Abstract
BackgroundGeneric drug substitution is a public health policy challenge with high economic potential. Generic drugs are generally cheaper than brand-name drugs. Drugs are a significant part of the total health expenditure, especially in ambulatory care. We conducted a cross-sectional study with general practitioners in the Champagne-Ardenne region to determine physician-related factors and beliefs causing doctors to use the Not for Generic Substitution (NGS) mention.MethodsQuestionnaires were sent to General Practitioners (GPs) practicing in Champagne-Ardenne via 3 shipments, from January 2015 to May 2015. Prescriber characteristics and beliefs influencing the use of the NGS mention were assessed for frequent (≥ 5%) and less frequent (< 5%) users of the NGS mention.ResultsFactors associated with above average NGS mention use in bivariate analysis included patient comorbidity, polypharmacy, a concern that generic and brand-name drugs are not bioequivalent and belief in higher efficacy of the brand name drug. The use of an e-prescribing system (EPS) and medical practice in rural areas appeared to be associated with lower use of NGS mention in bivariate analysis but not in multivariable analysis. In multivariable analysis, patient request was associated with a higher use of the NGS mention (NGS ≥ 5%, adjusted Odds Ratio (aOR) = 2.52; 95% CI = [1.46–4.35]; p = 0.001), which was also linked to patient age over 65 (NGS ≥ 5%, aOR = 2.33; 95% CI = [1.03–5.30]; p = 0.04). The NGS mention was often used for drugs where substitution is debated in the literature (thyroid hormones, antiepileptic drugs).ConclusionThis work highlights the involvement of the doctor-patient pair for the use of the NGS mention. Patient request was the major reason for using the NGS mention, even though it was not always endorsed by prescribers. Further studies are needed to assess patient views on generic drugs and drug substitution, accounting for their health status and socio-economic condition, to help improve the relevance of the information available to them.
Highlights
Generic drug substitution is a public health policy challenge with high economic potential
We identified two groups of physicians based on their declared use of the Not for Generic Substitution (NGS) mention, the threshold value being the average national rate (5%)
Percentages were calculated using available data bNGS Not for Generic Substitution though they were not entirely convinced it was necessary. 75.1% of physicians in our study reported they would try to convince their patients to accept generic substitution when it was possible to do so
Summary
Generic drug substitution is a public health policy challenge with high economic potential. Drugs are a significant part of the total health expenditure, especially in ambulatory care. We conducted a cross-sectional study with general practitioners in the ChampagneArdenne region to determine physician-related factors and beliefs causing doctors to use the Not for Generic Substitution (NGS) mention. Drugs are a significant part of the total health expenditure, especially in ambulatory care, amounting to € 34.3 billion in France for the year 2012 [1]. The substitution of brand-name drugs is accomplished by the issue of generic drugs, copies of brand-name drugs whose patents are public domain. Physicians can exclude the possibility of substitution by affixing the “Not for Generic Substitution” (NGS) mention on prescriptions In France, 4.8–22% of prescriptions contain the NGS mention [5]
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