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Associations between generic substitution and patients' attitudes, beliefs and experiences

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

Abstract

Background

Generic substitution has been implemented in many countries, but knowledge about patients’ attitudes, beliefs and experiences is still sparse.

Aim

To assess associations between generic switching and patients’ attitudes, beliefs and experiences with previous generic switching.

Design and setting

A cross-sectional study comprising questionnaire responses from 2,476 randomly selected patients aged 20 years or older and living in the Region of Southern Denmark, who had redeemed substitutable drugs.

Methods

The questionnaire included items on beliefs about medicine, views on generic medicine and confidence in the healthcare system. Only prescriptions issued by the general practitioners were included. For each patient, we focused on one purchase of a generically substitutable drug (index drug). Patients were identified by means of a dispensing database.

Results

Earlier generic switches within the index ATC code were statistically significantly associated with experience of a generic switch (adjusted OR 5.93; 95 % CI 4.70–7.49). Having had more than five earlier switches within other ATC codes and having negative views on generic medicines reduced the odds of experiencing a generic switch. No associations were found between generic substitution and gender, drug group, number of different drugs used by the patient, confidence in the health care system and beliefs about medicine in general.

Conclusion

Patients who had once experienced a generic switch were more likely to accept a future generic switch within the same ATC code. Negative views on generic medicines were negatively associated with switching, while beliefs about medicine and confidence in the healthcare system had no influence.

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References

  1. WHO Generic Drugs. 18-2-2013. Available from: URL: http://www.who.int/trade/glossary/story034/en/index.html

  2. Strom O, Landfeldt E (2012) The association between automatic generic substitution and treatment persistence with oral bisphosphonates. Osteoporos Int 23(8):2201–2209

    Article  PubMed  CAS  Google Scholar 

  3. Danish Health and Medicine Authority (Lægemiddelstyrelsen), Substitution. 21-6-0011. Available from: URL: http://laegemiddelstyrelsen.dk/en/topics/statistics,-prices-and-reimbursement/substitution

  4. Danish Health and Medicines Authority: (Lægemiddelstyrelsen). Report from 22. November 2006 Generic prescription - advantage and disadvantage (Generisk substitution - fordele og ulemper), Rapport fra lægemiddelstyrelsen. 22-11-2006. Available from: URL: http://medicaldevices.dk/∼/media/19C8A12E9E6640A39004E4E0C98F7C7B.ashx

  5. Kesselheim AS, Misono AS, Lee JL, Stedman MR, Brookhart MA, Choudhry NK, Shrank WH (2008) Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA 300(21):2514–2526

    Article  PubMed  CAS  Google Scholar 

  6. Van Wijk BL, Klungel OH, Heerdink ER, de Boer A (2006) Generic substitution of antihypertensive drugs: does it affect adherence? Ann Pharmacother 40(1):15–20

    Article  PubMed  Google Scholar 

  7. Kesselheim AS, Misono AS, Shrank WH, Greene JA, Doherty M, Avorn J, Choudhry NK (2013) Variations in Pill Appearance of Antiepileptic Drugs and the Risk of Nonadherence. JAMA Intern Med 173(3):202–208

    Article  PubMed  Google Scholar 

  8. Meredith PA (2009) Potential concerns about generic substitution: bioequivalence versus therapeutic equivalence of different amlodipine salt forms. Curr Med Res Opin 25(9):2179–2189

    Article  PubMed  CAS  Google Scholar 

  9. Kjonniksen I, Lindbaek M, Granas AG (2005) Patients' experiences with and attitudes to generic substitution. Tidsskr Nor Laegeforen 125(12):1682–1684

    PubMed  Google Scholar 

  10. Heikkila R, Mantyselka P, Ahonen R (2011) Do people regard cheaper medicines effective? Population survey on public opinion of generic substitution in Finland. Pharmacoepidemiol Drug Saf 20(2):185–191

    Article  PubMed  Google Scholar 

  11. Figueiras MJ, Marcelino D, Cortes MA (2008) People's views on the level of agreement of generic medicines for different illnesses. Pharm World Sci 30(5):590–594

    Article  PubMed  Google Scholar 

  12. Ganther JM, Kreling DH (2000) Consumer perceptions of risk and required cost savings for generic prescription drugs. J Am Pharm Assoc (Wash) 40(3):378–383

    CAS  Google Scholar 

  13. Banahan BF III, Kolassa EM (1997) A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med 157(18):2080–2088

    Article  PubMed  Google Scholar 

  14. Heikkila R, Mantyselka P, Hartikainen-Herranen K, Ahonen R (2007) Customers' and physicians' opinions of and experiences with generic substitution during the first year in Finland. Health Policy 82(3):366–374

    Article  PubMed  Google Scholar 

  15. Hakonsen H, Eilertsen M, Borge H, Toverud EL (2009) Generic substitution: additional challenge for adherence in hypertensive patients? Curr Med Res Opin 25(10):2515–2521

    Article  PubMed  Google Scholar 

  16. Himmel W, Simmenroth-Nayda A, Niebling W, Ledig T, Jansen RD, Kochen MM, Gleiter CH, Hummers-Pradier E (2005) What do primary care patients think about generic drugs? Int J Clin Pharmacol Ther 43(10):472–479

    Article  PubMed  CAS  Google Scholar 

  17. Shrank WH, Cadarette SM, Cox E, Fischer MA, Mehta J, Brookhart AM, Avorn J, Choudhry NK (2009) Is there a relationship between patient beliefs or communication about generic drugs and medication utilization? Med Care 47(3):319–325

    Article  PubMed  Google Scholar 

  18. 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(2):139–148

    Article  PubMed  Google Scholar 

  19. Generic substitution, Influence on medicine users' concerns and compliance (generisk substitution, Indflydelse på medicinbrugernes tryghed og komplians). 6-6-2012. Available from: URL: http://www.ft.dk/samling/20081/almdel/suu/bilag/704/738838.pdf

  20. Guidelines for ATC classification and DDD assignment 12'th edition (2009) 978-82-8082-288-8.

  21. Moller PK (2003) Pricing and reimbursement of drugs in Denmark. Eur J Health Econ 4(1):60–65

    Article  Google Scholar 

  22. Frank L (2000) Epidemiology. When an entire country is a cohort. Science 287(5462):2398–2399

    Article  PubMed  CAS  Google Scholar 

  23. Statistics Denmark. StatBank Denmark. 13-8-2012. Available from: URL: www.statbank.dk

  24. Medcom - Danish Health Data network (det danske sundhedsdatanet) www.medcom.dk. (2012)

  25. Dylst P, Vulto A, Simoens S (2013) Demand-side policies to encourage the use of generic medicines: an overview. Expert Rev Pharmacoecon Outcomes Res 13(1):59–72

    Article  PubMed  Google Scholar 

  26. Gaist D, Sorensen HT, Hallas J (1997) The Danish prescription registries. Dan Med Bull 44(4):445–448

    PubMed  CAS  Google Scholar 

  27. Horne R, Weinman J, Hankins M (1999) The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychology&Health 14(1):1–24

    Google Scholar 

  28. Horne R (2000) Assessing perceptions of medication: psychological perspectives In Handbook of Drug Research Methodology Publ UK Drug Utilization Research Group. 0953701107.

  29. Saks EK, Wiebe DJ, Cory LA, Sammel MD, Arya LA (2012) Beliefs about medications as a predictor of treatment adherence in women with urinary incontinence. J Womens Health (Larchmt) 21(4):440–446

    Article  Google Scholar 

  30. Heikkila R, Mantyselka P, Ahonen R (2011) Price, familiarity, and availability determine the choice of drug - a population-based survey 5 years after generic substitution was introduced in Finland. BMC Clin Pharmacol 11:20

    Article  PubMed  Google Scholar 

  31. Berg MJ, Gross RA, Haskins LS, Zingaro WM, Tomaszewski KJ (2008) Generic substitution in the treatment of epilepsy: patient and physician perceptions. Epilepsy Behav 13(4):693–699

    Article  PubMed  Google Scholar 

  32. Kjoenniksen I, Lindbaek M, Granas AG (2006) Patients' attitudes towards and experiences of generic drug substitution in Norway. Pharm World Sci 28(5):284–289

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank pharmacist Annette Foged and master in European Ethnology Karen Elberg, Ph.D. for their expertise and hard work with the report “Generic substitution—concerns and compliance”. We would also like to thank administrator Lise Stark for proofreading the manuscript.

Funding body

The Region of Southern Denmark Research Fund (Ph.D.) (j.nr: 11/28042).

The Region of Southern Denmark Research Fund (j.nr: 12/21277)

The Danish Ministry of Health.

Ethical approval

According to the Act on Biomedical Research Ethics Committee System the project was not a biomedical research project, and therefore did not need the Research Ethics Committee’s approval. The anonymity of patients was strictly preserved throughout the data entry and analysis process. The study was approved by the Danish Data Protection Agency (journal number 2008-41-2364)

Competing interests

The authors declare that they have no conflict of interests.

Author information

Authors and Affiliations

  1. Institute of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark

    Jette Rathe, Pia Larsen, Morten Andersen & Maja Paulsen

  2. Institute of Public Health, Research Unit of General Practice Odense, University of Southern Denmark, Odense, Denmark

    Dorte Jarbøl

  3. Institute of Public Health, Denmark, Research Unit of General Practice, University of Southern, Odense, Denmark

    Janus Thomsen & Jens Soendergaard

Authors
  1. Jette Rathe
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  2. Pia Larsen
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  3. Morten Andersen
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  4. Maja Paulsen
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  6. Janus Thomsen
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  7. Jens Soendergaard
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Corresponding author

Correspondence to Jette Rathe.

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Rathe, J., Larsen, P., Andersen, M. et al. Associations between generic substitution and patients' attitudes, beliefs and experiences. Eur J Clin Pharmacol 69, 1827–1836 (2013). https://doi.org/10.1007/s00228-013-1539-z

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  • DOI: https://doi.org/10.1007/s00228-013-1539-z

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