title: Perspectives of physicians practicing in low and middle income countries towards generic medicines: a narrative review.
abstract: OBJECTIVE
  This review was conducted to document published literature related to physicians' knowledge, attitudes, and perceptions of generic medicines in low- and middle-income countries (LMICs) and to compare the findings with high-income countries.
  
  
  METHODS
  A systematic search of articles published in peer-reviewed journals from January 2001 to February 2013 was performed. The search comprised nine electronic databases. The search strategy involved using Boolean operators for combinations of the following terms: generic medicines, generic medications, generic drugs, generic, generic substitution, generic prescribing, international non-proprietary, prescribers, doctors, general practitioners, physicians, and specialists.
  
  
  RESULTS
  Sixteen articles were included in this review. The majority (n=11) were from high income countries and five from LMICs. The main difference between high income countries and LMICs is that physicians from high income countries generally have positive views whereas those from LMICs tend to have mixed views regarding generic medicines. Few similarities were identified among different country income groups namely low level of physicians' knowledge of the basis of bioequivalence testing, cost of generic medicines as an encouraging factor for generic medicine prescribing, physicians' concerns towards safety and quality of generic medicines and effect of pharmaceutical sales representative on generic medicine prescribing.
  
  
  CONCLUSIONS
  The present literature review revealed that physicians from LMICs tend to have mixed views regarding generic medicines. This may be due to differences in the health care system and pharmaceutical funding system, medicine policies, the level of educational interventions, and drug information sources in countries of different income levels.
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. Electronic address: azmihassali@usm.my.
authors.forename: Mohamed Azmi
authors.initials: MA
authors.lastname: Hassali
authors.affiliation: Pharmacy Department, Hospital Teluk Intan, Jalan Changkat Jong, 36000 Teluk Intan, Perak, Malaysia. Electronic address: wongzy88@gmail.com.
authors.forename: Zhi Yen
authors.initials: ZY
authors.lastname: Wong
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. Electronic address: alian-a@hotmail.com.
authors.forename: Alian A
authors.initials: AA
authors.lastname: Alrasheedy
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. Electronic address: fahaduob@gmail.com.
authors.forename: Fahad
authors.initials: F
authors.lastname: Saleem
authors.affiliation: Pharmacy Department, Hospital Teluk Intan, Jalan Changkat Jong, 36000 Teluk Intan, Perak, Malaysia. Electronic address: dulha5@yahoo.com.
authors.forename: Abdul Haniff
authors.initials: AH
authors.lastname: Mohamad Yahaya
authors.affiliation: College of Pharmacy, King Saud University, 11451 Riyadh, Saudi Arabia. Electronic address: haljadhey@ksu.edu.sa.
authors.forename: Hisham
authors.initials: H
authors.lastname: Aljadhey
mesh_terms: D001291:Attitude of Health Personnel; D003906:Developing Countries; D057915:Drug Substitution / Q000191:economics*; D016568:Drugs, Generic / Q000627:therapeutic use*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013810:Therapeutic Equivalency
chemical_list: D016568:Drugs, Generic
keywords: Generic medicines; Low and middle income countries; Perspective; Physician; Review