Swedish patients’ trust in the bioequivalence of interchangeable generics. What factors are important for low trust?

Abstract

Background:Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients’ trust in GS.Objective:To assess Swedish patients’ level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors.Methods:A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the ‘views on generic medicine’-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors.Results:A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents’ trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p<0.01), patients perceiving that changes in product name and appearance make adherence more complicated (aOR=2.18, 95%CI 1.48:3.19, p<0.001), disagreeing in that GS saves money for me (the customer) (aOR=2.68, 95%CI 1.58:4.55, p<0.001) or that GS saves money for society (aOR=3.21, 95%CI 1.46:7.08, p<0.01).Conclusions:Seven out of ten respondents had trust in the bioequivalence of generic medicines, and one in three considered GS to complicate adherence. Four factors were associated with lower trust in GS, i.e. female gender, agreeing that changes in product name and appearance complicates adherence, disagreeing in that GS saves money for me or disagreeing in that GS saves money for the society. Low trust in GS needs to be addressed, not least in the communication between health professionals and patients.

Generic versus brand-name over-the-counter analgesics: knowledge and attitudes among Swedish pharmacy customers

“…There was also an association between a negative attitude towards generics and being able to match a maximum of two active substances with the correct brand. The results on attitudes in this study are in line with results from studies on generic prescription drugs [ 16 , 19 – 21 ]. A systematic review of studies from a wide range of countries showed that about one third of the general population hold negative views of generic drugs [ 19 ], a finding which coincides with a review restricted to studies from high-income countries [ 20 ] and the before-mentioned Swedish study [ 16 ].…”

“…The results on attitudes in this study are in line with results from studies on generic prescription drugs [ 16 , 19 – 21 ]. A systematic review of studies from a wide range of countries showed that about one third of the general population hold negative views of generic drugs [ 19 ], a finding which coincides with a review restricted to studies from high-income countries [ 20 ] and the before-mentioned Swedish study [ 16 ]. Possible explanations for the negative attitudes towards generics are the common lay belief that lower prices imply poorer quality and the familiarity and trust people tend to have in well-known brands [ 21 ].…”

“…According to the dispensing register, the use of generic drugs as a share of total sales are high, with acceptance rates of generic substitution close to 100% even in therapeutic areas where generic substitution has been considered controversial [13,14]. Despite this, studies have shown a dissatisfaction with generic drugs in a sizeable minority of Swedish patients [15,16]. In one of the studies, almost one third reported a low level of trust in the equality of interchangeable generics, of whom 53% still accepted substitution [16].…”

“…Despite this, studies have shown a dissatisfaction with generic drugs in a sizeable minority of Swedish patients [15,16]. In one of the studies, almost one third reported a low level of trust in the equality of interchangeable generics, of whom 53% still accepted substitution [16]. This apparent contradiction may be due to demand-side measures that stimulate the prescription and/or dispensing of generic drugs.…”

A Current Medical Term: Nocebo

“…Çalışmada, biyoeşdeğer ilaçlara güveni etkileyen 4 faktör; kadın cinsiyet, ilacın ticari isim ve görünümündeki değişikliklerin ilaca uyumu zorlaştırması, biyoeşdeğer ilaçların birey veya devlet ekonomisine katkı sağlamamaları gibi faktörler saptanmıştır. 24 Ayrıca, Finlandiya'da biyoeşdeğer ilaçların daha sık kullanılması ile ilgili yasal düzenleme sonrasında, hekimlerin bu ilaçlara bakış açısını değerlendirmek için yapılan ankette hekimlerin yarısının etkililik ve güvenlilik ile ilgili kaygılarının olduğu bildirilmiştir. 25 Bernard Lown'un, "Kelimeler, bir doktorun sahip olduğu en güçlü araçtır, ancak iki tarafı keskin bir kılıç gibidir."…”