title: Generic drug prescriptions following hospital discharge: a prospective study in France.
abstract: OBJECTIVE
  Systematic generic prescription at discharge could reduce confusion on drug-name usage, decrease commercial influence on medicine, and reduce drug-related expenditures. This study aimed to analyze generic drug prescriptions at discharge from hospital and to estimate the potential savings associated with a total substitution policy (substitution of every substitutable drug for its cheapest generic counterpart).
  
  
  METHODS
  Drug prescriptions before admission and at discharge of all patients from three medical units of a university hospital were prospectively collected for five weeks without informing prescribers.
  
  
  RESULTS
  Prescriptions from 85 patients were analyzed. On admission, 68 patients (80%) received 413 drugs; 141 were substitutable brand-name drugs and 23 (16%), which were directly prescribed as generics. At discharge, 488 drugs were prescribed to the 85 patients; 180 were substitutable drugs but only 5 (2.8%) were written as generics on prescription pads, a decrease of 78% (p<0.0001) compared to admission. In average, generics were 18% less expensive than brand-name drugs. Some common therapeutic classes offered even greater price difference, such as proton-pump inhibitors (42%), statins (32%), or antihypertensive agents (28%). Potential savings from a total substitution policy at discharge were estimated to €1512 per 1000 patients per week; for lifetime drugs, savings amounted to €18,960 per 1000 patients per year.
  
  
  CONCLUSIONS
  Very few drugs are written as generics on medical forms at discharge in France. Hospital practitioners should be encouraged to prescribe generics, particularly in chronic diseases. A broad generic prescription policy at hospital discharge would result in substantial savings for health insurance.
authors.affiliation: Pharmacy, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paul Brousse, 12-14 avenue Paul Vaillant-Couturier, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Chu
authors.forename: E
authors.initials: E
authors.lastname: Rudant
authors.forename: M
authors.initials: M
authors.lastname: Bonvalet
authors.forename: H
authors.initials: H
authors.lastname: Agostini
authors.forename: P
authors.initials: P
authors.lastname: Cavalié
authors.forename: L
authors.initials: L
authors.lastname: Bonhomme-Faivre
authors.forename: J
authors.initials: J
authors.lastname: Frenkiel
authors.forename: J
authors.initials: J
authors.lastname: Taillandier
authors.forename: A
authors.initials: A
authors.lastname: Boissonnas
authors.forename: D
authors.initials: D
authors.lastname: Vittecoq
authors.forename: B
authors.initials: B
authors.lastname: Wyplosz
mesh_terms: D000368:Aged; D016527:Drug Costs / Q000706:statistics & numerical data*; D011307:Drug Prescriptions; D016568:Drugs, Generic / Q000191:economics*; D005260:Female; D005602:France; D005102:Health Expenditures; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics*; D011446:Prospective Studies
chemical_list: D016568:Drugs, Generic