Flood David, Mathieu Irène, Chary Anita, García Pablo, Rohloff Peter
Wuqu' Kawoq | Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.
BMC Health Serv Res. 2017 Jan 13;17(1):27. doi: 10.1186/s12913-017-1991-z.
Access to low-cost essential generic medicines is a critical health policy goal in low-and-middle income countries (LMICs). Guatemala is an LMIC where there is both limited availability and affordability of these medications. However, attitudes of physicians and pharmacy staff regarding low-cost generics, especially generics for non-communicable diseases (NCDs), have not been fully explored in Guatemala.
Semi-structured interviews with 30 pharmacy staff and 12 physicians in several highland towns in Guatemala were conducted. Interview questions related to perceptions of low-cost generic medicines, prescription and dispensing practices of generics in the treatment of two NCDs, diabetes and hypertension, and opinions about the roles of pharmacy staff and physicians in selecting medicines for patients. Pharmacy staff were recruited from a random sample of pharmacies and physicians were recruited from a convenience sample. Interview data were analyzed using a thematic approach for qualitative data as well as basic quantitative statistics.
Pharmacy staff and physicians expressed doubt as to the safety and efficacy of low-cost generic medicines in Guatemala. The low cost of generic medicines was often perceived as proof of their inferior quality. In the case of diabetes and hypertension, the decision to utilize a generic medicine was based on multiple factors including the patient's financial situation, consumer preference, and, to a large extent, physician recommendations.
Interventions to improve generic medication utilization in Guatemala must address the negative perceptions of physicians and pharmacy staff toward low-cost generics. Strengthening state capacity and transparency in the regulation and monitoring of the drug supply is a key goal of access-to-medicines advocacy in Guatemala.
在低收入和中等收入国家（LMICs），获取低成本基本仿制药是一项关键的卫生政策目标。危地马拉是一个低收入和中等收入国家，这些药物的可及性和可负担性都很有限。然而，在危地马拉，医生和药房工作人员对低成本仿制药，尤其是用于治疗非传染性疾病（NCDs）的仿制药的态度尚未得到充分探讨。
对危地马拉几个高地城镇的30名药房工作人员和12名医生进行了半结构化访谈。访谈问题涉及对低成本仿制药的看法、仿制药在治疗两种非传染性疾病（糖尿病和高血压）中的处方和配药做法，以及对药房工作人员和医生在为患者选择药物方面所起作用的看法。药房工作人员是从随机抽取的药房中招募的，医生是从便利样本中招募的。访谈数据采用定性数据的主题分析法以及基本的定量统计方法进行分析。
危地马拉的药房工作人员和医生对低成本仿制药的安全性和有效性表示怀疑。仿制药的低成本常常被视为其质量低劣的证据。在糖尿病和高血压的治疗中，使用仿制药的决定基于多种因素，包括患者的经济状况、消费者偏好，以及在很大程度上医生的建议。
在危地马拉，为提高仿制药利用率而采取的干预措施必须解决医生和药房工作人员对低成本仿制药的负面看法。加强国家在药品供应监管和监测方面的能力及透明度是危地马拉药品可及性倡导的一个关键目标。
