What do pri mary care pa tients think about ge neric drugs? Ab stract. Ob jec tive: To ex am ine the at titude of pa tients to wards ge neric drugs and pre scriptions con tain ing ge neric drugs as an al ter na tive to brand-name prod ucts, with a spe cial fo cus on in for ma tion on pa tients at titude to ge neric drugs pro vided by their general prac ti tio ners (GPs). Meth ods: A to tal of 804 pa tients in 31 gen eral prac tices were surveyed us ing a self-ques tion naire. The in fluence of age, sex, ed u ca tion, dis ease, knowledge of ge neric drugs, ex pe ri ence with generic sub sti tu tion and in for ma tion pro vided by the GP on pa tient at ti tudes to wards ge neric drugs and sub sti tu tions were ex am ined. Results: Nearly two thirds of the pa tients (509/804) stated that they knew of the dif ference be tween brand-name drugs and generics; of these, one third were not sat is fied with the in for ma tion given by their GPs and 37% of pa tients ex pressed gen eral skep ti cism to wards ge neric drugs be cause of their lower price. This at ti tude was more fre quent among those who felt that ge neric pre scrib ing was "in vented" to solve the fi nan cial cri sis in the Ger man health in sur ance sys tem at their expense (odds ra tio (OR): 6.2; 95% con fi dence in ter val: 4.0-9.8) and those who had not been con fronted per son ally with a ge neric sub sti tu tion (OR: 1.8; 1.3-3.0). Pa tients who had been skep ti cal when first con fronted with a ge neric sub sti tu tion were more fre quently among those who con sid ered in ex pen sive drugs to be in fe rior (OR: 4.5; 2.0-10.4) and they were fre quently not sat is fied with the infor ma tion on sub sti tu tion pro vided by their GP (OR: 2.7; 1.2-5.9). Con clu sion: GPs are in an ideal po si tion to in form their pa tients ade quately about the equiv a lence of brandname and ge neric drugs. How ever, the pa tient view that in ex pen sive drugs must be in fe rior may be dif fi cult to rec tify in the short term. Key words ge neric drugs-prescriptions-cost-ef fec tive ness-in for ma tion on drug ther apy-fam ily prac tice Re ceived De cem ber 8, 2004; ac cepted

Although most GPs are aware of osteoporosis as an important health problem and felt competent in the management of this disease, only half of the respondents knew and used the national guideline. This may explain deficits in diagnosis and therapy of osteoporosis in Germany. Since guideline knowledge and frequency of consultations for osteoporosis strongly correlate, proper dissemination of the guideline may further enhance awareness of, and evidence-based treatment for, osteoporosis.

OBJECTIVE:Looking to the experience in the United States with managed care and the possible introduction of gatekeeping in the near future in Germany, we performed a population-based survey to examine preferences for future gatekeeping arrangements. DESIGN:Cross-sectional telephone survey. SETTING:Four health districts in Thuringia (formerly East Germany) and Lower Saxony (formerly West Germany). PARTICIPANTS:Out of a random sample of 644 adults in the 4 districts, 415 persons (64.4%) took part in the survey. MEASUREMENTS AND MAIN RESULTS:

This study compares the role of community gynecologists and family physicians, seen from the patients' perspective. A sample of 126 female patients in family practices and 212 patients in gynecological practices were surveyed about their preferences and expectations of whether their doctor should address personal, family and sexual problems. The effects of covariates (such as the type of doctor, patient age, family status, child desire) on patient expectations were simultaneously assessed by multiple logistic regression. Between 40% and 70% of the patients contacted confirmed the family-oriented approach, both in family practices and gynecological practices. Family practice patients more frequently stressed their doctor's knowledge of personal and family aspects (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.1-2.7); whereas communication about sexual problems and a possible desire to have a child was more often considered as the gynecologist's domain (OR = 2.8 [95% CI = 1.8-4.4] and OR = 1.8 [95% CI = 1.1-2.8], respectively). Female patients older than 30 years were more often interested in communication on family related affairs (OR = 2.2, 95% CI = 1.4-3.4). These data illustrate that many patients would like both their community gynecologist and their family physician to take notice of their personal and family life conditions, including sexual problems and to initiate communication about these subjects.

The BDT interface offers an opportunity to export computerised patient records without the requirement of additional documentation. If routine data are more readily available for health services research, a standardised data structure and open access must be assured e. g. by centralised certification via the Federal statutory health organisation.