Takura Tomoyuki, Yokoi Hiroyoshi, Honda Asao
Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan.
Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
JMIR Aging. 2024 Dec 6;7:e59234. doi: 10.2196/59234.
With countries promoting generic drug prescribing, their growth may plateau, warranting further investigation into the factors influencing this trend, including physician and patient perspectives. Additional strategies may be needed to maximize the switch to generic drugs while ensuring health care system sustainability, focusing on factors beyond mere low cost. Emphasizing affordability and clarifying other prescription considerations are essential.
This study aimed to provide initial insights into how patient severity, composite adherence, and physician-patient relationships impact generic switching.
This study used a long-term retrospective cohort design by analyzing data from a national health care database. The population included patients of all ages, primarily older adults, who required primary-to-tertiary preventive actions with a history of hospitalization for cardiovascular diseases (ICD-10 [International Statistical Classification of Diseases, Tenth Revision]) from April 2014 to March 2018 (4 years). We focused on switching to generic drugs, with temporal variations in clinical parameters as independent variables. Lifestyle factors (smoking and drinking) were also considered. Adherence was measured as a composite score comprising 11 elements. The physician-patient relationship was established based on the interval between physician change and prescription. Logistic regression analysis and propensity score matching were used, along with complementary analysis of physician-patient relationships, proportion of days covered, and adherence for a subset of the population.
The study included 48,456 patients with an average follow-up of 36.1 (SD 8.8) months. The mean age was 68.3 (SD 9.9) years; BMI, 23.4 (SD 3.4) kg/m; systolic blood pressure, 131.2 (SD 15) mm Hg; low-density lipoprotein cholesterol level, 116.6 (SD 29.3) mg/dL; hemoglobin A (HbA), 5.9% (SD 0.8%); and serum creatinine level, 0.9 (SD 0.8) mg/dL. Logistic regression analysis revealed significant associations between generic switching and systolic blood pressure (odds ratio [OR] 0.996, 95% CI 0.993-0.999), serum creatinine levels (OR 0.837, 95% CI 0.729-0.962), glutamic oxaloacetic transaminase levels (OR 0.994, 95% CI 0.990-0.997), proportion of days covered score (OR 0.959, 95% CI 0.948-0.97), and adherence score (OR 0.910, 95% CI 0.875-0.947). In addition, generic drug rates increased with improvements in the HbA level band and smoking level (P<.01 and P<.001). The group with a superior physician-patient relationship after propensity score matching had a significantly higher rate of generic drug prescribing (51.6%, SD 15.2%) than the inferior relationship group (47.7%, SD17.7%; P<.001).
Although physicians' understanding influences the choice of generic drugs, patient condition (severity) and adherence also impact this decision. For example, improved creatinine levels are associated with generic drug choice, while stronger physician-patient relationships correlate with higher rates of generic drug use. These findings may contribute to the appropriate prescription of pharmaceuticals if the policy diffusion of generic drugs begins to slow down. Thus, preventing serious illness while building trust may result in clinical benefits and positive socioeconomic outcomes.
随着各国推动通用名药物的处方开具，其增长可能会趋于平稳，这就需要进一步调查影响这一趋势的因素，包括医生和患者的观点。可能需要采取其他策略来最大程度地转向使用通用名药物，同时确保医疗保健系统的可持续性，关注不仅仅是低成本的因素。强调可承受性并阐明其他处方考虑因素至关重要。
本研究旨在初步了解患者病情严重程度、综合依从性以及医患关系如何影响通用名药物的转换。
本研究采用长期回顾性队列设计，通过分析国家医疗保健数据库中的数据。研究人群包括所有年龄段的患者，主要是老年人，他们因心血管疾病（国际疾病分类第十版[ICD - 10]）住院史而需要从初级到三级预防行动，时间跨度为2014年4月至2018年3月（4年）。我们重点关注转向使用通用名药物的情况，将临床参数的时间变化作为自变量。还考虑了生活方式因素（吸烟和饮酒）。依从性通过包含11个要素的综合评分来衡量。医患关系根据医生更换与处方之间的时间间隔来确定。使用逻辑回归分析和倾向得分匹配，以及对医患关系、覆盖天数比例和部分人群依从性的补充分析。
该研究纳入了48456名患者，平均随访36.1（标准差8.8）个月。平均年龄为68.3（标准差9.9）岁；体重指数为23.4（标准差3.4）kg/m²；收缩压为131.2（标准差15）mmHg；低密度脂蛋白胆固醇水平为116.6（标准差29.3）mg/dL；糖化血红蛋白（HbA）为5.9%（标准差0.8%）；血清肌酐水平为0.9（标准差0.8）mg/dL。逻辑回归分析显示，通用名药物转换与收缩压（比值比[OR]0.996，95%置信区间0.993 - 0.999）、血清肌酐水平（OR 0.837，95%置信区间0.729 - 0.962）、谷草转氨酶水平（OR 0.994，95%置信区间0.990 - 0.997）、覆盖天数比例评分（OR 0.959，95%置信区间0.948 - 0.97）和依从性评分（OR 0.910，95%置信区间0.875 - 0.947）之间存在显著关联。此外，通用名药物使用率随着HbA水平区间和吸烟水平的改善而增加（P <.01和P <.001）。倾向得分匹配后医患关系良好的组通用名药物处方率（51.6%，标准差15.2%）显著高于医患关系较差的组（47.7%，标准差17.7%；P <.001）。
虽然医生的认知会影响通用名药物的选择，但患者状况（严重程度）和依从性也会影响这一决策。例如，肌酐水平的改善与通用名药物的选择相关，而更强的医患关系与更高的通用名药物使用率相关。如果通用名药物的政策推广开始放缓，这些发现可能有助于合理开具药品处方。因此，预防严重疾病同时建立信任可能会带来临床益处和积极的社会经济成果。
