Thaver Ali, Chee Mark, Wroblewski Kristen, Weissman Arlene, Cook Michelle, Zhang James, Samarth Anita, Moriates Christopher, Wallingford September, Lynch Shalini, Stebbins Marilyn, Shah Neel, Farnan Jeanne, Ngooi Samantha, Tracy Chris, Meltzer David O, Arora Vineet M
Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2020 Dec;35(12):3478-3484. doi: 10.1007/s11606-020-06239-6. Epub 2020 Sep 28.
As prescription drug costs rise, it is important to understand attitudes among primary care physicians and nurse practitioners (NPs) towards generic drugs.
We aimed to examine the generic skepticism index (GSI) among primary care clinicians, and their willingness to discuss and prescribe generic antidepressants (ADs) and generic oral contraceptives (OCPs).
We used a factorial vignette design survey to test 4 factors: message source, message, brand preference, and drug class. Participants were randomized to different combinations of factors.
This was a cross-sectional study.
Physicians registered with the American College of Physicians (ACP) and NPs registered with the American Association of Nurse Practitioners (AANP) participated in the study.
The primary outcomes were generic skepticism as measured using the generic skepticism index (GSI), and clinician willingness to discuss and prescribe generics.
Surveys were completed by 56% of physicians (n = 369/661) and 60% of NPs (n = 493/819). Compared with physicians, NPs were younger (p < 0.001), predominantly female (p < 0.001), and differed in the race (p < 0.001). According to the GSI, 16% (n = 138/862) were identified as generic skeptics (18.5% of NPs and 12.7% of physicians, p = 0.023). Generic skeptics had lower odds of willingness to discuss switching (OR 0.22, 95% CI (0.14-0.35), p < 0.001) or prescribe (OR 0.18, 95% CI (0.11-0.28), p < 0.001) generic OCPs. Participants had lower odds of willingness to prescribe generic drugs to patients with brand preference compared with brand-neutral patients (OR 0.64, 95% CI 0.50-0.82, p < 0.001).
Generic skepticism was associated with lower willingness to discuss or prescribe generic drugs. Clinicians reported lower willingness to discuss switching or prescribe generics for OCPs than for ADs. Patient brand preference hindered generic prescribing. Message source and message type were not significantly associated with outcomes.
随着处方药成本的上升，了解初级保健医生和执业护士对仿制药的态度很重要。
我们旨在研究初级保健临床医生中的仿制药怀疑指数（GSI），以及他们讨论和开处方使用仿制药抗抑郁药（ADs）和仿制药口服避孕药（OCPs）的意愿。
我们采用析因 vignette 设计调查来测试4个因素：信息来源、信息、品牌偏好和药物类别。参与者被随机分配到不同的因素组合中。
这是一项横断面研究。
在美国医师学会（ACP）注册的医生和在美国执业护士协会（AANP）注册的执业护士参与了该研究。
主要结果是使用仿制药怀疑指数（GSI）测量的仿制药怀疑态度，以及临床医生讨论和开处方使用仿制药的意愿。
56%的医生（n = 369/661）和60%的执业护士（n = 493/819）完成了调查。与医生相比，执业护士更年轻（p < 0.001），以女性为主（p < 0.001），种族也有所不同（p < 0.001）。根据GSI，16%（n = 138/862）被确定为仿制药怀疑者（执业护士为18.5%，医生为12.7%，p = 0.023）。仿制药怀疑者讨论改用（比值比0.22，95%置信区间（0.14 - 0.35），p < 0.001）或开处方使用（比值比0.18，95%置信区间（0.11 - 0.28），p < 0.001）仿制药口服避孕药的可能性较低。与对品牌无偏好的患者相比，参与者向有品牌偏好的患者开处方使用仿制药的可能性较低（比值比0.64，95%置信区间0.50 - 0.82，p < 0.001）。
仿制药怀疑态度与讨论或开处方使用仿制药的意愿较低有关。临床医生报告说，与抗抑郁药相比，讨论改用或开处方使用仿制药口服避孕药的意愿较低。患者的品牌偏好阻碍了仿制药的处方开具。信息来源和信息类型与结果没有显著关联。
