Norwegian patients on generic antihypertensive drugs: a qualitative study of their own experiences

Abstract

ObjectivesThe aim of this study was to investigate experiences with and attitudes toward generic substitution in patients on antihypertensive medication.Materials and methodsStudy participants were 22 patients from pharmacies in Oslo who had taken brand antihypertensive products as well as substituted generic products. Five focus- group discussions were held.ResultsOnly a few participants claimed to take their medications as prescribed. Most reported low drug adherence before and after generic substitution. Fourteen said that their blood pressure was not under control. Most patients did not know what it meant to get a generic product. They normally accepted what the pharmacy offered, even if they thought the generics were of a lower quality than the brand products. Five participants experienced new side effects. Differences in name, color, form, or taste caused confusion. The patients had been told in the pharmacy that the effect of a generic product was as good as that of the brand product but were still confused, as in most cases the doctor said nothing to them about the substitution.ConclusionGeneric substitution works well in Norway as an economic health strategy, but drug adherence remains suboptimal under those circumstances. Patients are insecure with respect to the difference between the old and the new product when it comes to the drug’s physical attributes and perceived quality. Patients would feel safer if the doctor had a more active role in informing them about the system.

Patient knowledge, perceptions, and acceptance of generic medicines: a comprehensive review of the current literature

“…A number of studies conducted across several countries, including Japan, New Zealand, Bulgaria, Iraq, Malaysia, and Norway, explored medicine consumers' understanding of the differences between generic medicines and brand medicines, and many reported a lack of knowledge among a high proportion of participants. 34,36,38,39,41,61,62 For example, in Japan, only 71.1% stated that generic medicines and brand medicines have the same active ingredients. The majority (53.7%) of patients had no idea whether the inactive ingredients are the same or not, while 12.5% wrongly believed they are the same.…”

“…39 In Norway, most of the respondents were not aware what a generic medicine is and how it differs from the brand medicine, with only a few participants being aware that it is the same medicine (ie, the same active ingredient but possibly different excipients). 61 In Bulgaria, most participants were either in the "do not know" (46%) or "not sure" (43%) category when asked about the difference between brand and generic medicines. Further, nearly 75% of patients with chronic disease do not have enough information about the difference between generic and original medicines.…”

“…Therefore, in this study, patients hoped that physicians would play a more active role in telling them about generic medicines and generic substitution. 61 Lebanova et al 62 conducted a study in Bulgaria to evaluate patients' attitudes and knowledge of generic medicines. In this study, only 11% reported that they knew the difference between generic brand name medicines, while 46% did not know and 43% were not sure about the differences.…”

“…Toverud et al 61 conducted a qualitative study in Oslo, Norway, to evaluate the attitudes and experiences of generic substitution in patients with hypertension. The study included 22 hypertensive patients who had experienced of using brand medicines and switching at least once to a generic version.…”

Perception of the value of generic drugs in São Paulo, Brazil

“…Another study by Hakonsen et al 23 with 174 outpatients in Oslo and Bergen in Norway revealed that 29% of patients were anxious when they started to use a substitute generic drug; 8% felt that the drug effect changed, and 15% reported having new or more side effects from the substitute. In pharmacies in Oslo, some of 22 patients who had already made use of antihypertensive generic and brand name drugs mentioned experiencing more side effects and weaker effects upon drug substitution 24 . In two studies conducted in Southern Brazil (2002 and 2011), it was observed that 70% of 3,182 respondents and 64.3% of 374 respondents considered the quality of generic drug products to be similar to brand name drug 16,25 .…”