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International Journal of Clinical Pharmacy

, Volume 36, Issue 3, pp 623–629 | Cite as

Impact of generic substitution practice on care of diabetic patients

  • Olubukola O. OyetundeEmail author
  • Bolajoko A. Aina
  • Fola Tayo
Research Article

Abstract

Background Patients with chronic diseases like type II diabetes mellitus often have their prescriptions substituted with generic medicines in the course of care to save costs of medicines and to improve access. There is need to assess impact of this practice on patient care. Objective To assess patient’s knowledge of generic substitution practice and its impact on patient care. Setting An outpatient diabetic clinic of a tertiary hospital in Nigeria. Method The study is a cross sectional survey of patients attending a diabetic clinic. A structured questionnaire was used to interview willing patients. A total of 120 patients were enrolled for the study, but only 102 responded (85 % overall response rate). Main outcome measures: Patients’ knowledge of generic substitution practice, patients’ report of abstaining from drug use, experiences of more side effects and patients’ confusion. Results Over half (57.8 %) of surveyed patients (n = 59) had noticed brand switches, out of which, 30.5 % experienced brand switches more than 3 times within a year. More than a third of the respondents (38.6 %) did not know when pharmacists actually substituted their medicines. About one in five (19.6 %) patients did not use their medicines after substitution because they were not sure of the brand supplied but 35.6 % have rejected substitution at one time and insisted on doctors’ prescription. Respondents (14.9 %) agreed that brand substitution resulted in confusion while 24 % reported receiving brands that resulted in more side effects. More respondents (58.6 %) indicated that they never had a discussion with their pharmacists about the reasons for generic substitution and switches. Conclusion Generic substitution without adequate information resulted in confusion and subsequent lack of adherence. There is the vital need for appropriate policy and guidelines for generic substitution in Nigeria.

Keywords

Diabetes mellitus Generics Generic substitution Nigeria Patient care 

Notes

Acknowledgments

The authors wish to thank all the physicians and nurses in charge of the diabetic clinic of Lagos University Teaching Hospital, Lagos, Nigeria. We are also grateful to all the patients who agreed to be interviewed.

Funding

No external funding was obtained for this study.

Conflicts of interest

The authors declare that they do not have any conflicts of interest.

References

  1. 1.
    Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol. 2013;14:1.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Kazmi SZ. Controversies in drug substitution [Internet]. Medscape Pharmacist; 2007 [Cited 2008 Jun 30]. http://www.medscape.com/viewarticle/563959_1.
  3. 3.
    Andersson K, Sonesson C, Petzold M, Carlsten A, Lönnroth K. What are the obstacles to generic substitution? An assessment of the behaviour of prescribers, patients and pharmacies during the first year of generic substitution in Sweden. Pharmacoepidemiol Drug Saf. 2005;14(5):341–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Lloyds KB, Berger BA. Talking with patients about Generic medication [Internet]. US Pharm 2007; 32 (6). [Cited 2008 May 03] http://www.uspharmacist.com/content/t/generic_medications/c/10304/.
  5. 5.
    Federman AD, Halm EA, Zhu C, Hochman T, Siu AL. Association of income and prescription drug coverage with generic medication use among older adults with hypertension. Am J Manag Care. 2006;12(10):611–8.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Fairman KA, Curtiss FR. The elephant in the pharmacy: patient choice is the big challenge that no one talks about in affordability of prescription drugs. (Editorial). J Manag Care Pharm. 2007;17(7):620–2.Google Scholar
  7. 7.
    Steinman MA, Chren MM, Landefeld CS. What’s in a name? Use of brand versus generic drug names in United States outpatient practice. J Gen Intern Med. 2007;22(5):645–8.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Reichert S, Simon T, Halm EA. Physicians’ attitudes about prescribing and knowledge of the costs of common medications. Arch Intern Med. 2000;160(18):2799–803.PubMedCrossRefGoogle Scholar
  9. 9.
    Roberts RJ, Kauffman RE, Mirkin BL, Rumack BH, Snodgrass W, Spielberg SP. Generic prescribing, generic substitution and therapeutic substitution. Pediatrics. 1987;79:835.Google Scholar
  10. 10.
    Hoadley, J. Cost containment strategies for prescription drugs: assessing the evidence in the literature [Internet]. Kaiser Family Foundation; 2005 [cited 2013 Sept 24]. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/cost-containment-strategies-for-precription-drugs-assessing-the-evidence-in-the-literature-report.pdf.
  11. 11.
    Holmes DR Jr, Becker JA, Granger CB, Limacher MC, Page RL 2nd, Sila C. ACCF/AHA 2011 health policy statement on therapeutic interchange and substitution: a report of the American College of Cardiology Foundation Clinical Quality Committee. [Internet] 2011 [cited 2013 Sept 29]; 124: 1290–1310. doi:  10.1161/CIR.0b013e31822d97d5.
  12. 12.
    The Medical Letter. Generic drugs. Med Lett Drugs Ther. 2002;44(1141):89–90.Google Scholar
  13. 13.
    Heikkilä R, Mäntyselkä P, Hartikainen-Herranen K, Ahonen R. Customers’ and physicians’ opinions of and experiences with generic substitution during the first year in Finland. Health Policy. 2007;82(3):366–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Garattini L, Tediosi F. A comparative analysis of generics markets in five European countries. Health Policy. 2000;51(3):149–62.PubMedCrossRefGoogle Scholar
  15. 15.
    Hassali A, Stewart K, Kong D. Quality use of generic medicines. Austr Prescr. 2004;27(4):80–1.Google Scholar
  16. 16.
    Beecroft G. Generic drug policy in Australia: a community pharmacy perspective. Aust New Zealand Health Policy. 2007;4:7.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Hassali MA, Shafie AA, Jamshed S, Ibrahim MI, Awaisu A. Consumers’ views on generic medicines: a review of the literature. Int J Pharm Pract. 2009;17(2):79–88.PubMedGoogle Scholar
  18. 18.
    Kalisch LM, Roughead EE, Gilbert AL. Brand substitution or multiple switches per patient? An analysis of pharmaceutical brand substitution in Australia. Pharmacoepidemiol Drug Saf. 2008;17(6):620–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Johnston A, Asmar R, Dahlöf B, Hill K, Jones DA, Jordan J, et al. Generic and therapeutic substitution: a viewpoint on achieving best practice in Europe. Br J Clin Pharmacol. 2011;72(5):727–30.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Vallès JA, Barreiro M, Cereza G, Ferro JJ, Martínez MJ, Escribà JM, et al. A prospective multicenter study of the effect of patient education on acceptability of generic prescribing in general practice. Health Policy. 2003;65(3):269–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Chong CP, March G, Clark A, Gilbert A, Hassali MA, Bahari MB. A nationwide study on generic medicines substitution practices of Australian community pharmacists and patient acceptance. Health Policy. 2011;99(2):139–48.PubMedCrossRefGoogle Scholar
  22. 22.
    Hassali MA, Kong DC, Stewart K. Generic medicines: perceptions of consumers in Melbourne. Australia. Int J Pharm Pract. 2005;13(4):257–64.CrossRefGoogle Scholar
  23. 23.
    Ganther JM, Kreling DH. Consumer perception of risk and required cost savings for generic prescription drugs. J Am Pharm Assoc. 2000;40(3):378–83.Google Scholar
  24. 24.
    Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.PubMedCrossRefGoogle Scholar
  25. 25.
    Enwere OO, Salako BL, Falade CO. Prescription and cost consideration at a diabetic clinic in Ibadan, Nigeria: a report. Ann Ib Postgrad Med. 2006;4:32–6.Google Scholar
  26. 26.
    Gaither CA, Kirking DM, Ascione FJ, Welage LS. Consumers’ views on generic medications. J Am Pharm Assoc. 2001;41(5):726–36.Google Scholar
  27. 27.
    Simmenroth-Nayda A, Hummers-Pradier E, Ledig T, Jansen R, Niebling W, Bjerre L. et al. Prescription of generic drugs in general medical practice. Result of a survey of general medical practitioners. Med Klin (Munich) 2006; 9:705–10. PMID 16977394.Google Scholar
  28. 28.
    Jimoh AO, Sabir AA, Chika A, Sani Z. Patterns of antidiabetic drug use in a diabetic outpatient clinic of a tertiary health institution Sokoto, north western Nigeria. J Med Sci. 2011;11(5):241–5.CrossRefGoogle Scholar
  29. 29.
    Uloko AE, Ofoegbu EN, Chinenye S, Fasanmade OA, Fasanmade AA, Ogbera AO, et al. Profile of Nigerians with diabetes mellitus: Diabcare Nigeria study group (2008): results of a multicenter study. Indian J Endocrinol Metab. 2012;116(4):558–64.Google Scholar
  30. 30.
    Quintal C, Mendes P. Underuse of generic medicines in Portugal: an empirical study on the perceptions and attitudes of patients and pharmacists. Health Policy. 2012;104(1):61–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Ganther-Urmie JM, Nair KV, Valuck R, McCollum M, Lewis SJ, Turpin RS. Consumer attitudes and factors related to prescription switching decisions in multitier copayment drug benefit plans. Am J Manag Care. 2004;10(3):201–8.PubMedGoogle Scholar
  32. 32.
    Hassali MA, Kong DC, Stewart K. Generic drugs: perceptions of community pharmacists in Melbourne, Australia. J Pharm Financ Econ Policy. 2005;14(3):27–45.CrossRefGoogle Scholar
  33. 33.
    Wilner AN. Physicians underestimate the frequency of generic carbamazepine substitution: results of a survey and review of the problem. Epilepsy Behav. 2002;3(6):522–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Håkonsen H, Toverud EL. Special challenges for drug adherence following generic substitution in Pakistani immigrants living in Norway. Eur J Clin Pharmacol. 2011;67(2):193–201.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Olubukola O. Oyetunde
    • 1
    Email author
  • Bolajoko A. Aina
    • 1
  • Fola Tayo
    • 1
  1. 1.Department of Clinical Pharmacy and Biopharmacy, Faculty of PharmacyUniversity of LagosLagosNigeria

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