Perceptions and patterns of use of generic drugs among Italian Family Pediatricians: First round results of a web survey
Introduction
Healthcare costs are among the largest national expenditures in the industrialized countries, and governments are adopting strategies for reducing health-related costs without sacrificing quality of the offered health services. One of these strategies is represented by promotion of generic drugs prescription. Generic medicines are in fact from 20% to 80% cheaper than “branded” equivalents and their use represents a well-documented strategy for controlling healthcare expenditures [1], [2], [3]. Considerable savings were demonstrated in a US panel survey by switching from “branded” to generic equivalents prescription [4].
Italian total expenditure on health showed a constant increase in the last decades: it represented 7.3% of the Gross Domestic Product (GDP) in 1995 and progressively augmented to reach 9.5% of GDP in 2009 [5]. Pharmaceutical expenditure represents one the most important health-related expenditure item. In Italy, it reached the highest value in 2001, when it accounted for 32.7% of the total healthcare costs. As a result, in the following years, Italian Government promoted a cost-containment policy and in 2003 a 5.4% pharmaceutical expenditure reduction was observed [6]. Among the different implemented saving strategies, there was the promotion of generic drugs prescription. Although generic medicines prescription rate in Italy showed a constant increase in the last decades [7], it already continued to be limited respect to other European countries or to US. In 2006, generics prescription rate represented less than 10% of volume of prescriptions, whereas in countries such as Denmark, United Kingdom, Germany or the Netherlands it systematically exceeded 50% of volume of prescriptions [8]. This situation probably resulted either from a poor confidence with the prescription of generic drugs by Italian General Practitioners (GPs) and by Family Pediatricians (FPs) or from a diffuse scepticism about reliability of bioequivalence studies and safety of switchability from “branded” to equivalent medicines. These last issues are particularly important in pediatrics, since bioequivalence tests are performed only on voluntary healthy adult subjects, often resulting in greater pediatricians’ doubtfulness when deciding to prescribe a generic equivalent instead of a well-known “branded” drug. Despite these particular “pediatric concerns”, data about prescribing habits of Italian FPs are still lacking. Considering the importance of understanding pediatricians’ perceptions about quality and safety of generic drugs, we conducted a first nation-wide web survey to evaluate and analyze generic drugs perception and use among Italian FPs.
Section snippets
Materials and methods
A web survey was undertaken between January and March 2011. The survey was made up of a 20-item questionnaire accessible online from a link published on the homepage of the Federazione Italiana Medici Pediatri (FIMP) web site. Questionnaire was addressed to all Italian FPs, included some questions to record basic demographic characteristics of respondents, and was comprised of two main sections: a section about generic drugs perception and prescribing habits and a section about FPs knowledge of
Demographic characteristics of Family Pediatricians
A slight majority of respondent FPs were female (53.8%), and the great majority of respondents were FPs aged between 46 and 53 years and 54 years or more (109, 36% and 178, 58.7%, respectively). The youngest FPs (aged less than 45 years) were less likely to respond to the questionnaire. As regard geographical distribution, FPs coming from the central and southern regions were more likely to respond compared to those coming from the North of Italy (112, 37.0%; 110, 36.6% and 81, 26.7%,
Discussion
Given the current troublesome worldwide financial situation, public expenditure savings are imperative. Generic drugs prescription is definitely an effective healthcare costs containment strategy [1], [2], [3], [9], [10], [11]; in the last decades several industrialized countries have encouraged the use of generic equivalents and in some cases generic substitution policies were introduced, resulting in increased rate of generic medicines prescription and significant savings in drug expenditures
Conclusion
Consistently with national data about generic medicines prescription rate in Italy, Italian FPs do not seem to prescribe generic drugs so frequently and barriers to their larger use in pediatric daily practice still exist. A still insufficient and sometimes not completely correct knowledge of generic medicines may explain FPs’ doubfulness about efficacy and safety of generic drugs and represents a major obstacle to a larger use of generics by Italian FPs. For this reason, scientific community
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