Background: Newly developed biosimilar agents confer significant cost saving advantages, yielding the potential to mitigate rising drug costs and expand patient access to care for important biologic therapies. Biosimilar market uptake greatly depends upon healthcare provider willingness to promote, prescribe, and use biosimilars in clinical practice. Objective: To perform a systematic review evaluating current United States (U.S.) and European (EU) health care provider knowledge, perceptions, and prescribing behaviors of biosimilar medicines to assess the need for clinician-directed, biosimilar education. Methods: An electronic literature search was conducted using journal databases, including PubMed, Embase, and Cochrane Library. Terms related to biosimilar agents, survey questionnaires, and education were used. Two independent reviewers evaluated 158 citations published from January 1, 2014 to March 5, 2018, that were the result of this search. Studies in English were included if they surveyed U.S. or EU physician and/or pharmacist knowledge, attitudes, and/or prescribing preferences of biosimilar drugs. Overall trends in prescribing behavior and perceptions were abstracted. Results: A total of 20 studies met inclusion criteria. Three studies originated from the U.S. and 17 from Europe. Hospital specialists, gastroenterologists, and rheumatologists were the most frequently surveyed practitioners. Percent of biosimilar prescribing varied widely between countries and within similar practice fields. If used, biosimilars were predominantly prescribed in biologic-treatment naïve patients. An overall lack of biosimilar familiarity in both U.S. and EU health care settings accompanied concerns about biosimilar safety, efficacy, extrapolation, and interchangeability. Detailed descriptions of biosimilar education programs were lacking from the literature. Conclusions: Findings from this review indicate that U.S. and EU healthcare providers still approach biosimilar medicines with caution, citing limited biosimilar knowledge, low prescribing comfort, and safety and efficacy concerns as main deterrents for biosimilar use. To realize the full cost-saving potential of biosimilar medicines, clinician-directed, biosimilar education will be imperative to address gaps in biosimilar knowledge, facilitate prescribing changes, and ultimately increase biosimilar use.

OBJECTIVE: Our objectives were to examine how certain aspects of provider-patient communication recommended by national asthma guidelines (ie, provider asking for child and caregiver input into the asthma treatment plan) were associated with child asthma medication adherence 1 month after an audio-taped medical visit. METHODS: Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All medical visits were audio-tape recorded. Children were interviewed 1 month after their medical visits, and both children and caregivers reported the child’s control medication adherence. Generalized estimating equations were used to determine if communication during the medical visit was associated with medication adherence 1 month later. RESULTS: Children (n = 259) completed a home visit interview ∼1 month after their audio-taped visit, and 216 of these children were taking an asthma control medication at the time of the home visit. Children reported an average control medication adherence for the past week of 72%, whereas caregivers reported the child’s average control medication adherence for the past week was 85%. Child asthma management self-efficacy was significantly associated with both child- and caregiver-reported control medication adherence. When providers asked for caregiver input into the asthma treatment plan, caregivers reported significantly higher child medication adherence 1 month later. CONCLUSIONS: Providers should ask for caregiver input into their child’s asthma treatment plan because it may lead to better control medication adherence.

Conflicting health information is increasing in amount and visibility, as evidenced most recently by the controversy surrounding the risks and benefits of childhood vaccinations. The mechanisms through which conflicting information affects individuals are poorly understood; thus, we are unprepared to help people process conflicting information when making important health decisions. In this viewpoint article, we describe this problem, summarize insights from the existing literature on the prevalence and effects of conflicting health information, and identify important knowledge gaps. We propose a working definition of conflicting health information and describe a conceptual typology to guide future research in this area. The typology classifies conflicting information according to four fundamental dimensions: the substantive issue under conflict, the number of conflicting sources (multiplicity), the degree of evidence heterogeneity and the degree of temporal inconsistency.

Objective-This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence selfefficacy and outcome expectations for medications.Methods-Vasculitis patients (n=228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect.Results-A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by selfefficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence. Conclusion-Patientswho encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information.Practice Implications-Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information.

Conflicting medication information has been defined as contradictory information about a medication topic from two or more sources. The objective of this study was to determine whether arthritis patients are exposed to conflicting medication information, to document sources of conflicting information, and to explore whether conflicting information is associated with sociodemographic factors, clinical characteristics, and medication adherence. Using an online survey, arthritis patients (N = 328) reported how often they received conflicting information about 12 medication topics as well as sources of conflicting information, demographic/clinical characteristics, and medication adherence. A linear regression model, which controlled for various demographic/clinical factors, determined whether conflicting information was associated with medication adherence. The majority of patients (80.1%) received conflicting information and were most likely to receive conflicting information about medication risks. Physicians, media sources, and the Internet were the most common sources of conflicting information. Less conflicting information (B =-0.13, p < .05), more information source use (B = 0.22, p < .01), and lower perceived regimen complexity (B =-0.17, p < .05) were associated with better medication adherence. In conclusion, conflicting medication information is pervasive, comes from a variety of sources, and may negatively affect patient health outcomes. To potentially decrease exposure to conflicting information, providers should direct patients to high-quality medication information sources.