371 Substituting Brand-Name Drugs With Generics In German General Practice

Anne Simmenroth-Nayda, Eva Hummers-Pradier, Wilhelm Niebling, Thomas Ledig, Rolf Jansen, Michael M. Kochen and the Generic Drugs Project Group
In Germany, the market for generic drugs is well developed and general practitioners (GPs) are supposed to prescribe more generics to contain health care costs. Difficulties in substituting GP patients’ brand name drugs by generic drugs were studied in a multicentre intervention study.
Methods: 62 (10 %) of all GPs in one geographical area of southern Germany agreed to participate in the trial. As part of the intervention, 46 GPs shared their experiences with an interviewer during an educational outreach visit, all conducted by the same person .
Results: While most of the GPs realise the economic necessity of generic substitution, they are not always convinced of the equivalence of generic compared to brand name drugs. The most important barrier, however, is perceived to be patients’ lack of acceptance. Several different strategies to approach the substitution issue could be identified. Some GPs emphasized the importance of the doctor-patient relationship: A fair discussion would usually result in acceptance of substitution, except in patients having suffered a myocardial infarction or in generally very demanding patients. Other GPs stated that a rather authoritarian approach was helpful. Another group of GPs said the main barriers were lack of cooperation of hospitals, pharmacies, community specialists or political institutions, leaving them with feelings of helplessness or resignation. Some of these GPs had finally resigned from substitution attempts.
The results of this study suggest that GPs` attitudes are more important than patients` non-acceptance in generic substitution. Many GPs perceive strong barriers to continuously implement cost saving policies.
371 Substituting Brand-Name Drugs with Generics in German General Practice