Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India

Abstract

IntroductionGeneric medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines.MethodsThe study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system.ResultsThe generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients’ and health workers’ perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system.ConclusionNegative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.

Knowledge, attitude and practices regarding generic medicines and its usage: a community-based study

“…9 Though the common perception seems to be that Generic Medicines are of poor quality, studies have shown Generic Medicines to have the same composition and quality as branded medications. [10][11][12][13] Despite this, usage of Generic medication has not become a communally acceptable practice in India. Some determining factors could be poor awareness among the general population, non-availability of drugs, distrust about the quality of the medicine and doctors not recommending generic medicines.…”

Health systems research on access to medicines: unpacking challenges in implementing policies in the face of the epidemiological transition

“…As a consequence, patients depend on expensive and episodic care in the largely unregulated private sector, repeating a situation familiar to district-level health systems in many LMICs. This is accompanied by another paper by Aivalli et al 12 based on the same research project in Tumkur, Karnataka. While Elias et al 11 focus on the supply-side and district preparedness for chronic care, the latter paper by Aivalli et al 12 explores the demand-side determinants and finds a general distrust in generic medicines dispensed in public health facilities.…”

“…This is accompanied by another paper by Aivalli et al 12 based on the same research project in Tumkur, Karnataka. While Elias et al 11 focus on the supply-side and district preparedness for chronic care, the latter paper by Aivalli et al 12 explores the demand-side determinants and finds a general distrust in generic medicines dispensed in public health facilities. It delves deeper into the potential role of private interests in mediating this distrust and finds that, on account of this role, strategies solely focused on improving public supply of services will not be sufficient.…”

Improving Access to Medicines for Non-Communicable Diseases in Rural Primary Care: Results from a Cluster Randomised Trial in a District in South India

“…In this paper, we present results only from the quantitative part of the study. Results from qualitative part has been published elsewhere (27,32).…”

“…Generic and branded medicines were sampled from both government and private facilities across the study talukas. While the details of such medicines sampling and medicine quality tests could be accessed from study protocol paper (30), results of the quality tests are published elsewhere (32).…”