Introduction
Pharmaceuticals play an important role in the community’s health improvement and maintenance. Controlling their expense in healthcare budgets, on the other hand, is a big challenge for governments all over the world [1,2]. In many countries, the advancement of cheaper generics, whether by generic prescription or generic replacement, has resulted in significant savings in the healthcare sector [3]. Furthermore, generic drugs offer patients and the government a way to offset the increasing cost of healthcare [4]. In developing countries, one-third of the population has no access to medicines [5]. The high costs of brand-name drugs often hinder accessibility. One alternative is for healthcare providers to be encouraged to use generic medications [6].
The World Health Organization defines generic medicine as a pharmaceutical product, usually intended to be interchangeable with an innovator product that is manufactured without a license from the innovator company and marketed after the expiry date of the patent or other exclusive rights [7]. According to the Food and Drug Administration (FDA), generic medicine is a drug product that is bioequivalent to a brand or reference listed drug product in terms of dosage form, strength, route of administration, quality, safety, performance characteristics, and intended use [8]. The European Medical Agency defines a generic medicine as a medicine that is developed to be the same as a medicine that has already been authorized. A generic drug contains the same active ingredients as the reference medicine and is prescribed at the same doses to treat the same diseases [9].
Although generic drugs are bioequivalent to their innovator counterparts and are manufactured in identical facilities using good manufacturing practices [10,11], they are generally thought to be inferior to branded products in terms of therapeutic efficacy and quality [12,13]. With limited resources, we aim to provide a high-quality healthcare system to the people [14], the expanded use of generic drugs will help to make healthcare more affordable without compromising quality [15]. The US FDA has determined that generic medicines are bioequivalent to brand-name drugs in terms of safety, strength, and quality [16].
To overcome the cost issue, there has been a rise in the number of drugs entering the market under generic names. However, since most marketed drugs are produced by multinational companies and large Indian companies are strongly supported by prescribing doctors, it has largely failed to affect economic pressure on health care [17–19]. To address this issue, which has had a significant economic effect on the poor people, the Indian government launched the Jan Aushadhi campaign in April 2008, opening government-controlled centers across the country to provide quality generic medicines at lower prices than their branded counterparts, making them more affordable and easily available to a common man [20].
Understanding potential pharmacists’ views, such as those held by pharmacy preregistrants, is critical because their experience and attitudes at this point in their careers will affect their future prescribing and replacement of generic medicines [21]. Inadequate or inaccurate generic awareness among healthcare professionals causes hesitation in the use of these drugs, especially when it comes to their effectiveness, and this is becoming a major barrier to their widespread use [22,23].
Generic medicines are approved to be bioequivalent to brand-name drugs in terms of safety, strength, and quality by the US FDA. However, in most of the developing countries, generic medicines are not as frequently prescribed due to a lack of knowledge and awareness regarding generic medicines in both prescribers and patients. There is a perception of pharmacists and the general population that generic medicines are of inferior quality to branded medicines. Hence, the present study was planned to compare and evaluate knowledge, attitude, and practice (KAP) among community registered pharmacists and students of pharmacy.
Methods and Materials
A cross-sectional questionnaire-based study, which is designed to evaluate theKAP of generic versus branded medicines among the pharmacy students of RPCP, CHARUSAT, and pharmacists working at various community pharmacy stores. The study population was categorized into two groups, in which, group 1 involves 140 pharmacy students and group 2 involves 100 pharmacy professionals as registered pharmacists in community-based Pharmacies of Anand and Nadiad cities. The study duration was from October 2020 to January 2021.
The data collection procedure was carried out using a questionnaire by personal interaction. A self-administered questionnaire was developed through an extensive review of available literature on KAP regarding generic medicines. The questionnaire was developed in English language and contained sections on the socio-demographic profiles of the participants which were followed by questions that assess their KAP toward generic medicines. Two different sets of questionnaires were created for pharmacy students and pharmacy professionals on KAP using available questionnaires [21,24,25]. A questionnaire was prepared using Google Form and a link was circulated among both the groups. For pharmacy students group-1, the Google Forms link was forwarded through class coordinators in their WhatsApp class groups, and responses were collected. For pharmacy professionals group-2, personal interaction was carried out at their pharmacy store and priorly verbal consent was taken before initiation of the survey; in addition, a link was forwarded to their WhatsApp number, and responses were collected.
Statistical analysis including descriptive analyses was performed using Microsoft Excel. Data were expressed as numbers and percentages. Overall % knowledge score was obtained and compared between both groups. The score was assigned to each knowledge variable, where a score of ‘‘1’’ was assigned to each correct answer and a score of ‘‘0’’ for incorrect or do not know answers. The maximum cumulative knowledge score (CKS) for pharmacy students was 10 since there were 10 questions to evaluate the knowledge of respondents toward generic medicines and for registered pharmacists was 8 since there were 8 questions to evaluate the knowledge of respondents toward generic medicines. The overall % knowledge score (score obtained/CKS × 100) was calculated for each participant. Knowledge score was interpreted as; good (score ≥70%), fair (score 50.1%–69.9%), and poor (score ≤50%). The percentage knowledge score was also calculated against each domain of results.
Results
A total of 140 pharmacy students from RPCP and CHARUSAT were willing to participate in the study from October 2020 to January 2021. Most of the respondents were from the age between 19 and 21 years which constitutes 72%. Female students (72%) participation was predominant in the present study. The majority of the students enrolled in the study were from the second year of pharmacy (40%). The most of respondents were residing in the Urban area of residence (61%). Nearly 92% of the students disclosed that they were aware of branded and generic medicines (Table 1).
Table 1.
Demographic characteristics of pharmacy students (N=140).
| Sr. no. | Variables | Number (n, %) | Frequency (%) |
|---|---|---|---|
| 1 | Age | ||
| 18 years | 16 | 11 | |
| 19 years | 32 | 23 | |
| 20 years | 36 | 26 | |
| 21 years | 32 | 23 | |
| 22 years | 13 | 9 | |
| 23 years | 8 | 6 | |
| 24 years | 3 | 2 | |
| 2 | Gender | ||
| Male | 39 | 28 | |
| Female | 101 | 72 | |
| 3 | Year of study | ||
| First year | 7 | 5 | |
| Second year | 56 | 40 | |
| Third year | 44 | 31 | |
| Fourth year | 33 | 24 | |
| 4 | Area of residence | ||
| Rural | 54 | 39 | |
| Urban | 86 | 61 | |
| 5 | Awareness of generic medicines | ||
| Yes | 127 | 91 | |
| No | 13 | 9 | |
| 6 | Awareness of branded medicines | ||
| Yes | 129 | 92 | |
| No | 11 | 8 | |
Out of 140 pharmacy students, the mean age was 21 ± 2.16 years with a minimum of 18 years to a maximum of up to 24 years. The majority of students were from the age between 19 and 21 years which constituted 72% of the study population. Out of the total students, the majority of the students who participated in the study were female (72%) as compared to male (28%).
A total of 10 questions regarding knowledge of generic medicines against which their performance was checked. For question 1, 94 (67.1%) out of 140 responded “yes” for generic medicines to be used in place of branded medicines. The majority of them believed that generic medicine contains the same active substance as the branded medicine 92 (65.7%). Maximum out of the total, 85 (60.7%) respondents were aware of the scheme of the Government of India called “Jan Aushadhi” purpose is to set up generic medicines stores around the country (Table 2).
Evaluation of attitude about generic medicine among pharmacy students
In this section, there is 12 question, which evaluates pharmacy students’ attitude toward generic medicines. The majority of the students disagreed with the fact that generic medicines are not as safe 61 (43.6%) and effective 66 (47.1%) as branded medicines (Table 3).
Evaluation of practise about generic medicine among pharmacy students
There are three questions for pharmacy students that would evaluate their practice toward generic medicines. Nearly 60% of students would recommend as well as prefer to take generic medicines over branded medicines (Table 4).
A total of 100 registered pharmacists from the region of Anand and Nadiad participated in the study from October 2020 to January 2021. Most of the respondents were from the age between 20 and 29 years which constitutes 61 (61%), the mean age was 30 ± 6.20 years ( Table 5).
There are eight questions that represent the response of registered pharmacists on various statements regarding their knowledge and understanding of generic medicines. Nearly 82% of pharmacists were aware of the Jan Aushadhi Scheme by the Government of India (Table 6).
In this section, there are 10 questions regarding the attitude of generic medicines among registered pharmacists. The majority of the respondents agree to the fact that generic medicines are less effective 65 (65%), produce more side effects 52 (52%), and have a slow onset of action 55 (55%) than branded medicines (Table 7).
Table 2.
Pharmacy student’s knowledge on generic medicines.
| Sr. no. | Variables | Yes | No | Do not know |
|---|---|---|---|---|
| 1 | Can generic medicines be used in place of branded medicines? | 94 (67.1%) | 32 (22.9%) | 14 (10%) |
| 2 | Can generic medicines only be marketed after the expiry of branded medicines? | 42 (30%) | 77 (55%) | 21 (15%) |
| 3 | Does a generic medicine contain the same active substance as the branded medicine? | 92 (65.7%) | 28 (20%) | 20 (14.3%) |
| 4 | Can a generic medicine be used at the same dose to treat the same disease as the branded medicine? | 84 (60%) | 27 (19.3%) | 29 (20.7%) |
| 5 | Does a generic medicine manufacturer need to repeat the preclinical studies and clinical trials for generic medicines? | 48 (34.3%) | 60 (42.9%) | 32 (22.9%) |
| 6 | Do generic medicine manufacturers need to conduct bioavailability and bioequivalence studies to demonstrate between generic and branded medicines? | 89 (63.6%) | 20 (14.3%) | 31 (22.1%) |
| 7 | Are generic medicines costlier than branded medicines? | 15 (10.7%) | 113 (80.7%) | 12 (8.6%) |
| 8 | Is there any law in India that states that every physician should, as far as possible prescribe drugs with generic names? | 46 (32.9%) | 39 (27.9%) | 55 (39.3%) |
| 9 | Are you aware of the scheme of the Government of India called “Jan Aushadhi” purpose is to set up generic medicines stores around the country? | 85 (60.7%) | 27 (19.3%) | 28 (20%) |
| 10 | Is the patient or pharmacist legally empowered to purchase or sell generic medicines in place of prescribed branded medicines? | 63 (45%) | 40 (28.6%) | 26.4%) |
Table 3.
Pharmacy student’s attitude on generic medicines.
| Sr. no. | Variables | Agree | Disagree | Neutral |
|---|---|---|---|---|
| 1 | Generic medicines are not as safe as branded medicines | 34 (24.3%) | 61 (43.6%) | 45 (32.1%) |
| 2 | Generic medicines are not as effective as branded medicines | 33 (23.6%) | 66 (47.1%) | 41 (29.3%) |
| 3 | Generic medicines have a shorter duration of action in comparison to branded medicines | 40 (28.6%) | 60 (42.9%) | 40 (28.3%) |
| 4 | Branded medicines are made in modern manufacturing facilities whereas generic medicines are often made in substandard manufacturing facilities | 52 (37.1%) | 45 (32.1%) | 43 (30.7%) |
| 5 | Generic medicines cost less because they are inferior to branded medicines | 67 (47.9%) | 44 (31.4%) | 29 (20.7%) |
| 6 | Give your opinion about whether there should be a training program to increase awareness regarding generic medicines among doctors and patients | 108 (77.1%) | 10 (7.1%) | 22 (15.7%) |
| 7 | Do you think that there should be a generic medicines store at every government hospital? | 103 (73.6%) | 13 (9.3%) | 24 (17.1%) |
| 8 | What is your opinion about whether there should be a law that limits doctors to compulsorily prescribing generic drugs? | 46 (32.9%) | 35 (25%) | 59 (42.1%) |
| 9 | Do you think that medical insurance companies should give preference to generic medicines over branded medicines while reimbursing insurance? | 55 (39.3%) | 26 (18.6%) | 59 (42.1%) |
| 10 | What is your opinion about whether patients should be legally given the freedom to choose generic or branded medicine? | 101 (72.1%) | 13 (9.3%) | 26 (18.6%) |
| 11 | Branded medicines should be preferred over generic medicines in life-threatening conditions | 80 (57.1%) | 17 (12.1%) | 43 (30.7%) |
| 12 | Do generic medicines produce more side effects than branded medicines? | 25 (17.9%) | 52 (37.1%) | (45%) |
Table 4.
Pharmacy student’s practise on generic medicines.
| Sr. no. | Variables | Yes | No |
|---|---|---|---|
| 1 | Have you ever read any article on the comparison of the safety and efficacy of generic versus branded medicines? | 48 (34.3%) | 92 (65.7%) |
| 2 | Would you recommend generic medicines over branded medicines? | 84 (60%) | 56 (40%) |
| 3 | Would you prefer to take generic medicines over branded medicines? | 83 (59.3%) | 57 (40.7%) |
Table 5.
Demographic characteristics of registered pharmacists (N=100).
| Sr. no. | Variables | Number (n) | Frequency (%) |
|---|---|---|---|
| 1 | Age | ||
| 20–29 years | 61 | 61 | |
| 30–39 years | 28 | 28 | |
| 40+ years | 11 | 11 | |
| 2 | Gender | ||
| Male | 55 | 55 | |
| Female | 45 | 45 | |
| 3 | Qualifications | ||
| Diploma | 25 | 25 | |
| Bachelors | 66 | 66 | |
| Masters | 9 | 9 | |
| 4 | Employment position | ||
| Full/Part owner | 42 | 42 | |
| Employee | 57 | 57 | |
| Business | 1 | 1 | |
| 5 | Registered pharmacist with a license | ||
| Yes | 93 | 93 | |
| No | 7 | 7 | |
| 6 | Work experience | ||
| <1 year | 13 | 13 | |
| 1–3 years | 25 | 25 | |
| 4–6 years | 30 | 30 | |
| 7–10 years | 19 | 19 | |
| >10 years | 13 | 13 | |
| 7 | Number of prescriptions dispensed per day | ||
| 0–20 | 19 | 19 | |
| 21–40 | 24 | 24 | |
| 41–60 | 21 | 21 | |
| 61–80 | 12 | 12 | |
| 81–100 | 7 | 7 | |
| >100 | 17 | 17 | |
The majority of their personal experience with medicines will affect the dispensing of generic drugs 71 (71%) (Table 8).
The mean CKS was 5.33 ± 2.17 for pharmacy students and 4.67 ± 2.07 for registered pharmacists. Among pharmacy students, the percentage of respondents with good knowledge was 25%, while 40.7% and 34.3% of respondents had fair and poor knowledge, respectively. In the case of registered pharmacists, the percentage of respondents with good knowledge was 18%, while 44% and 38% had fair and poor knowledge, respectively. The pharmacy students were more knowledgeable as compared to the pharmacists working in the community settings (Table 9).
Discussion
Brand medicines are usually highly expensive, and their widespread use increases the healthcare budget. In economically developing countries, this creates significant financial and clinical issues [26]. As a result, approving their substitution with generic medications lowers healthcare costs while increasing public access and adherence to essential medicines [27]. It has been reported that not only doctors but also pharmacists prefer to dispense brand-name medications [28,29]. Furthermore, patients have a poor understanding of generic medicines and have misconceptions about them [30]. A clear understanding of essential concepts with generic medicines and specific regulatory standards for drugs to be registered as generic is critical and there are important measurements of KAP [31].
The present study was planned to evaluate the KAP of generic versus branded medicines among the pharmacy students and registered pharmacists working at various community pharmacy stores.
In the present study, there were a “total of 140 study participants as a pharmacy students” from RPCP and CHARUSAT. The “mean age of pharmacy students was 21 ± 2.16 years with a minimum of 18 years to a maximum of up to 24” years which is by the study done by Asif et al. [32]. The majority of participants enrolled were “female (72%) as compared to male (28%)” and a similar study was done by Sharif et al. [33] shows the majority (83.9%) of students were females. Nearly “more than 90% of students were aware of generic medicines and branded medicines” which was similar to the study carried out by Siam et al. [25] in which nearly 85% of the students were aware of branded and generic medicines.
Table 6.
Registered pharmacist’s knowledge of generic medicines.
| Sr. no. | Variables | Agree | Disagree | Neutral |
|---|---|---|---|---|
| 1 | A generic medicine is bioequivalent to a branded medicine | 68 (68%) | 27 (27%) | 5 (5%) |
| 2 | A generic medicine must contain the same amount of active ingredients as the branded medicine | 57 (57%) | 41 (41%) | 2 (2%) |
| 3 | A generic medicine must be in the same dosage form as the branded medicine | 73 (73%) | 25 (25%) | 2 (2%) |
| 4 | Generic medicines are cheaper than branded medicines | 61 (61%) | 32 (32%) | 7 (7%) |
| 5 | Wider use of generic medicines helps in decreasing the country’s health care expenditure | 71 (71%) | 26 (26%) | 3 (3%) |
| 6 | Community pharmacists have the right to suggest generic substitutions to patients | 64 (64%) | 29 (29%) | 7 (7%) |
| 7 | Generic substitution of medicines with narrow therapeutic index is inappropriate | 59 (59%) | 31 (31%) | 10 (10%) |
| 8 | Are you aware of the “Jan Aushadhi Scheme” by the Government of India? | Yes 82 (82%) | No 18 (18%) | - |
Table 7.
Registered pharmacist’s attitude on generic medicines.
| Sr. no. | Variables | Agree | Disagree | Neutral |
|---|---|---|---|---|
| 1 | Generic medicines are less effective than branded medicines | 65 (65%) | 33 (33%) | 2 (2%) |
| 2 | Branded medicines are of higher quality compared to generic medicines | 57 (57%) | 41 (41%) | 2 (2%) |
| 3 | Generic drugs produce more side effects than branded medicines | 52 (52%) | 38 (38%) | 10 (10%) |
| 4 | Generic medicines have a slow onset of action | 55 (55%) | 39 (39%) | 6 (6%) |
| 5 | I suggest generic substitutions for branded medicines in all cases where a generic is available | 62 (62%) | 33 (33%) | 5 (5%) |
| 6 | The price difference between generic and branded medicine is often so great that I feel I must dispense prescriptions with generic substitutions, especially for people who cannot afford | 66 (66%) | 32 (32%) | 2 (2%) |
| 7 | Patients should be given enough explanation about the reasons for choosing generic medications | 66 (66%) | 30 (30%) | 4 (4%) |
| 8 | The intensity of promotional activities by promoters plays an important role in dispensing branded medicines | 64 (64%) | 27 (27%) | 9 (9%) |
| 9 | Community pharmacists should be allowed to dispense generic substitutions without consulting prescribing physicians | 71 (71%) | 26 (26%) | 3 (3%) |
| 10 | National-level online reference should be made available for generic medicines | 75 (75%) | 21 (21%) | (4%) |
Table 8.
Registered pharmacist’s practise on generic medicines.
| Sr. no. | Variables | Yes | No |
|---|---|---|---|
| 1 | Do you dispense generic medicines? | 68 (68%) | 32 (32%) |
| 2 | Do you dispense generic medicines from local manufacturers? | 55 (55%) | 45 (45%) |
| 3 | Do you discuss with patients before dispensing generic medicines? | 59 (59%) | 41 (41%) |
| 4 | Do you dispense generic medicines based on the socio-economic status of patients? | 52 (52%) | 48 (48%) |
| 5 | Do you allow patients to substitute generic for branded or branded for generic drugs? | 61 (61%) | 39 (39%) |
| 6 | My personal experience with medicines will affect the dispensing of generic drugs. | 71 (71%) | 29 (29%) |
In the current study, the maximum number of students 94 (67.1%) agreed, “generic medicines can be used in place of branded medicines.” The majority of the students 77 (55%) denied, “generic medicines can only be marketed after the expiry of branded medicines” which shows a knowledge deficit in terms of the marketing and approval process. Moreover, 92 (65.7%) students knew that “generic medicine contains the same active substance as the branded medicine” and 84 (60%) found that “generic medicine be used at the same dose to treat the same disease as the branded medicine.” A similar study was done on medical students which found parallel observations showed that 76.5% knew that generic drugs can be used in place of innovator drugs, only 13.2% agreed that generic drugs can only be marketed after the expiry date of innovator drugs; 61.8% knew that generic drug contains the same active substance as the innovator drug, while 63.2% knew that it is used at the same dose to treat the same disease as the innovator drug by Tandel et al. [34].
Table 9.
Comparison of knowledge score between both groups.
| Groups | Good | Fair | Poor |
|---|---|---|---|
| Pharmacy students | 35 (25%) | 57 (40.7%) | 48 (34.3%) |
| Registered pharmacists | 18 (18%) | 44 (44%) | 38 (38%) |
Students knew of preclinical studies, clinical trials, and bioavailability and bioequivalence studies which showed that 60 (42.9%) students knew that “generic medicine manufacturer need not repeat the preclinical studies and clinical trials for generic medicines” as well as 89 (63.6%) students said, “generic medicine manufacturer need not conduct bioavailability and bioequivalence studies to demonstrate between generic and branded medicines.” Regulatory requirements by the government mention generic medicines need not be passed from preclinical studies and clinical trials, but they must be passed from bioavailability and bioequivalence studies [35].
India has developed a strong capability in manufacturing high-quality generic and branded drugs across a wide range of therapeutic categories over the years. However, there are still overburdened healthcare costs for the country’s population. As a result, the government has taken some significant measures to achieve the primary goal of ensuring that all citizens have access to high-quality medicines at reasonable rates. As part of this mission, the Indian government launched the Jan Aushadhi project in November 2008, which assists in all aspects of setting up a generic medicine shop. However, no progress has been made against the target goals. As a result, in August 2013, a new initiative was launched with a new goal of establishing 3,000 generic medicine stores across India by the end of 2016–2017. To date, 2,849 Jan Aushadhi stores have opened across India, with a total of 757 generic drugs available. Furthermore, the government has released guidelines for opening a generic drug store [34,36]. The majority of the students 113 (80.7%) were aware that “generic medicines are cheaper than branded medicines” and 85 (60.7%) were “aware about of the scheme of the Government of India called Jan Aushadhi whose purpose is to setup generic medicines stores around the country”.
Many students 55 (39.3%) did not know that “there any law in India which states that every physician should, as far as possible prescribe drugs with generic names”. Moreover, maximum students 63 (45%) agreed that the “patient or pharmacist legally empowered to purchase or sell generic medicines in place of prescribed branded medicines”, similar to findings reported by Tandel et al. [34].
In the present study, the attitude of pharmacy students toward generic medicines showed that the majority of the students 61 (43.6%) disagreed, “generic medicines are not as safe as branded medicines” and 66 (47.1%) students believed that, “generic medicines are not as effective as branded medicines” and 60 (42.9%) students assumed “generic medicines have a shorter duration of action in comparison to branded medicines”. In contrast, the results of the study conducted in the USA, state that participants perceived generic drugs to be safe (68%) and effective (62%), and 50% did not consider them to be identical to brand equivalents by Sansgiry et al. [37]. Of maximum students, 52 (37.1%) believed that “branded medicines are made in modern manufacturing facilities whereas generic medicines are often made in substandard manufacturing facilities” and 67 (47.9%) students agreed that “generic medicines cost less because they are inferior to branded medicines,” which is similar to the previous study which states nearly a half of the respondents believed that generics are inferior in quality, which is why they are cheap and have more side effects by Siam et al. [25].
When it comes to opinion, 108 (77.1%) students strongly agreed that “there should be a training program to increase the awareness regarding generic medicines among doctors and patients” and 103 (73.6%) students believed that “there should be a generic medicines store at every government hospital.” In India, doctors, as well as patients, have little less awareness about generic medicines so, 88% of participants agree that there should be some training sessions for doctors and patients about awareness of generic medicines. The government hospitals are providing safe, affordable, and effective healthcare services to poor and needy patients. Hence, the government should take the initiative to start generic drug stores in every government hospital in India by Chavda et al. [38].
In the next opinion regarding prescribers, 59 (42.1%) students showed neutral responses about “there should be a law which bounds doctors to compulsory prescribe generic drugs” and 59 (42.1%) showed a similar response in “do you think that medical insurance companies should give preference to generic medicines over branded medicines while reimbursement of insurance.” Maximum students 101 (72.1%) believed that “patients should be legally given the freedom to choose generic or branded medicine.” Similar findings were reported by Tandel et al. [39].
The majority of the 80 (57.1%) believed that “in case of emergency branded medicines should be preferred over generic medicines in life-threatening conditions” which corresponds to a study carried out by Siam et al. [25] in which (80%) of students believed in this statement. Many students 63 (45%) did not conclude whether “generic medicines produce more side effects than branded medicines” and, in this situation, they had neutral responses. Similar study findings were reported in Australia, it was found that generic medicines are inferior in quality, less effective, produce more side effects, and are less safe than brand-name medicines by Hassali et al. [21].
In the present study, for the pharmacy students in this practice section, their preferences and recommendations were evaluated rather than dispensing practice because they are currently pursuing their studies and have zero work experience. From their responses, it is observed that a maximum of students 84 (60%) would “recommend generic medicines over branded medicines” as well as 83 (59.3%) students agreed they would “prefer to take generic medicines over branded medicines.” Maximum 92 (65.7%) “students have not come across or had you ever read any article on the comparison of the safety and efficacy of generic versus branded medicines.” A similar finding was reported showing that 66% of intern doctors and 80% of medical students have not come across any article on the comparison of the safety and efficacy of generic versus branded medicines by Tandel et al. [39] and Chavda et al. [38].
Community pharmacists play an important role in drug therapy and have a professional responsibility to assist patients in selecting high-quality, safe, effective, and affordable medications. Furthermore, they have sufficient knowledge, a positive attitude, and practice that can influence pharmaceutical product selection and promote medical access [40].
In the present study, a total of 100 registered pharmacists from various community pharmacies from the region of Anand and Nadiad city were enrolled. The mean age was found to be 30 ± 6.20 years. Overall, there was higher participation from “male pharmacists (55%) whereas female pharmacists were (45%)” which is in accordance with the study done by Yared [22]. It shows that the participants in this study above half were male and 58.2% were in the age range of 20–29.
The majority of the “registered pharmacist pharmacists were holding bachelor’s degree in pharmacy (66%) whereas the rest had diploma (25%) and master’s (9%) degree in pharmacy,” which is similar to the previous study which shows that 80% had BPharm degree as their highest qualification by Alkhuzaee et al. [41]. Maximum of respondents were “working as an employee at the pharmacy store (57%).” Nearly “93% of the pharmacists were registered with the license.” Moreover, “30% of pharmacists had 4–6 years of work experience.” Similar findings reported overall work experience with 40% having 4–7 years of practice experience by Alkhuzaee et al. [41].
In the current study, the majority of the registered pharmacists 68 (68%) agreed that a “generic medicine is bioequivalent to the branded medicine,” a similar study reported 80% carried out by Wajid et al. [42], and 57 (57%) agreed that “generic medicine must contain the same amount of active ingredients as the branded medicine,” a similar finding observed 76% by previous study Gupta et al. [43], while 73 (73%) assumed that “generic medicine must be in the same dosage form as the branded medicine,” a similar finding observed 72% reported by Wajid et al. [42], and 61 (61%) believed that “generic medicines are cheaper than branded medicines,” which is similar to 70% of the previous study carried out by Babar et al. [40].
Maximum responses 71 (71%) show that pharmacists believed that “wider use of generic medicines helps in decreasing the country’s health care expenditure,” which is similar to the study shows 68% agreed that linked reduction of governmental healthcare expenditure to wider use of generics by Shraim et al. [6], and 64 (64%) believed that “community pharmacists have the right to suggest generic substitution to patients.” Moreover, many of them 59 (59%) agreed that “generic substitution of medicines with narrow therapeutic index is inappropriate” which is similarly reported by 75% in a study carried out by Chong et al. [29]. Out of the total, 82 (82%) registered pharmacists were “aware of the Jan Aushadhi Scheme by the Government of India.” A similar study was done which found 68% reported by Gupta et al. [14].
In the present study as per the observation of the responses, the majority of the registered pharmacists 65 (65%) believed that “generic medicines are less effective than branded medicines,” a similar study had much lower responses of 34% who had an attitude of generic medicines are less effective compared to brand name medicines by Yared [22] and 41 (41%) disagreed that “branded medicines are of higher quality compared to generic medicines,” which is similar to 50% in the study by Yared [22], while 52 (52%) assumed that “generic drugs produce more side effects than branded medicines,” a similar study reported 51% by Wajid et al. [42] and 55 (55%) agreed that “generic medicines have a slow onset of action.”
Many of the pharmacists 62 (62%) suggest that “generic substitutions for branded medicines in all cases where a generic is available,” a similar study had much lower responses of 39% carried out by Yared [22]. Moreover, 66 (66%) believed that “pharmacists feel that the price difference between generic and branded medicine is often so great that they must dispense prescriptions with generic substitutions especially for people who cannot afford.”
Of maximum pharmacists, 66 (66%) agreed that “patients should be given enough explanation about the reasons for choosing generic medications” and 71 (71%) believed that community pharmacists should be allowed to “dispense generic substitutions without consulting prescribing physicians,” a similar finding observed 69% by previous study Shraim et al. [6]. Many of the pharmacists 64 (64%) do feel that “the intensity of promotional activities by promoters plays an important role in dispensing branded medicines” which is similar to the study that shows 62% believed that advertisements by drug companies will influence their dispensing pattern carried out by Alkhuzaee et al. [41]. Lastly, maximum responses 75 (75%) showed that “national level online reference should be made available for generic medicines” which would be better for all in healthcare facilities. Similar findings were reported by 85% of doctors in a study carried out by Prasad et al. [44].
In the current study, this section shows the dispensing pattern of generic medicines. Out of the total, 68 (68%) of them “dispense generic medicines,” a similar study reported 58% while 55 (55%) dispense generic medicines “from local manufacturers” constitutes which is in contrast to 27% in the previous study carried out by Prasad et al. [44]. Among the total, 59 (59%) of pharmacists say that they “discuss with patients before dispensing generic medicines” and also, 52 (52%) “dispense generic medicines based on the socio-economic status of patients” and a majority of the time, 61 (61%) they “allow patients to substitute generic for branded or branded for generic drugs,” the observations of the study are in accordance to discussion on dispensing generic medicines (64%), patients socioeconomic factors (74%) and patients demand (60%) by Wajid et al. [42]. At last, the maximum number of respondents 71 (71%) agreed that “based on their personal experience with medicines it will affect dispensing of generic drugs.” The finding is similar to 66% of the study done by Prasad et al. [44].
Conclusion
The overall knowledge score findings showed that pharmacy students had better knowledge when compared with pharmacists working in community pharmacies. Generic medicine substitution among pharmacists is widespread and prevalent. The findings of the study found that participant pharmacists had basic knowledge with regard to generic medicine. However, their knowledge score pertaining to the technical and regulatory aspects of bioequivalence and pharmacokinetic parameters, in particular, was insufficient. The dispensing pattern of generic medicines at various community pharmacies showed that the majority of them have been dispensing generic medicines from local manufacturers. This may also create awareness about the right of the patient to opt for generics (when available) and gain momentum for affordable health care.
