Educational interventions affecting generic prescription
|
NRCT
|
Wensing et al., 200918; Germany |
PHC clinics |
Periodic meetings with physicians to inform generic prescription rates and clarify doubts; 2001 to 2003. |
3,180 physicians (Intervention 1,090; Control 2,090). |
Compared to the control group, the intervention group increased, on average, the prescription of all drugs with the possibility of prescribing the generic in 0.75% CI 95% 0.40 - 1.10]. |
Niquille et al., 201025; Switzerland |
PHC clinics |
Continuing education on practical norms and feedback on prescriptions at meetings moderated by trained pharmacists |
24 physicians, 6 pharmacists |
The increase of each class of drug in the period was as follows: Beta-blockers (I-24.9 C-21.3); Calcium channel blockers (I- 42.1 C-43.6); Antihypertensive agents (I-7.44 C-13.6); Diuretics (I-32.2 C-37.8); Lipid-lowering agents (I-45.9 C-39.2). It does not show global data on generics. |
Rausell et al., 200517; Spain |
Hospital |
Monthly individual reports of revenue reviews. Intervention was implemented in June 2003; monitoring occurred at 4-6 and 10-12 months following the intervention; |
94 physicians from 16 services |
There was no significant difference in the proportion of generics in the pre-intervention period p = 0.284. After 4-6 months, means were as follows: control group, 1.81% (95% CI 1.08-2.54), and intervention group, 3.13% (95% CI 1.79 - 4.47); p = 0.041. After 10-12 months, the control group showed a mean of 2.22% (95% CI 1.56-2.87) and the intervention group, 4.01% (95% CI 2.28-5.73); p = 0.025. Significant difference between groups, maintained in the two post-intervention periods. |
Walker & Mathers, 200226; United Kingdom |
PHC clinics |
Pharmaceutical counseling, practical feedback, evaluative meetings, written information. Feb to May 1998. |
Intervention: 36 physicians from 9 clinics; Control: 44 physicians from 9 clinics |
Median change of 5.37% (IQR 2.56-6.32) prescriptions in the intervention group and 1.61% (IQR 1.37-4.27) prescriptions in the control group; p = 0.17. |
Calvo Alcántara & Inesta Garcia, 19993; Spain |
PHC clinics |
Educational sessions on generics (advantages, drawbacks ...), list of selected generic drugs and reports on generic prescription; Jan 1993 to Sep 1993 (pre) Jan 1994 to Sep 1994 (During / post) |
Intervention: 24 physicians from 5 clinics Control: 24 physicians from 5 clinics |
Pre-intervention: the mean of generic drugs in the control area was 0.87 generic items / 100 thousand inhabitants (SD 0.29) and 1.07 / 100 thousand inhabitants in intervention (SD 0.51); p = 0.0923. Post-intervention: the mean of generic drugs prescribed in the control area was 0.98 / 100 thousand inhabitants (SD 0.37) and 1.61 / 100 thousand inhabitants in intervention (SD 0.81); p=0.0012. |
CBA
|
Wensing et al., 200430; Germany |
PHC clinics |
Feedback on prescriptions and intensive program of educational sessions (n = 11) for small groups of prescribers; Apr to Jun 1998 |
177 prescribers |
Baseline: intervention group 68.3% of the prescriptions were generic and 67.4% in the control group. Post intervention: 71.1% of the prescriptions were generic in the intervention group and 68.4% in the control group. Effect of intervention was OR 1.10 (95% CI 1.08-1.13). |
Sicras Mainar & Palaez de Lono, 200531; Spain |
Geriatric centers |
Letter of presentation, informative interview, monitoring of prescriptions with return of prescription information to physicians; Jan 2002 to Dec 2003 |
Intervention: 32 geriatric residences (21 and 11 in 2002 and 2003, respectively); Control: 161 geriatric residences (75 and 86 in 2002 and 2003, respectively). |
Generic prescription increased in the intervention group from 8.1% to 18.4% and from 8.3% to 14.6 in the control group. Year-on-year growth of 127.2% for the intervention group and 75.9% for the control group (p <0.001) |
ITS
|
dLopez-Picazo Ferrer et al., 200232; Spain |
PHC clinics |
Monthly report on the pattern of generic prescription; half-yearly letters updating the printed list of generic drugs; dissemination and discussion sessions on the results achieved; Oct 1998 to Mar 2000. |
339 physicians from 45 teams |
Prescription of generics increased from 2.79% in the pre-intervention period to 17.63% in post-intervention. The absolute increase was 14.84% and the relative increase was 15.27%. Before the intervention, mean of prescriptions by generic name was 3.12%; during the intervention, it was 11.9%; and after the intervention, it increased to 20.25%. |
Educational interventions affecting the pharmacist in the replacement of reference medicines with generic drugs
|
RCT
|
Knowlton & Knapp, 199433; USA |
Community pharmacies |
Workshop for pharmacists to intervene in the choice between branded or generic medicines; Apr to Dec 1991 |
Intervention: 9 pharmacists; Control: 9 pharmacists; Comparison: 9 pharmacists |
The average replacement rate of generic drugs in the intervention group pharmacies was 6.34% higher compared to control pharmacies (35.83% vs. 29.45%, p <0.05). |
Educational interventions affecting the prescription of reference drugs
|
CBA
|
Mastura & Teng, 200816; Malaysia |
PHC clinics |
Meetings for detailed information on prescription by generic name; March to Apr. 2004 |
Two clinics; 9 offices (5 intervention and 4 control); 3,371 prescriptions |
Significant reduction of prescription of drugs by reference name comparing the pre- and post-intervention phases. Reduction from 33.9% to 19.0%, representing a 44% reduction (post-intervention RR of 0.56; 95% CI 0.48-0.66). |
Educational interventions affecting user’s replacement of reference medicines with generic drugs
|
NRCT
|
Sedjo & Cox, 200935; USA |
Health plan |
Receiving messages encouraging treatment adherence and increasing awareness on the low cost of the generic alternative; 2007 |
Intervention: 904 plan members; Control: 1,409 members |
Those who received educational intervention were more likely to replace with the lower cost generic antihypertensive (ACEI) (ORadj = 29.82, 95% CI 4.41-201.93) and there was no difference for users of antidepressants and lipid-lowering agents. |
Financial incentives affecting generic prescription
|
RCT
|
Bhargava et al., 201036; USA |
PHC clinics |
Intervention: Receipt of generic drug voucher + folder with generic drug information; Control: folder only; Jul. 2007 to Mar. 2008 |
21 clinics (10 intervention x 11 control) participated |
The generic dispensing rate for all drugs increased by 7.4 percentage points (p.p.) in the intervention group (53.4% to 60.8%) and 6.2 percentage points in the control group (55.9% to 62.1%). The estimated effect of the voucher is an increased generic dispensing rate of 1.77 p.p. (p = 0.047) |
ITS
|
dLopez-Picazo Ferrer et al., 200232; Spain |
PHC clinics |
Monthly report on the pattern of generic prescription; half-yearly letters updating the printed list of generic drugs; dissemination and discussion sessions on the results achieved; and financial incentive for each prescriber to achieve those goals; Oct 1998 to Mar 2000. |
339 physicians from 45 teams |
Prescription of generics increased from 2.79% in the pre-intervention period to 17.63% in post-intervention. Absolute increase was 14.84% and the relative increase was 15.27%. Prior to intervention, the mean of prescriptions by generic name was 3.12%; during intervention, 11.9% and after the intervention, 20.25%. |
CBA
|
Scott et al., 200737; USA |
PHC clinics |
Implementation of automated generic sample supply system supplemented by detailed information (on co-payment, evidence-based information on replacement, chemical equivalence and patent expiry); 2003 to 2006. |
2005: 64 clinics and 301 prescribers; 2006: 168 clinics and 631 prescribers |
Baseline Measures: dispensed Generic drug rate (DGR) was 47.8% in both groups. After the first year, DGR had an absolute increase of 7.5 p.p. (from 47.8 to 55.3%) in the intervention group, and 6.3 p.p. (47.8% to 54.1%) in the control group. The absolute difference between the participant and nonparticipant groups in the first year of follow-up was 1.2 p.p. In the second year, the difference fell to 0.8 p.p. (59.9% for the intervention group and 59.1% in the control group). |
Financial incentives affecting user’s use of generics over reference drugs
|
CBA
|
Dunn et al., 20064; USA |
Health Plan’s Mental Health Clinics |
Introduction of a “Generic Start! Program” with financial incentives to generics in the “3-tiered” co-payment system; Jan. 2004 to Dec 2005 |
Intervention: 440 thousand HMO members; Control: 500 thousand HMO members |
Prescription of generics increased 20 p.p. (32.5% to 52.5%) in the intervention group and 7.4 p.p. in the control group (24.9 to 32.3%) between 2004 and 2005, with a relative increase of 61.5% in the intervention group and 29.7% in the control group. |
Electronic prescription affecting user’s use of generics over reference drugs
|
CBA
|
Fischer et al., 201438; USA |
University Medica Center |
Electronic prescription that brings the generic to prominence; Oct 2003 to Mar 2004 |
Intervention: 35,651 physicians; Control: 1,198 physicians |
Generic equal to “Tiers 1”. Baseline: the proportion of generic prescriptions was 53.2% in the intervention group and 54.8% in the control group. After the intervention: 61.4% of electronic prescriptions were generic, representing a 6.6% increase in the generic prescription rate (95% CI 5.9%-7.3%) compared to a 2.6% increase (95% CI 2.5-2.7%) in the control group. |
ITS
|
Stenner et al., 201039; USA |
Hospital |
Electronic prescription that brings the generic to prominence; Jul 2005 to Sep 2008. |
Over de 1.1 million electronic prescriptions |
The proportion of generic drugs increased after the intervention, from 32.1% to 54.2% (an increase of 22.1% 95% CI 21.9%-22.3%). In the control group, the proportion of generic prescriptions was 29.3%, 31.4% and 37.4% in the pre-intervention, post-intervention and final study periods, respectively). |
Managerial Reform affecting user’s use of generics over reference drugs
|
CBA
|
Bradlow & Coulter, 199340; United Kingdom |
Medical clinics |
Reform in the NHS (introduction of budget ceiling for prescribers); 1990/1 - phase 1; 1991/2 - phase 2 |
Intervention: fixed-budget clinics; Control: clinics without a fixed budget. |
The percentage of generic drugs prescribed in the two phases of the study Phase 1 - with a dispensing budget ceiling: 26.9%. Without a non-dispensing budget ceiling: 46.5%. Phase 2 - Fixed dispensing budget - 34.5% [increased 7.6% (95% CI 7.2 - 8.0)] and control - 46.6% [increased 0.1% (95% CI 0.2-0.4)]. |