Generic medicines: Perceptions of general practitioners in Melbourne, Australia

Generic medicines: Perceptions ofgeneral practitioners inMelbourne, AustraliaReceived (in revised form): 10th December, 2005

Mohamed Azmi Hassaligraduated with a pharmacy degree and a master’s degree in clinical pharmacy from Universiti Sains Malaysia. His researchinterests are in the areas of clinical pharmacoeconomics, social pharmacy and the role of pharmacists in public health.Currently he is undertaking his PhD research on the topic of generic medicine utilisation in the Department of PharmacyPractice, Monash University, Australia.

David C. M. Konggraduated with a pharmacy degree from the Victorian College of Pharmacy, Australia and with Master’s and PhD degrees inthe field of pharmaceutics and organic chemistry from Monash University. Currently he holds a joint appointment as alecturer in the Department of Pharmacy Practice, Monash University and as a senior pharmacist at the Alfred Hospital,Melbourne, Australia.

Kay Stewartgraduated with a pharmacy degree and PhD in pharmacy practice from the University of Queensland, Australia. Herresearch interests include quantitative and qualitative aspects of medication usage and implementation of specialisedservices in community pharmacy. Currently she holds a senior lecturer position in the Department of Pharmacy Practice,Monash University, Melbourne, Australia.

Abstract The aims of this study were to investigate factors affecting generic medicineprescribing among general practitioners (GPs) in Melbourne, Australia. A qualitative approach wasused. A convenience sample of GPs practising in Melbourne was interviewed using a semi-structured interview guide. Thematic content analysis of the interviews identified seven majorthemes: medicine prescribing patterns, knowledge and confidence with generic medicines, patientacceptance of generic medicines, issues related to ‘pseudo-generics’ and medicine labelling, drugadvertising and marketing, brand substitution by community pharmacists and, finally, strategies toincrease generics prescribing. Informants suggested some methods that could be used to increasethe current rate of generics prescribing, including financial reward for GPs, patient education ongeneric medicines, convincing GPs of the safety and efficacy of generic medicines and educatingsenior medical students on issues involving generic medicines and generics prescribing. This studysuggested that GPs in Melbourne have mixed attitudes to generics prescribing. The findings alsoshow that misconceptions about safety and efficacy of generic medicines still persist among someGPs. Unless they are sufficiently educated by interested parties, such as the government and thegeneric medicines industry, this will have a negative impact on utilisation of generic medicines infuture.

Keywords: generic medicines, perceptions, general practitioners

INTRODUCTIONExpenditure on prescription medicines inAustralia continues to increasesignificantly.1,2 A recent report of the

Commonwealth Government Budgetshows that the Pharmaceutical BenefitsScheme (PBS), which is a comprehensivesystem for subsidy of prescription

Kay StewartSenior LecturerDepartment of PharmacyPracticeVictorian College ofPharmacyMonash University381 Royal ParadeParkville, VIC3052AustraliaTel: +61 3 9903 9618Fax: +61 3 9903 9629E-mail: [email protected]

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medicines covering the whole population,is currently the fastest growing area ofhealth expenditure.3 Expenditure for theyear ended 30th June, 2004, totalledA$5.0bn, compared with a $4.5bn forthe previous year — a 9.3 per centincrease.3 In the last decade, PBSexpenditure has experienced an estimatedaverage annual growth rate of around14 per cent.4,5

The growing expense of the PBS haspushed the government towards a morerigorous prescription policy.6 Within thiscontext, the Commonwealth Governmenthas attempted to encourage the use ofgeneric medicines as a cost-containmentmeasure.6 In Australia, generics accountedfor about 20 per cent of all prescriptionsfilled in 2001. When compared with othercountries, such as Germany, theNetherlands, Canada, the UK, the USA,Sweden and Denmark, however, thispercentage is still relatively low.7

Prescribing drugs by generic name andencouraging pharmacists to dispenseprescriptions with generic medicines is onefrequently suggested means for loweringthe costs of healthcare.8–10 Various articleshave discussed the implications of genericsubstitution and other strategies to reducepharmaceutical expenditure.7,11–13 Theconcept of prescribing, dispensing andusing generic medicines has beencontroversial, however.10 Concern hasbeen expressed both in Australia andelsewhere about the efficacy of genericmedication.14,15 This debate has centredon issues related to bioequivalence andpotential confusion that might arise whenchanges of medicine brands occur in somepatient populations.6,11

In Australia, little is known aboutgeneral practitioners’ (GPs’) perceptionsof generic medications and genericsubstitution. Therefore, the aim ofthis study was to investigate factorsaffecting generic medicine prescribingamong GPs.

METHODSSince little research has been carried out inAustralia to identify GPs’ perceptions ofthe use of generic medicines, qualitativemethods were used to uncoverthemes.16,17 The study took place inMelbourne in the state of Victoria,Australia, upon ethics approval by theMonash University’s Standing Committeeon Ethics in Research Involving Humans(SCERH). Using a semi-structuredquestionnaire, interviews were conductedwith a convenience sample of GPs untilsaturation of themes was reached.18,19 Thesemi-structured questionnaire wasdeveloped after reviewing the literatureand consultation with selectedrepresentatives from the Division ofGeneral Practice, Melbourne Branch. Theten GPs were identified following anadvertisement in the weekly newsletter ofthe Division of General Practice,Melbourne Branch. The interviewsfocused on the following issues: genericmedicine prescribing trends, knowledgeand confidence with generics and patients’acceptance of generics. Appropriateprobing questions were used whennecessary to get more in-depth views fromthe participants.20 In addition, to draw outmore complete ideas from the participants,they were given freedom to expressadditional views on the topic at the end ofthe interview session. All interviews wereconducted at a place suitable for theinformants, eight at the place of practiceand two at the Department of PharmacyPractice, Monash University.

The interviews took an average of20–30 minutes and were conducted by atrained interviewer (MAH). Interviewswere audio taped, transcribed verbatim andthe transcripts supplemented with fieldnotes taken during the interview andimmediately after. Two of the authors(MAH and KS) listened to all tapes andMAH analysed the transcripts for relevantcontent and themes, using NVivo�

Perceptions of general practitioners in Melbourne

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software for qualitative data management(QSR International Pty Ltd. Melbourne,Australia). The thematic frameworkcomprised dominant themes that wererefined as associations were made inattempt to provide explanations for thefindings.21,22

RESULTSTen GPs practising in various grouppractices were interviewed after providinginformed consent. Four were practising inthe inner city and the other six insuburban areas. Five GPs held fellowshipsof the Royal Australian College of GeneralPractice. Demographic characteristics aresummarised in Table 1.

Seven major themes were identified.

Theme 1: Medicine prescribingpatternsInformants were asked about the factorsthey take into consideration whenprescribing a medicine to their patients.The major factors identified were safetyprofile of the medicine, cost and patientcompliance:

Well, cost would be a factor, whetherit’s on the PBS is a factor, how often it

needs to be taken, interaction with theother drugs that somebody is already onand, really, whether a patient is willingto take it according to the instructions.(GP02)

There were mixed reactions amonginformants when asked whether theyactively prescribe generic medicines. Somewere opposed to generic prescribing,whereas others were more open to theconcept.

Reasons for opposing genericsSome GPs believed that generic medicinesare not equivalent to the innovator brandand this discouraged them from prescribinggeneric medicines.

I don’t prescribe generic medicinesbecause I don’t believe that they’re allequivalent and I think it is a lie thatthey’re all equivalent. (GP04)

I don’t have confidence with genericsbecause, although they are regarded asbeing identical, we know that theGovernment allows a certain percentageabove or below strength and it is stillclassified the same when in fact it’s notthe same. And I think that I’m also rightin saying that there is little or no controlwith the excipients, which candrastically affect bioavailability and theabsorption curve and the side effectprofile. (GP05)

Support for research-based companiesthat are actively involved in discovery ofnew drugs was seen by some GPs as areason for opposing generic medicines.

I am anti generic medicines since thegeneric companies do not put in anyresearch and development and that isthe attitude of them and as such I think,I am ashamed that all doctors don’t get

Table 1: General practitionersdemographic characteristics

Descriptions n

Age range30–40 241–50 651–60 2GenderMale 7Female 3Place of graduationAustralian university 8New Zealand university 2Number of prescriptions written per day10–20 6More than 20 4Number of years practising in AustraliaUnder 15 years 5More than 15 years 5

Hassali, Kong and Stewart


rid of them and not prescribe them.(GP06)

Concerns were raised by some of theGPs with regard to the government moveto encourage generics prescribing amongAustralian GPs:

I’m very reluctant for the Governmentto be telling me as a practitioner whatto do. I mean, I’m supposed to be aneducated professional person who hasdone suitable training. I have on-goingeducation and then to actually be toldwhat I should and should not do, I feelthat that is a little overstepping themark. (GP03)

As a doctor I work in the best interestsof my patients. If my prescribing patternis going to be changed by anotherperson then I certainly cannot take theresponsibility for the patient. (GP05)

Informants were also concerned about thedrug choices made by their prescribingsoftware:

I think I need more training with myprescribing software before I know howto default my prescribing to genericmedicines. Right now it seems quickerto refer to book rather than navigatingthe software. (GP02)

Some informants indicated that patientsmay become confused by different brandsof the same medicine:

The main disadvantages are that peopledon’t necessarily recognise what drugthey’re on because usually people havebeen prescribed a drug by trade nameand if we use generic names, sometimesthey can be a bit confused. Besides that,there are too many branded generics inthe market which is complicating thingsfor us and patients. (GP02)

I’m practising in a fairly multiculturalarea. There is one incident where I canrecall an older Lebanese man who hadbeen given, I think it was hypertensivemedication, a different named one.Stopped taking it and got confused;came back in; had his old ones in apacket. (GP09)

The failure of patients with low incometo prioritise their health needs was seen asa barrier to prescribing generically by someGPs.

These people in low social economicalgroups, number one, I would beinterested to know first of all how manycigarettes packets they smoke per week,how much do they drink per week andhow much do they spend on Lottotickets and when their last holiday wasto Bali. And if the answers to all ofthose is they can’t afford any of those, Iwould then certainly consider genericand, in fact, be happy to give themsamples and help in any other way Ican. But unfortunately, a lot of peopleare not prepared to pay forpharmaceuticals, which were consideredfree, but will still actually smoke, youknow, one or two packet of cigarettes aday, drink alcohol, spend A$70 for ahaircut every fortnight. I think it’s a bitunfair. (GP03)

Reasons for supporting genericprescribingCost to patients was seen as advantageousin prescribing a generic medicine:

I prescribe it more routinely tohealthcare card holders and pensionersbecause they feel that a couple of dollarsdifference does make a difference tothem. And there are some medicines,particularly older ones, I think all thebrands are equally effective. (GP02)



Increases in pharmaceutical expenditureover recent years had prompted somedoctors to prescribe less expensive genericmedicines as a method of cost reductionwithin the healthcare system.

There is an obligation on thegovernment to minimise the expense.So I’m in favour of that policy; it’s agood policy. (GP07)

There is a lower price option to theconsumer but I’m more interested inkeeping the country’s drug bill low.(GP10)

Prescribing generically was suggested asa way to overcome the complexity of thebrand names available in the market:

Generic prescribing might be betterbecause it will actually make it clearerabout what we are prescribing. I thinksometimes doctors might not be awarethat, you know, three or four drugs ofdifferent brand names, they will be thesame drug. (GP02)

Theme 2: Knowledge andconfidence with genericsInformants were questioned about thebioequivalence criteria required by theAustralian drug regulatory body, theTherapeutic Goods Administration (TGA),for generic medicines and appeared to bepoorly informed on this topic.

No, I don’t have a clue. (GP01)

Differences between? No, I don’tprescribe them so I’ve never tried tofind that out, no interest. (GP06)

Despite their lack of detailed knowledge,the informants expressed strong confidencein the TGA:

I’m really confident with all the drugsregistered by TGA. (GP01)

Theme 3: Patient acceptance ofgeneric medicinesMost of the informants who supportedgeneric medicines felt that their patientswere willing to use generic medicines dueto cost reasons.

Very good, a lot of people are veryactively asking, ‘Is there a cheaperversion?’ If the pharmacy offers them acheaper version, ‘Can I take it?’ I thinkacceptance is very high. (GP07)

Well, it depends on the patient’sbackground. Some of them who arewell off prefer to be prescribed brandedproducts, whereas those who are fromlow socio-economic background, theyprefer to go for generics. (GP09)

Theme 4: Pseudo-generics andmedicine labellingInformants expressed concerns about thetactics of innovator drug companiesventuring into the generic drug marketupon patent expiration. These medicinesare physically identical to brand namemedicines and manufactured on the sameproduction lines; however, they are soldunder a different trade name and priced tocompete in the generics market.

You can’t challenge a company wantingto make the most money they can, whatyou can challenge is how stupid we areas a profession that we are prepared tobe conned by it. For that reason itwould be helpful to educate patients tosay look your product is produced bythe brand company, who labels one boxone way and another box another wayand charges twice as much for thebrand. (GP01)



Some informants were concerned aboutinadequacies in the medicine labelling inAustralia.

I would like the drug name to beperhaps a little bit more evident and alsoI like that fact that, the pharmaciststicker shouldn’t cover up what it is thatthe drug is, frequently when you lookon a bottle of medication theinformation from the pharmacist hasobscured the actual bottle and it’s veryhard often to work out what it is and ifthe typing was wrong, if the pharmacisthad made an error there is no way ofchecking it. So yeah I think it could beimproved. (GP01)

I think labelling must change for brandsubstitution to work. To be more clearwhat the generic drug is and also somerestriction on how many times a drugcan be substituted. (GP09)

Theme 5: Effect of drugadvertising and marketing onbrand medicine choicesGPs interviewed agreed that drugadvertising and marketing can influencethe choice of medicine brands that theywill prescribe.

The industry tries very hard to make ususe their products. All our pens havebrand names on them, and also thename is often easier, it does becomeeasier just to use the brand name thatyou’ve been exposed to. (GP07)

Even though we don’t have drugrepresentatives at the practice, if you goto talks, there are always drugrepresentatives from different companies;again you get exposed to theirproducts and sometimes you justrecall their product and prescribe it.(GP09)

Theme 6: Brand substitution bycommunity pharmacistsSome informants described theirdissatisfaction with the move allowingcommunity pharmacists to substitute drugsthat they had prescribed.

I just at this point in time don’t have agood understanding of what there is tokeep pharmacists honest, in as much asI’m not sure, I don’t like the idea of thepharmacist potentially brand substitutingbecause it is financially suiting themversus suiting the community as awhole, which makes me a little bitconcerned I guess. The ability ofpharmacists to be bought out by thedrug companies just like doctors are.(GP01)

Because I feel that it is an attempt todisempower doctors. It is an attempt tosay, alright you’ve written brand A,you’ve gone to the trouble of specifyingbrand A, the government doesn’tknow what my reason is, it might beblind following of a particular brandname or it might just be for a goodreason. They don’t know my motivesbut it’s like they are discounting mymotives as if I wouldn’t know andI can prescribe brand names and thechemist will dispense brand B or Cand that’s awful. I find that verydevaluing of me as a professional.(GP05)

On the other hand, support was expressedfor the move:

My opinion is that it’s fine for apharmacist to do that, it’s fine for thegovernment to want to spend fewer ofthe tax payer’s dollars possible toachieve the desired affect. (GP07)

Oh yes, they are well trained in drugs.(GP08)



Theme 7: Strategies to improvegenerics prescribingGPs who were supportive of the movevolunteered suggestions as to how toimprove the rate of generics prescribing.

Financial reward for GPs

I think it’s a really hit and miss approachand having come from the UK we werefinancially rewarded, because we heldour own budgets for our drug costs, wewere financially rewarded. Well, notrewarded, we didn’t get any money inour pockets but we had more money tospend on our patients, if we were costeffective prescribers. I felt that that wasa really positive thing whereas herethere is nothing like that. (GP01)

Patient education

I think we need more patient educationby the government regarding the use ofgeneric medicines. (GP02)

Information for prescribers

To encourage us that we canconfidently prescribe a generic brand ofmedication and not fear that that’s sortof inferior. The more information thatshows generic doxycycline equivalent tothe brand name item the better. (GP07)

Medical student education

I would have thought that thegovernment could focus very much onmedical students about the importanceof generic prescribing. (GP01)

I personally believe that undergraduatemedical education, especially towardsthe senior medical students, will behelpful because sometimes it is hard tochange the existing prescribing

behaviour. You have to deal with it atthe early levels. Certainly it is an areathat needs to be covered and have alittle bit more understanding of gettingout of the other side of prescribing.(GP07)

DISCUSSIONPrescribing medications to patients is oneof the core activities of GPs. In Australia,the Bettering the Evaluation and Care ofHealth (BEACH) data from 2002 to 2003showed that at least one medication isprescribed in about 55 per cent of GPencounters, and the overall rate was 104per 100 encounters.23 Generics prescribingis recognised as good prescribing practiceand encouraged from an educational andcost-effectiveness point of view.8,10 GPs inAustralia are currently under increasingpressure to review prescribing habits asdrug expenditure continues to rise.6 Thisexploratory study provides some insightsinto the perceptions held by GPs when itcomes to the use and prescribing ofgenerics. From the interviews, GPsappeared to be either ‘pro-generics’ or‘anti-generics’.

The three main reasons given by thosewho opposed generics included patientconfusion due to the use of differentgeneric products from differentmanufacturers, concerns over the bio-inequivalence of generic medicines and therisk of less money for research-basedcompanies to discover new drugs. Thesereasons are similar to those from twoprevious limited Australian studies thatfocused on GPs’ and pharmacists’ opinionson generic substitution.12,24 None of theGPs interviewed in this study knew thebioequivalence acceptability criteria forgeneric medicines as set by the TGA. Thecurrent TGA criteria for assessingbioequivalence for generic products arebased on single dose in vivo studies inhealthy volunteers. Bioequivalence is



established based on assessments of the rateof absorption involving peak plasmaconcentration (Cmax) and area under theplasma concentration–time curve (AUC).25

The TGA’s criteria are designed to achieve90 per cent confidence that the ratios ofthe test product to that of a referenceproduct under log-transformed meanvalues for AUC and Cmax fall within theinterval from 80 to 125 per cent.25 Thislack of knowledge could have a negativeimpact on the future of genericsprescribing. Product quality data are alsorequired before a generic product can beregistered or listed on the PharmaceuticalBenefits Scheme (PBS).25

On the labelling of generics, concernswere raised about deficiencies in thecurrent labelling requirements by the drugregulatory bodies and their impact onpatient safety. The GPs’ comments mayalso partly be a reflection of patients’general lack of familiarity with genericmedicines and Australians’ greatertendency to identify medicines by theirmakers’ brand names.14 There is a goodcase for Australia to adopt stricter labellingrequirements, similar to those in Britainand the Philippines, which require amedicine to be labelled first by itsscientific or generic name in order toavoid confusion among patients.26,27

Access to medication by patients was amajor concern among those whosupported generics. Based on thedemographics of their practice setting,some of the GPs recognised that patientsmay not have their prescription filled ifthey were prescribed expensive brandedmedicines. Therefore, to improve access tomedication, prescribing cheaper genericmedicines became their preferred option.With regards to the availability of pseudo-generics, GPs felt that it was unfair forpatients to pay different amounts for thesame medicine manufactured by the samecompany with a different brand name.Currently, there has been a proliferation of

pseudo-generics in the Australian market,most of which are available through thePBS.25,28 To overcome this problem, itwas suggested that patients should be toldabout the existence of pseudo-generics sothat they are aware of the profit-makingtactics employed by these types ofmanufacturers.

On the issue of prescribing software,some informants were unhappy with drugcompanies advertising their medicines viathe prescribing software. They alsohighlighted the difficulties in prescribinggenerically with their current prescribingsoftware. The uptake of computers byAustralian GPs was stimulated by theAustralian Government in 1999.29 A one-off grant of around A$10,000 was offeredto those practices that purchased acomputer, acquired internet connectivity(an e-mail address) and promised to usecomputer prescribing software to write themajority of their prescriptions.29 Thisincreased the numbers of GPs writingprescriptions with the aid of a computerfrom around 50 per cent in 1999 to morethan 90 per cent in 2004.29 Legible,printed prescriptions have been one of anumber of positive outcomes of thisinitiative; however, new problemsemerged. One software vendor (HealthCommunication Network Ltd) became thedominant market leader because itsbusiness model relied on pharmaceuticalpromotion to heavily subsidise the cost ofGPs purchasing and updating itsprescribing software (MedicalDirector ).29 This business modelfacilitated software uptake but also resultedin advertisements for the latest and mostexpensive drugs appearing on thecomputer screen at the time of prescribing(and elsewhere).30,31 GPs using thissoftware package were shown to prescribemore antibiotics per patient than thosewho wrote prescriptions manually. It wassuggested that this may have been due todefault settings in the software



automatically writing in the maximumnumber of repeat prescriptions allowed.32

Another default option in this softwarewas the automatic production of a ‘Do notsubstitute generic drugs’ message on theprescription. To overcome this problem,from February 2003, the FederalGovernment required all prescribingsoftware to default to generic medicines,since the existing software — which issponsored by the manufacturers of brandname medicines — automatically ticks the‘not for substitution’ box.33 Doctors willbe able to select brand name drugs, butthey will have to reset the default.

Informants’ opinions of the influences ofdrug advertising were also explored. Theimportance of education for medicalpractitioners in how to deal ethically withinformation received from medicalrepresentatives was highlighted. This typeof education is important becauserelationships involving medicalpractitioners and the pharmaceuticalindustry raise serious concerns andcontroversy within both the medicalprofession and the broader community.34

Furthermore, most information comingfrom the companies is for new and usuallymore expensive medicines, which couldcontribute to financial pressure on the PBSif prescribed in higher volumes withoutsignificant judgments.35 The potential forbias as a result of sponsorship of meetingsby drug companies was also raised. Thereare clearly common interests betweenprofessional societies, which are usuallyresponsible for organising conferences, andthe pharmaceutical industry; the formerstand to gain substantial funding from thepharmaceutical industry for their meetingsand other activities, while, for the latter,targeted opportunities are provided toshowcase their products.34,36 The use ofincentives — such as promotional gifts, bypharmaceutical companies to influenceGPs’ prescribing patterns — was alsodiscussed during the interviews. From the

GPs’ feedback it appears that small gifts,such as pens and notebooks, with apharmaceutical company logo and theirmedicine brand prominently written on it,can influence their prescribing patterns.This is due to the fact that it is easy forthem to remember the names of themedicines from the gifts they see or use ona daily basis.

Dissatisfaction with the governmentpolicy that allows community pharmaciststo perform brand substitution was raisedby some informants, on the basis that theirprofessional role as a prescriber is beingthreatened by the actions of thepharmacist. They were also concernedabout the incentives that pharmacists mightreceive from the generics companies tosupply their products. Furthermore, theycriticised the current policy because thereis no restriction on how many timespharmacists can change patients’medication brands, which, in the longterm could increase the possibility ofpatient confusion. The same issues hadbeen highlighted by GPs in a previousstudy conducted in the early phase of theimplementation of brand substitutionpolicy in Australia.12

Those GPs who were comfortable withgenerics prescribing made somerecommendations on how to improve thecurrent rate of generics prescribing,including giving financial incentives tothose GPs who prescribe generically.The use of financial incentives wasimplemented in countries such as the UKand Ireland in the early 1990s, where GPswere set annual prescribing budgets andallowed to keep a proportion of anyunderspending for future health planningwithin the practice.37 Evidence from theUK suggested GP fundholding led to anincrease in generics prescribing.38,39 Astudy by Bateman et al. focusing on theeffect of using financial incentives tochange generics prescribing behaviour ofnon–fundholding GPs, found that the



incentives increased generics prescribingand resulted in the achievement of targetsavings.40

Patient education on the use of genericsby GPs was also seen as a method ofimproving the utilisation of genericmedicines. An Australian study by Newbyet al., looking at drug information seekingbehaviour among consumers, revealed thatmedical practitioners were more frequentlythe main source of prescription medicationinformation than pharmacists.41 ThereforeGPs are in the best position to educatepatients about the availability of genericmedicines. One of the informants felt thatthere is a need for more informationpertaining to the quality and efficacy ofgeneric medicines to be relayed to GPs.This information is vital to make themconfident in prescribing generic medicines.A study by McGettigan et al., focusing onthe level of generics prescribing amongIrish GPs, identified a low level of genericsprescribing in Ireland compared withEngland, owing to the concerns of IrishGPs about the reliability and quality ofgeneric products.42 In the USA, toovercome GPs’ ambivalence when itcomes to generic prescribing, informationpertaining to issues of quality, safety andefficacy was relayed to them via the federaldrug regulatory body, the Food and DrugAdministration (FDA).43,44 It wassuggested in the interviews that educationof senior medical students on genericsprescribing issues would help to increasegeneric medicine use and prescribing inthe future. Experience from the UKsuggests that teaching medical students toprescribe medicines using the internationalnon-proprietary name (INN) has boostedthe use of unbranded generics.45

Educational intervention strategies aimedat medical students is important becausestudies have shown that to change existingprescribing behaviour among practisingGPs would be difficult and needs morerigorous interventions.46,47

STUDY LIMITATIONSAn often cited limitation of qualitativeresearch is the inability to generalise to alarger population.48 This study wasconducted only with GPs in Melbourneand thus the findings cannot beconfidently generalised to Australian GPspractising in other states. The opinionsgathered from all the interviews conductedin the present study will be useful for alarge follow-up quantitative survey amongthe GPs, however, since the prescribingprocess for medications under the PBSsystem are uniform across Australia.

CONCLUSIONPrescribing generic medicines involvescomplex decision-making processes thatrequire a number of personal andprofessional judgments to be made aboutphysical, psychosocial and economicdimensions of health. Perceptions of theGPs in this qualitative study show thatthey are interested in economic prescribingbut are not being educated and reassuredabout generic medicines by the interestedparties. Accordingly, lack of knowledgestill persists about the safety and efficacy ofgeneric medicines. These are issues whichmust be tackled if the current level ofgenerics prescribing in Australia is toincrease.

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Generic medicines: Perceptions of general practitioners in Melbourne, Australia

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