Special challenges for drug adherence following generic substitution in Pakistani immigrants living in Norway

Abstract

PurposeThis study aims to explore how long-term drug users with a Pakistani background living in Oslo (Norway) perceive generic substitution and how generic substitution influences drug adherence in this population.MethodsPersonal interviews using a semi-structured questionnaire were carried out with 83 Pakistani immigrants (aged 40–80 years) who were using antihypertensives, antidiabetics, and/or cholesterol-lowering drugs.ResultsIn all, 73% of the participants were using generic drugs at the time of the interview. Of these, 10% were erroneously using two equivalent generics at the same time. One quarter of the participants were of the opinion that cheaper generic drugs were counterfeit drugs. Two thirds had accepted generic substitution in the pharmacy whereas the remaining participants had either opposed or were unaware of the substitution. Of those who had accepted substitution, 27% claimed that the effect of the new drug was poorer and 20% reported more side-effects. Generic substitution had resulted in concerns about the therapy in 41% of the patients, and 26% thought it had become more demanding to keep track of their medication. Poor adherence tended to be most common among patients who were not fluent in Norwegian, patients who had concerns about medicine use, and patients who had accepted generic substitution in the pharmacy.ConclusionThis study shows that generic substitution may have a negative effect on drug adherence in Pakistani immigrants in Oslo (Norway) because of concerns and misconceptions, including confusion with regard to counterfeit drugs. Problems result primarily from inadequate information caused by language barriers but also from culturally conditioned views on encounters with the health care system.

Societal value of generic medicines beyond cost-saving through reduced prices

“…This difference might be explained by the fact that patients in The Netherlands are usually registered and serviced at a single pharmacy, which facilitates the communication between the pharmacist and the patient. This emphasizes the importance of the role of physicians and pharmacists in informing patients about generic medicines and providing guidance in appropriate drug use [54,55,58]. Confusion due to different physical appearances of generic medicines might also be avoided if generic medicine manufacturers would be obliged to produce generic medicines with a similar appearance as originator medicines.…”

“…Generic substitution might also lead to concerns about the reliability of the medicine and insecurity about the intervention. This may have an unintentionally negative effect on medication adherence, as the patient may decide to not taking the substituted medicine [53][54][55][56][57]. Van Wijk et al, however, did not observe a relation between decreased medication adherence and generic substitution [48].…”

South Asians’ cardiac medication adherence

“…19,22,26,29 For South Asians living outside of South Asian countries, language barriers could be problematic. 14,30 However, this matter has not been explicitly studied.…”

Attitudes of Physicians and Pharmacists Towards International Non‐Proprietary Name Prescribing in Belgium

“…These concerns were probably founded as literature showed that differences in medicinal product name, packaging and physical attributes negatively influence medication adherence and result in medication errors, due to patient confusion and discontent [32][33][34][35][36][37][38]. Studies also confirmed that good communication with patients is essential when medication switches occur [39][40][41].…”