title: Generic immunosuppression: deciphering the message our patients are receiving.
abstract: BACKGROUND
  The introduction of generic immunosuppressants elicited controversy within the transplant community and it is unknown whether patient attitudes mirror the ambiguity of provider perceptions. With the current health care economic crisis, it is necessary to consider generic immunosuppression as an option. A greater understanding of patient perceptions would enhance vital communication between providers and patients to facilitate education and appropriate monitoring.
  
  
  OBJECTIVE
  To evaluate transplant recipients' perceptions of generic versus brand immunosuppressants based on experience with these agents and the willingness of patients to convert treatment from brand to generic formulations based on socioeconomic variables and baseline demographics.
  
  
  METHODS
  Key informant interviews were conducted to inform the development of the survey instrument. The survey was distributed to solid organ transplant recipients at a large, academic medical center from October to December 2010.
  
  
  RESULTS
  Nine patients participated in key informant interviews. Financial considerations and provider recommendations were the most commonly identified factors to influence perceptions of generic immunosuppressants. A total of 255 patients completed the survey; treatment in 81 (32%) participants had been converted to a generic immunosuppressant. Those currently receiving a generic immunosuppressant expressed higher beliefs of generic and brand equivalency (75% vs 54%, p = 0.006) and an increased willingness to convert treatment to a generic given equivalent cost (51% vs 32%, p = 0.024). African American participants were found to have a decreased belief of generic and brand equivalency compared to other ethnicities (60% vs 75%, p = 0.013). Participants with an annual income of less than $30,000 had higher beliefs of generic and brand equivalency (60% vs 40%, p = 0.0001). Education level and age did not impact beliefs of generic efficacy or willingness to convert therapy.
  
  
  CONCLUSIONS
  Patient ethnicity, income, and experience with generic immunosuppressants appear to contribute to perceptions of generic immunosuppressants. The prevalence of generic immunosuppressant use supports the importance of communication of this issue between providers and patients.
authors.affiliation: Department of Pharmacy Services, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Hulbert
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Pilch
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D016568:Drugs, Generic / Q000627:therapeutic use*; D004522:Educational Status; D005006:Ethnicity / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007182:Income; D008297:Male; D008875:Middle Aged; D013022:South Carolina; D014180:Transplantation / Q000523:psychology*
chemical_list: D016568:Drugs, Generic; D007166:Immunosuppressive Agents