title: Brand name or generic? What are the health professionals prescribed for treating diabetes? A longitudinal analysis of the National Health Insurance reimbursement database.
abstract: OBJECTIVE
  This study aimed to explore whether physicians prescribe more brand-name oral hypoglycemic agents (OHA) for diabetic patients with medical training background (MP) than for general patients (GP).
  
  
  METHODS
  A longitudinal analysis of 1,000,000 National Health Insurance cohorts of 1998-2008 was conducted. Univariate and multivariate models were performed to assess the associations of the outcome (the ratio of brand-name/generic odds in the MP group to that in the GP group) and the covariates, including patient medical training background, characteristics of patient, prescriber, and medical settings, and market competition. A generalized estimating equation method was used to control the dependency of longitudinal data.
  
  
  RESULTS
  A total of 46,850 diabetic patients were prescribed with 2,703,149 OHA prescriptions during the study period. Compared with GP, MP had 1.37 times greater odds of being prescribed with brand-name instead of generic OHA, among whom pharmacists and physicians had the highest odds ratios of 2.78 (95%CI, 1.05-7.36) and 1.68 (95%CI, 0.99-2.85), respectively. Patients' diabetes severity, prescribers' level of experience, medical settings that were publicly owned, had a higher accreditation level, and were located in a higher urbanized area, lower market competition, and earlier dates of prescription were positively associated with brand-name prescription. Among all medical sub-specialties, cardiologists were more likely to prescribe brand-name OHA.
  
  
  CONCLUSIONS
  This study is the first to demonstrate how a patients' medical training background, in addition to the characteristics of patients, prescribers, and medical settings, and market competition might influence physicians' prescribing choice of brand-name or generic OHA.
authors.affiliation: Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Wen-Shyong
authors.initials: WS
authors.lastname: Liou
authors.forename: Shu-Ching
authors.initials: SC
authors.lastname: Hsieh
authors.forename: Wai-Yuan
authors.initials: WY
authors.lastname: Chang
authors.forename: Grace Hui-Min
authors.initials: GH
authors.lastname: Wu
authors.forename: Hsu-Shan
authors.initials: HS
authors.lastname: Huang
authors.forename: Chuanfang
authors.initials: C
authors.lastname: Lee
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002755:Choice Behavior; D057225:Data Mining; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D016568:Drugs, Generic / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017891:Pharmacoepidemiology; D060735:Pharmacovigilance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D016568:Drugs, Generic; D007004:Hypoglycemic Agents
keywords: brand name or generic; database analysis; pharmacoepidemiology; prescribing behavior