Physicians' Knowledge, Attitude and Practice of Generic Substitution in China: A Cross-Sectional Online Survey.

Mingyue Zhao,Lingyi Zhang,Yu Fang,Zhitong Feng

doi:10.3390/ijerph18157749

Abstract

The purpose of this study is to investigate physicians’ knowledge, attitudes and practice of generic medicine substitutions in China. We conducted a cross-sectional online questionnaire survey on physicians from secondary or tertiary hospitals in China from 2020 December to 2021 April. Descriptive statistical and ordered logistic regression were used for analysis. A total of 1225 physicians were included in the final analysis, and only 330 (26.94%) of them scored 4 or above in the knowledge part, which means that the physicians have a good knowledge of generic substitutions. Of the total, 586 (47.83%) agreed or strongly agreed that generic drugs could be substituted for originator drugs and 585 (47.75%) always or often prescribed generic medicines. The percentage of physicians with a positive attitude toward or that practice prescribing generic medicine is below 50%, which needs to be improved in China. Physicians’ knowledge, their attitude toward generic substitution, if familiar with the policy of generic substitution, and incentives for prescribing generic medicines are influencing factors for the practice of generic substitution. Our studies show that the practice of generic substitution by physicians could be improved by several measures in China. We suggested that the physicians should be taught more about the bulk-buy policy and the generic-originator equivalence evaluation policy. Moreover, government incentives to promote generic substitution should be established. Our study also suggested that physicians with less working experience and female physicians should learn more about generic substitution.

Highlights

IntroductionFor the past few decades, the Chinese government had not required generic drugs to have the same quality and efficacy as the original drugs
We found that 541 responses agreed or strongly agreed that the safety of the generic medicines is similar to the originators
We found that Chinese physicians do not have a good knowledge of generic substitution and the attitudes toward and practice of generic substitution are poor

Summary

Introduction

For the past few decades, the Chinese government had not required generic drugs to have the same quality and efficacy as the original drugs. In 2016, the Chinese government issued an announcement requiring quality and efficacy consistency assessment of generic drugs, as the first step to promoting generic substitution in China [3]. The volume-based purchase policy was introduced in 2019 in China to reduce the price and to improve generic substitution. The government can ensure through regulations that generic medicine is distributed to hospitals. This kind of macro level policy may not achieve the goal of generic substitution in the Chinese market. Some policies to enhance the prescribing/dispensing of low-cost generics fail because the authorities have not taken into consideration all parties when developing the reforms, for example, in South Korea and

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