Is there a relationship between patient beliefs or communication about generic drugs and medication utilization?
BACKGROUND
Insurers and policymakers strive to stimulate more cost-effective prescribing and, increasingly, are educating beneficiaries about generics.


OBJECTIVE
To evaluate the relationship between patient beliefs and communication about generic drugs and actual drug use.


METHODS
We performed a national mailed survey of a random sample of 2500 commercially-insured adults. Patient responses were linked to pharmacy claims data to assess actual generic medication use.


METHODS
We used factor analysis to develop 5 multi-item scales from patient survey responses that measured: (1) general preferences for generics, (2) generic safety/effectiveness, (3) generic cost/value, (4) comfort with generic substitution, and (5) communication with providers about generics. The relationship between each scale and the proportion of prescriptions filled for generics was assessed using linear regression, controlling for demographic, health, and insurance characteristics. Separate models were created for each scale and then all 5 scales were included simultaneously in a fully-adjusted model.


RESULTS
The usable response rate was 48%. When evaluated independently, a 1 SD increase in each of the 5 scales was associated with a 3.1% to 6.3% increase in generic drug use (P < 0.05 for each). In the fully adjusted model, only 2 scales were significantly associated with generic drug use: comfort with generic substitution (P = 0.021) and communication with providers about generic drugs (P = 0.012).


CONCLUSIONS
Generic drug use is most closely associated with the 2 actionable items we evaluated: communication with providers about generics and comfort with generic substitution. Educational campaigns that focus on these 2 domains may be most effective at influencing generic drug use.
Shrank
William H
WH
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA. wshrank@partners.org
Cadarette
Suzanne M
SM
Cox
Emily
E
Fischer
Michael A
MA
Mehta
Jyotsna
J
Brookhart
Alan M
AM
Avorn
Jerry
J
Choudhry
Niteesh K
NK
D000328:Adult; D000368:Aged; D003142:Communication; D016527:Drug Costs; D016568:Drugs, Generic / Q000627:therapeutic use*; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010465:Perception; D010817:Physician-Patient Relations; D012449:Safety; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
D016568:Drugs, Generic