug prescriptions: a multilevel, cross-sectional study in general practice. Eur J Clin Pharmacol 75, 275–283 (2019). https://doi.org/10.1007/s00228-018-2580-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-018-2580-8

Keywords

Search

Navigation