title: Pharmacy switch of antipsychotic medications: patient's perspective.
abstract: OBJECTIVE
  Several studies have raised concerns over consequences of brand-to-generic and generic-to-generic pharmacy-generated medication substitutions in psychiatric and non-psychiatric patients. The purpose of this retrospective study was to assess behavioral and emotional responses of patients with schizophrenia to antipsychotic medication substitution performed by pharmacies.
  
  
  METHODS
  A group of Polish ambulatory patients with schizophrenia (n = 196) chronically treated with antipsychotic medications were asked whether antipsychotic medication substitution had been proposed by a pharmacist in the last 12 months. Ninety-nine patients answering positively were administered more questions addressing the patient's emotional and behavioral response to the pharmacy proposal.
  
  
  RESULTS
  The most important findings of the present study can be summarized as follows: (1) approximately half of the patients were confronted with a pharmacy proposal to switch their antipsychotic medications in the last 12 months, (2) one quarter of these patients did not accept the pharmacy switch, (3) a substantial proportion of patients (>40 %) did not receive any explanation from a pharmacist offering medication substitution, (4) pharmacy-generated substitution proposals were mainly associated with negative patient attitudes and negative emotional responses, (5) substitution proposals provoked an unscheduled psychiatric visit in approx. 10 % of patients, (6) despite the negative attitudes reported by patients, the pharmacy switch rarely led to treatment discontinuation, but did provoke a change in drug dosing in 7 % of patients accepting the switch.
  
  
  CONCLUSIONS
  A pharmacy proposal to switch their antipsychotic medications is a relatively common experience of Polish ambulatory patients with schizophrenia. Pharmacy-generated substitution proposals are mainly associated with negative patient attitudes, but rarely lead to antipsychotic treatment discontinuation in this group of patients.
authors.affiliation: Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02957 Warsaw, Poland.
authors.forename: Slawomir
authors.initials: S
authors.lastname: Murawiec
authors.affiliation: Department of Psychiatry, Medical University, Poznan, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Rajewska-Rager
authors.affiliation: Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Samochowiec
authors.affiliation: Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Kalinowska
authors.affiliation: Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kurpisz
authors.affiliation: Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02957 Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Krzyzanowska
authors.affiliation: Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02957 Warsaw, Poland.
authors.forename: Halina
authors.initials: H
authors.lastname: Sienkiewicz-Jarosz
authors.affiliation: Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02957 Warsaw, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Kurkowska-Jastrzebska
authors.affiliation: Department of Clinical Psychology, Institute of Psychology, University of Szczecin, Szczecin, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Samochowiec
authors.affiliation: Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02957 Warsaw, Poland.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Bienkowski
keywords: Antipsychotic treatment; Generic drugs; Medication switching; Pharmacy substitution; Schizophrenia