A Study to Assess The Knowledge and Practice of Healthcare Workers and The General Public About Generic and Branded Medicine In Bengaluru

Introduction

According to the FDA, “A generic drug is a medication created to be the same as an already marketed brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.”¹

As a result of the economic strain on drug budgets, the use of generic pharmaceuticals is expanding steadily across the world. Generic medications can help save a lot of money on healthcare costs because they are usually much less expensive than brand-name drugs. Despite the fact that generic medicines are bioequivalent to their innovator counterparts and are manufactured in similar facilities using good manufacturing procedures, they are typically considered inferior to branded pharmaceuticals in terms of therapeutic efficacy and quality. People are more skeptical about differences in effectiveness and quality. The use of generic drugs has the potential to drastically reduce the out-of-pocket expenditure on drugs for patients, especially those with chronic diseases.²

The 'Jan Aushadhi Scheme’ was launched by the Department of Pharmaceuticals, Ministry of Chemicals & Fertilizers, Government of India in November 2008 with the vision of reducing the healthcare budget of every Indian citizen by providing quality generic drugs at affordable prices. The government revamped the ‘Jan Aushadhi Scheme’ in September 2015 as ‘Pradhan Mantri Jan Aushadhi Yojana’ (PMJAY). To give further impetus to the scheme, it was renamed again 'Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana’ (PMBJP) in 2016.³ For the Below Poverty Line customers, the scheme was beneficial in allowing them to buy the medicine because it was cheap. It has been observed that lack of awareness in the public, distribution of free medicines by state governments, lack of support for the Jan Aushadhi Scheme (JAS), moderate supply chain, and doctors who do not prescribe generic drugs are the major constraints facing the JAS leading to its moderate success. The study aimed to assess the knowledge and practice of healthcare workers and the general public about generic and brand-name medicines.

Materials and Methods

A questionnaire-based cross-sectional study with 150 respondents each from the general public and health care workers was conducted using convenient sampling in Bengaluru. The general public and healthcare workers between 20-60 years of age were included in the study. People with cognitive disorders and communication challenges were excluded from the study. The study was started after obtaining approval and permission from the Institutional Ethics Committee.

Since there was no established evidence on the proportion of people with good knowledge and practice of generic and branded medicines among healthcare professionals and the general public, we assumed a 50% prevalence rate for knowledge and practice of generic and branded medicines. This assumption was made to obtain the maximum sample size. With an absolute precision of 8% and a confidence interval of 95%, the estimated sample size was 150. We reached 200 people in each category, and the survey was concluded when we received 150 responses in each category.

The data was collected using a questionnaire that was mailed electronically as Google forms to the respondents. The questionnaire had demographic details and questions to assess the knowledge and practice, respectively. Above 70% was scored as good, 40% to 70% was scored as moderate, and less than 40% was scored as poor. The study results showed that no respondents had scores less than 40% for the knowledge and practice categories. The data was analyzed using SPSS. The association between knowledge and practice regarding generic and branded medicine among respondents with their demographic variables was studied using Chi-square and Fisher’s exact probability test, as applicable.

Results

The following tables show the knowledge and practice among the general public and healthcare workers about generic medicine (Tables 1 to 6). A five point likert scale was used to assess ranging from Strongly Agree, Agree, Neutral, Disagree and Strongly Disagree.

The study revealed that among healthcare workers, the majority (63.3%) belong to the 20-39 age category,41.3% were females and 58.67% were males, 36.7% were married, and 63.3% were unmarried (Table 2). Among them, 28.7% were doctors, 40% were nurses, 18% were pharmacists, and 13.3% were others. Among healthcare workers, 85.33% were aware of generic drugs. Among them, only 76.67% believed in the effectiveness of generic drugs, and only 40% were aware of the availability of generic drugs and only 22% were aware of the nearby Jan Ausadhi Kendra. 40% knew where to buy generic medicine and 60% did not know where to get it.

Most of the general public and healthcare workers were aware that generic medicine is cheaper than branded medicine. Compared to the general public, healthcare workers were more aware of the Jan Aushadhi scheme. But most public and healthcare workers had less knowledge of the nearby Jan Aushadhi Kendra. Healthcare workers in the 20-29 age category had more knowledge and practice of generic medicines than other age categories. The general public that belongs to the age category 20-29 had more knowledge and practice than other age categories. The study showed that compared to women, men had more knowledge and practice about generic medicine (Table 3).

Among the general public, graduates had better knowledge and practice of generic medicine (Table 4). People who work in private organizations had better knowledge and practice on generic medicines.

The study showed that healthcare workers had more faith in the effectiveness of generic drugs than the general public. Compared to the general public, healthcare workers had read more articles on the comparison of generic and branded drugs. It is also seen that most of the general public had not tried to find out the availability of generic drugs at their local pharmacy. The general public believed that branded medicine was more effective than healthcare workers (Table 5).

Among the general public, only 57.33% knew about generic drugs. Only 47.33% believed in the effectiveness of generic drugs. 46% were aware of the availability of generic drugs and only 12.67% were aware of the nearby Jan Ausadhi Kendra (Table 6).

Discussion

The study revealed that the age group 20-29 had higher knowledge and participants with higher education had a greater belief in the efficacy of generic medicine, which is similar to the results of the studies by Dunne SS. et.al ^4,5

In Malaysia, Zhi Y. Wong et al. conducted a study on patients' attitudes about generic drugs, and patients attending outpatient pharmacy department at a tertiary care hospital in Malaysia were enrolled.⁶ Only 49% knew what the term 'generic medicine' meant, whereas the present study showed that 57.33% of the general public were aware of generic medicine. According to the study by Ballala K et.al The knowledge of generic medicines was found to be low among the respondents (57.9%), similar to our study.⁷ Better knowledge and perception of generic drugs among the public and healthcare workers is crucial in the successful adoption of national generic medicine policies and guidelines.⁸

A systematic review by Colgan S et al. showed that most doctors, pharmacists, and lay people had negative perceptions about generic drugs. This may pose a major hurdle in the widening use of generics.⁹ In India, almost 70% of the total expenditure in the healthcare sector is out of pocket.¹⁰ It is better to use generic drugs to reduce the burden of healthcare expenditure, especially in the poor. Despite this, generic medicines are not widely used in India. Some of the factors could be moderate awareness among the population of thesource of availability of drugs, distrust of the quality of the medicine, and doctors not recommending generic medicines.^11,12 The present study revealed that most of the general public had not tried to find the availability of generic drugs in their local pharmacy. Only 47.33% of the general public believed in the effectiveness of generic drugs. Only 46% were aware of the availability of generic drugs.

Gupta et al. conducted a study in the southern region of India to investigate doctors' attitudes about generic drugs. The main goal was to investigate the knowledge, attitude and practice of doctors when generic medicines were taken into account. As a result, the results indicated that doctors were strongly supportive of the use of generic drugs and the promotion of their efficacy in the treatment of various ailments, just as their branded counterparts. The doctors were also well versed in generic drugs.¹³ The majority of doctors (72%) believe that the generic drugs were manufactured using moderate techniques. However, more than three-quarters of doctors (78%) routinely prescribed generic drugs.¹⁴ While this study shows that only 64% of doctors claimed to prescribe generic drugs and to have positive knowledge of generic medicines.

Nirav Kumar M Patel and colleagues used a questionnaire to perform a cross-sectional study titled "A study of knowledge, attitude, and practice on generic medications among teaching faculties at a tertiary care teaching hospital in South Gujarat." 61.8% of faculty agreed that generic medications have the same active ingredients as brand-name drugs. Only 80% of the people agreed that generic drug prescriptions should be encouraged. Generic drugs were known by a large percentage of medical faculties.¹⁵ The current study showed that 60% of healthcare workers were unaware of the availability of generic medicines. 85.33% of healthcare workers knew about generic medicine. It was also found that the majority 76.67% have faith in generic medicine.

Conclusion

The present study was carried out with the aim of knowing the knowledge and practice of generic drugs among the general public and healthcare workers. The study revealed that healthcare workers had more knowledge of generic medicine than the general public. It was also found that the general public used more generic drugs than healthcare workers. The study revealed that men were more knowledgeable about generic medicines than women among the general public. The public at large is willing to go by generic drugs provided the physicians prescribe them.

Conflicts of interest

Nil