Physicians often continue to prescribe brand-name drugs to their patients even when less expensive generic equivalents are available. In a 1994 study, Judith Hellerstein advances two hypotheses to explain this behavior. First, doctors may consciously conclude that certain brand-name drugs impart a relative therapeutic benefit that outweighs their higher cost. Second, physicians may choose to prescribe brand-name drugs without evidence of therapeutic superiority if neither they nor their insured patients bear the increased cost of these drugs. The second hypothesis implies that moral hazard is evident in physicians' prescribing behavior. Hellerstein's findings support neither hypothesis, but her estimation equation does not explicitly capture the effects of brand-name/generic price differentials and information diffusion on the probability of generic prescription. The author adapts Hellerstein's theoretical model to a modified estimation equation that incorporates these effects and uses it to create new estimates based on data on antimicrobial prescriptions from the 1994 National Ambulatory Medical Care Survey (NAMCS). Unexpectedly, the results appear to affirm both hypotheses. The evidence for moral hazard is particularly strong, as self-paying patients are significantly more likely than patients with Medicare or private insurance to be prescribed the generics that are cheapest relative to their brand-name counterparts. The author also finds that certain popular antimicrobial drugs such as amoxicillin and sulfamethoxazole/trimethoprim are prescribed in the same form (generic or brand-name) by most doctors to most patients. The market power exhibited by these preferred forms leads the author to conclude that they are "brands" in the economic sense. / Master of Arts

Generic medicines are very important in driving down the health care cost. In a country like South Africa, where more than 80% of the population depend on the state health care, it is important to find ways to reduce cost. The main aim of the study was to evaluate the attitude towards generic medicines by pharmacists in Gauteng province of South Africa. Gauteng as the economic hub of the country, with the highest population and the highest number of pharmacies and pharmacists, obtaining a picture around the attitude towards generic medicines would help the all the stakeholders in the health care sector to identify areas of concern and address them to drive a positive attitude. In order to evaluate the attitude, Fishbein models, which noted the intention to perform the behaviour in question as the immediate antecedent of any behaviour, were used. The models identified two conceptually independent determinants of intention, which are attitude towards the behaviour (personal) and subjective norm (social). Depending of which model one is using, one more determinant of the intention “perceived behavioural control” can be added on the theory of reasoned action to form model of planned behaviour. By evaluating the attitude one can therefore determine the level of intention to perform the behaviour of interest which is generic substitution in this study. An empirical study was conducted among 116 pharmacists and assistants in Gauteng province. The methodology included research design, instrument development, sampling methods, data collection, capturing and statistical analysis. The results were analysed using Cronbach Alpha coefficients to measure reliability of the research instrument, t-test and ANOVA to test the hypothesis and the variance between groups; the effect sizes and Spearman's rho to determine the correlation and relationship between two variables of interest. The results of the study showed that, 94% of the respondents believe that generics are viable alternatives to innovator medicines. On the question of pharmacists’ attitude towards generic medicines results showed that there was no significant difference in almost all the demographic characteristics gender, age, qualifications, employment level, years of experience and type of pharmacy one practices. The only significant driver of the difference in attitude is the location of the pharmacy where pharmacists practicing in the townships and the city centre were found to be more receptive to generics than those in the suburbs. Due to reliability failure on the control belief construct, the theory of planned behaviour was downgraded to theory of reasoned action, to exclude the control belief construct for further statistical analysis. Correlation between the two attitudes constructs, behavioural belief and evaluation of behavioural outcome was one of the highest, where behavioural belief was identified as the direct measure of attitude and also the main driver. The study concluded that attitude is one of the most important personal factors influencing both the organisation and individual consumer buying behaviour. Evaluating individuals’ attitude to the behaviour (use of a product or service) would help marketers to communicate the right message to the right customers. / MBA, North-West University, Potchefstroom Campus, 2015

Generic medicines are very important in driving down the health care cost. In a country like South Africa, where more than 80% of the population depend on the state health care, it is important to find ways to reduce cost. The main aim of the study was to evaluate the attitude towards generic medicines by pharmacists in Gauteng province of South Africa. Gauteng as the economic hub of the country, with the highest population and the highest number of pharmacies and pharmacists, obtaining a picture around the attitude towards generic medicines would help the all the stakeholders in the health care sector to identify areas of concern and address them to drive a positive attitude. In order to evaluate the attitude, Fishbein models, which noted the intention to perform the behaviour in question as the immediate antecedent of any behaviour, were used. The models identified two conceptually independent determinants of intention, which are attitude towards the behaviour (personal) and subjective norm (social). Depending of which model one is using, one more determinant of the intention “perceived behavioural control” can be added on the theory of reasoned action to form model of planned behaviour. By evaluating the attitude one can therefore determine the level of intention to perform the behaviour of interest which is generic substitution in this study. An empirical study was conducted among 116 pharmacists and assistants in Gauteng province. The methodology included research design, instrument development, sampling methods, data collection, capturing and statistical analysis. The results were analysed using Cronbach Alpha coefficients to measure reliability of the research instrument, t-test and ANOVA to test the hypothesis and the variance between groups; the effect sizes and Spearman's rho to determine the correlation and relationship between two variables of interest. The results of the study showed that, 94% of the respondents believe that generics are viable alternatives to innovator medicines. On the question of pharmacists’ attitude towards generic medicines results showed that there was no significant difference in almost all the demographic characteristics gender, age, qualifications, employment level, years of experience and type of pharmacy one practices. The only significant driver of the difference in attitude is the location of the pharmacy where pharmacists practicing in the townships and the city centre were found to be more receptive to generics than those in the suburbs. Due to reliability failure on the control belief construct, the theory of planned behaviour was downgraded to theory of reasoned action, to exclude the control belief construct for further statistical analysis. Correlation between the two attitudes constructs, behavioural belief and evaluation of behavioural outcome was one of the highest, where behavioural belief was identified as the direct measure of attitude and also the main driver. The study concluded that attitude is one of the most important personal factors influencing both the organisation and individual consumer buying behaviour. Evaluating individuals’ attitude to the behaviour (use of a product or service) would help marketers to communicate the right message to the right customers. / MBA, North-West University, Potchefstroom Campus, 2015

Generic drugs and generic substitution from the patient perspective I. Autor: Jana Novotná Supervisor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague Introduction: Generic substitution and generic drugs are important instruments of drug policy in many countries, which allow to reduce price of medicines, while maintaining their quality. Experience shows that a prerequisite for the rational use of both instruments is sufficient awareness among both health professionals and patients. Objective: The aim of this study was to analyze the opinions, knowledge and experience of patients regarding generic drugs and generic substitution. Methods: Data were collected between 1 March 2015 and 31 March 2015 in a workplace practitioner in Prague. It was an observational survey. We contacted all patients who visited a doctor during that period. Patients had to agree to their inclusion in the investigation and also meet "inclusion criteria" (e.g., at least 18 years old, literate in Czech, long-term use at least one medicine). The questionnaire included 28 questions (4 open and 24 closed), focusing on socio-demographic characteristics and knowledge, opinions, experiences and self-activity of the respondent regarding generic...

Generic drugs and generic substitution from the patient perspective II. Autor: Martina Kůtková Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmay, Faculty of Pharmacy in Hradec Králové, Charles University in Prague Introduction and aim: Generic drugs and generic substitution are an integral part of the healthcare systems of many countries. The aim of this thesis was to carry out an research which was focused on attitudes, opinions and experiences of patients (general public) regarding generic drugs and generic substitution and to analyze extracted results. Metodology: Data were collected since February to June 2016 in a workplace practicioner in Jičín. We asked all patients who came to the doctor's office during that period. Data were collected through printing anonymous questionnaire. The questionnaire was piloted. Patients got a cover letter with questionnaire together. Respondents were categorized based on the cover letter and the questionnaire was filled out by the respondents who the survey was focused on. The questionnaire included 36 questions (26 closed, 7 open and 3 half-open). The first part of the questionnaire (first 10 questions) was focused on socio- demographic characteristics of respondents. The rest of the questionnaire detected patient's knowledge of...

Generic drugs and generic substitution from the patient perspective III. Author: Terezie Papoušková Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introducion: A generic substitution is one of the instruments of the drug policy in many countries. Its authorization is supposed to bring a considerable savings not only for healthcare systems but also for patients. Objective: The aim of this thesis was to analyse patient's attitudes, opinions and experiences,which are related to the generic drugs and the generic substitution. Methodology: A data collection was gathered in the general practitioner's office in Prague in the time span from 18th of November 2015 to 21st of November 2016. All respondents, who visited the general practitioner during this period, were asked to cooperate. Only those who meet the input criteria could participate in a questionnaire investigation. The questionnaire consists of 36 questions which can be devided into 5 thematic areas (an actual disease and its treatment, socio-demographics characteristics, common awareness about generic substitution and generic drugs, own experiences with this topic, attitudes of the respondents). The questionnaire was piloted. The acquired data has been...

The objective of this thesis is to identify factors, which are influencing pharmacists` choice of a particular drug in a situation when generic substitution can be offered to a patient, and to analyse the relative importance of these factors for the pharmacists. This study investigates such behavioural patterns of pharmacists operating within chain of pharmacies called Alphega. The research consists of 2 consecutive parts; Firstly, qualitative inquiry through depth-in interviews has been carried out in order to identify variables, which may shape pharmacist's choice. And subsequently, quantitative investigation has been performed for the purpose of assessing importance of each variable. The results of the research have finally been used to evaluate the strategy of antibiotic Augmentin produced by company GlaxoSmithKline.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24188号 / 医博第4882号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 中山 健夫, 教授 寺田 智祐 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.