Volume 7, Issue 1 , Pages 108-112, March 2011
Consumer perception on generic medicines in Basrah, Iraq: Preliminary findings from a qualitative study
Article Outline
- Abstract
- Introduction
- Methods
- Results
- Themes
- Discussion
- Conclusion
- Appendix 1. Consumers' interview guide
- References
- Copyright
Abstract
Background
The use of generic medicines has been increasing steadily internationally, primarily because of cost concerns. Knowledge and use patterns of generic medicines in Iraq have not yet been measured.
Objective
This study aimed to explore consumers' perception and knowledge on issues relating to generic medicine use in Basrah, Iraq.
Methods
A qualitative approach was used to gather information from consumers in Basrah, Iraq. A purposive sample of 14 consumers in Basrah was interviewed face-to-face using a semistructured interview guide.
Results
Thematic analysis of the interviews identified 5 major themes: understanding of the term “generic medicine,” preference for generic medicine, refusal of generic medicine, generic substitution, and education on the use of generic medicines. Not all the consumers were familiar with the term “generic medicine;” they were familiar with the term “commercial medicine.” Most of the participants understood that generics cost less compared with their branded counterparts. Most of the consumers said that their physicians and pharmacists had given them information on generics.
Conclusion
Knowledge of generic medicines may be lacking among consumers in Iraq. Development of consumer education on generics by health care providers is required to support the implementation of the policy on generic medicines in Iraq.
Keywords: Medicine, Generic, Knowledge, Attitudes, Consumer education
Introduction
The Iraqi health care system can be divided into the public and private sectors. In the public sector, medicines are free to all patients in government hospitals, primary health care centers, and public clinics. Medicines dispensed in the government sector are generally generic medicines.1 In private pharmacies, patients pay the full cost of their medicines. Medicines dispensed in the private sector can be either generic or brand-name medicines.1 In Iraq, the current market value for medicines is worth approximately U.S. $200 million annually, with a potential to grow to around U.S. $250 million by 2011.
Generic medicine substitution in community pharmacies could reduce consumer expenditures on medicines. This study intends to encourage the use of generic medicines. However, specific regulations that would encourage Iraqi pharmacists and physicians to do this have not been implemented. Therefore, consumers' knowledge of generic medicines and their willingness to choose generics are currently important determinants of the success of generic medicine policy.2 The aims of this study, therefore, were to evaluate consumers’ knowledge of generic medicines, whether consumers would be willing to use generic medicines, and the reasons for their choice.
Methods
Because little research has been conducted in Iraq to identify consumer perceptions on generic medicines, qualitative methods were used to gain understanding of this issue.3, 4 A qualitative approach was adopted because it allows a flexible exploration of attitudes and experiences of informants and produces a richness of data that allows the researcher to gain a deeper understanding of social phenomena.5, 6
The interview guide used in this study was a modified version of the interview guide form used by Hassali et al7 in Australia. Consumers were approached personally by the researcher at a hospital or private pharmacy. The interviews focused on knowledge of and experiences with generic medicines and safety and quality issues surrounding generic medicines. All interviews were conducted at venues suitable for the participants; 10 took place at the researcher's private pharmacy and 4 in a hospital pharmacy in Basrah, Iraq. The researcher analyzed all the transcripts manually for relevant contents and themes.7, 8 Open coding was performed, and the necessary headings were generated to describe all aspects of the content excluding “dross;” the headings were then grouped together under higher order headings. The new list of headings and subheadings was worked through, and repetitive or very similar headings were removed to produce a final list. From the analyses of the interviews, saturation of data was obtained after 14 interviews, with no new theme arising in the last 3 interviews.7
Results
Characteristics of participants
Fourteen medicine consumers aged from 21 to 60 years were interviewed. Nine of them suffered from chronic diseases. Four of the consumers had B.Sc. degrees, 1 had a Ph.D. degree, and the remaining 9 had secondary school education. Ten interviews took place at the researcher's private pharmacy and 4 at a hospital pharmacy in Basrah, Iraq. Demographic characteristics of the participants are shown in Table 1.
Table 1. Demographic characteristics of the participants (N
=14)
| Description | n |
|---|---|
| Age (yr) | |
| 25-35 | 2 |
| 36-45 | 5 |
| >46 | 7 |
| Sex | |
| Male | 9 |
| Female | 5 |
| Type of chronic disease suffered | |
| Diabetes | 5 |
| Hypertension | 3 |
| Asthma | 2 |
| Rheumatoid arthritis | 2 |
| Diabetes and hypertension | 2 |
| Marital status | |
| Married | 10 |
| Single | 4 |
| Education | |
| Ph.D. | 1 |
| B.Sc. | 4 |
| Secondary school | 9 |
Themes
Thematic content analysis of the interviews identified 5 major themes: understanding of the term “generic medicine,” preference for generic medicine, rejection of generic medicine, generic substitution, and education of consumers.
Theme 1: understanding of the term “generic medicine”
The researcher explained the meaning of the term “generic medicine” to consumers and then asked whether this term is commonly used in Iraq. All participants responded that this term was not widely used, with the term “commercial” (tejari) medicine used instead.
The term commercial (tejari) medicine refers to medicines that are similar to the original (asli) drugs, but sold at a lower price. (C01)
Commercial medicines are similar to the originals, but the drug is manufactured in different laboratories and the price is less than the original medicine. (C10)
To learn more on the understanding of the participants, they were asked about the difference between trade names and generic names; none of the participants had information on drug nomination.
I don't have any idea. (C05)
I know that the brand name is trademarked back to a particular company, but what the difference between them is, I have no idea. (C03)
Theme 2: preference for generic medicines
The interviews revealed that the most important reason for the use of generic medicine is the cost, which is less compared with that of the original medicine.
The price of generic medicine is cheap compared with the original medicine, and it is suitable for me, suitable with my income. (C06)
The price of medicine is important for me; I have diabetes and hypertension, so I use two types of medicine. If I buy Daonil and Tenormin, which are original drugs, those medications cost me a lot of money, so I choose the cheaper medicines. (C02)
In addition to the cost of medicines, the general availability of generic medicines in pharmacies helped to promote the use of this type of medication. The original medicines are not available most of the time.
It is very difficult to obtain original medicine, in addition to the high price; so I prefer to use generic medicine. (C11)
Original drugs are not available in all pharmacies, so it is very difficult to find this type of drug; for me, I prefer to use commercial drugs. (C12)
Consumers' experiences with generic medicines have a positive effect on their use by other consumers.
At the beginning, I never used generic medicines, but some friends who had used these medicines were happy with the outcome of these drugs, I tried this type of medicines and did not have any problem, so I continue to use them. (C09)
Trust in health care providers and the reputations of the companies that produce generic medicines were also seen as important factors for preferring generic medicines.
I trust my doctor, who prescribes the medicines, and my pharmacist, who dispenses the medicines. (C03)
I choose my drug depending on its origin; if it is from a good manufacturer, I will buy it. (C08)
Medicines of European origin are better than those with other origins. (C07)
Theme 3: rejection of generic medicine
Barriers to acceptance of generic medicines include the following:
(1) Physicians' inclination to prescribe innovative drugs
I have full confidence in what the physician prescribes for me; he prefers the original medicine, and I've been using what he prescribes for me. (C02)
My physician refuses to prescribe commercial drugs; his advice to me is to use original ones. (C08)
(2) Confusion may arise from the use of different brands
I'm 75 years old and use three types of medications daily. I distinguish between them by colour or shape, so any change in their colour or shape will confuse me. (C05)
Various names confuse me, so always I prefer to use original medicines with familiar names. (C04)
(3) Comfort with innovator brands
I have suffered from diabetes for ten years, and my condition is stable with the original drug (DAONIL®), so I prefer not to change my drug. (C01)
I have full confidence in the original drug used to treat ulcers, and my condition is stable with (Zantac®). So why change? Money? Nothing is more important than health. (C02)
(4) Counterfeit medicines in the market
The presence of counterfeit drugs in the market has pushed me to use original drugs only. (C06)
I had a bad experience with commercial medicines. I suffer from high blood pressure and could not find my original medicine, so I had to buy commercial medicine. The result was the deterioration of my health condition due to the ineffectiveness of the commercial medicine. This meant that this type of drug was not like my previous one, which was original. (C12)
Theme 4: generic substitution
Most of the participants agreed on the process of generic substitution, but after consulting their physicians and obtaining the approval for switching, only a small number of participants depended on the pharmacist's recommendation.
I agree with generic substitution after the approval of a doctor. (C03)
I have full confidence in dealing with the pharmacist. There is no objection to generic substitution, which leads to the same outcome and at a lower cost. (C07)
Theme 5: education necessary to use generic medicines
Knowledge about generic substitution had a strong effect on whether a patient had switched to a generic medication or not, and a combined effort by physicians and pharmacists appeared to be the most effective method of education. Some participants called for direct education from the physician and pharmacist that emphasized the safety and efficacy of generic medicines to increase their future use.
I prefer that the information regarding generic medicines be relayed to me from physicians and pharmacists, since they are well-versed in the knowledge of medicine. (C05)
Discussion
Not all participants in this study knew the term “generic medicines.” This result is in line with a study conducted in Malaysia, where most of the Malaysian consumers did not know what generic medicines were1, but differs from other international studies. In a German study, 63% of consumers had heard of the difference between generics and brand-name medicines, mainly from the media and/or their physicians.9 The results of this study indicate that some people do not know the term “generic medicines” as such but possibly are aware of or have had experience with a cheaper or commercial, equivalent alternative to a brand-name medicine. Most of the participants in this study knew that generic medicines were cheaper and of equivalent quality to brand-name medicines. This result is in line with the study conducted in Brazil, where 70% of the consumers knew that generic medicines were cheaper and equivalent to the brand-name medicines.10
Consumers with experience of generic medicines generally had a more positive perception of them. Similar results were found in a survey on consumers' perceptions of generic substitution among 505 consumers in the United States11 and in a study among 804 patients in Germany.9 The cheaper cost of generic medicines was found to be one of the factors for choosing them. Similarly, consumers interviewed in Australia by Hassali7 claimed that the main reason for accepting generic medicines was their price. Physicians' inclinations to prescribe brand-name medicines and lack of knowledge were the main barriers on the use of generic medicines in our study. The Iraqi government and health organizations may adopt methods such as using magazines, newspapers, posters, public service announcements, and advertisements to educate consumers on the benefits of using generic medicines.
Study limitations
One of the limitations of qualitative methodology used in this research is the inability to generalize to a larger population.12 This study was conducted on consumers in Basrah city in Iraq, and the findings, therefore, may not be confidently extrapolated to consumers living in other governorates in Iraq. The results are also limited by the interview questions used and the thematic analysis and coding procedures of the researcher.
Conclusion
The present study showed a lack of awareness of generic medicines among Iraqi consumers. Consumers' main reason for using generic medicines was that they were less expensive. Physicians' inclinations to prescribe brand-name medicines and lack of knowledge on generic medicines were the main barriers to accept the use of generic medicines. Consumer education on generic medicines is important to correct misconceptions and give consumers the knowledge that they need to make an informed decision about using generic medicines.
Appendix 1 is a sample of the interview guide used in gathering the data.
Appendix 1. Consumers' interview guide
Part 1. Knowledge, experience, and cost of generic medicines
Part 2. Safety and quality issues
Part 3. Consumer requests for generic medicines
Part 4. Information source for medicine use
Part 5. Conclusion
References
- IZDIHAR, Pharmaceutical and medical products in Iraq, 2007. Available at: www.izdihar-iraq.com. Assessed June 15, 2008.
- . Consumers' perception of generic medicines in community pharmacies in Malaysia. South Med Rev. 2009;2:20–23
- Designing qualitative research. In: Berg B editors. Qualitative Research Methods for the Social Science. 5th ed.. Boston, MA: Allyn and Bacon; 1995;p. 37
- . Health services research methods in pharmacy—qualitative interviews. Int J Pharm. 1998;6:97–108
- . Research Methods in Pharmacy Practice. London, UK: Pharmaceutical Press; 2002;
- . Qualitative Research Methods for Health Professionals. 2nd ed.. London, UK: Sage Publications; 1995;
- . Generic medicines: perceptions of consumers in Melbourne, Australia. Int J Pharm Pract. 2005;13:257–264
- . A method of analysing interview transcripts in qualitative research. Nurse Educ Today. 1991;11:461–466
- What do primary care patients think about generic drugs?. Int J Clin Pharmacol Ther. 2005;43:472–479
- . Generic drugs in Brazil: known by many, used by few. Cad Saude Publica. 2005;21:1808–1815
- . Consumer perceptions of generic drug substitution practices in the USA. J Pharm Pract Res. 2004;34:262–266
- . Designing a mixed methods study in primary care. Ann Fam Med. 2004;2:7–12
PII: S1551-7411(10)00003-3
doi:10.1016/j.sapharm.2009.12.003
© 2011 Elsevier Inc. All rights reserved.
Volume 7, Issue 1 , Pages 108-112, March 2011
