Generic medicines: a holistic assessment of stakeholder perceptions and online information provision

Background: Generic medicines result from expired intellectual property protection and the ability of pharmaceutical producers, other than originator companies, to manufacture analogous medicines containing identical active ingredients and to distribute them in relevant markets. Cost reductions associated with procurement of generics by national agencies, and subsequent savings for patients buying generic medicines from pharmacies, result in policies regarding generic medicines and reference pricing being promoted by governments internationally. In Ireland, however, generic medicines usage has been poor historically and attitudes of stakeholders, other than the Irish Government, have been relatively negative. In June 2013 the Health (Pricing and Supply of Medical Goods) Act was signed into law, meaning that Irish patients are now more likely than ever before to receive a generic medicine. Objectives From 2013, general practitioners (GPs) and pharmacists alike are likely to encounter greater patient awareness, and discussion, of generic medicines, their potential benefits and disadvantages. This thesis focused initially on providing a comprehensive description of generic medicines and their development and, at a time immediately preceding introduction of the Irish Act, on gaining insight into current stakeholder attitudes and awareness towards generic medicines in Ireland. In parallel, a novel tool based on principles of understandability and readability of text was developed. This was utilised to assess websites most likely to be accessed by patients seeking information regarding generic medicines across a number of English speaking regions, with emphasis on Ireland. Methods Mixed methods studies (in the format of 1:1 interviews) with GPs, pharmacists and patients from rural and urban settings in Ireland. Analysis of interviews was both qualitative and quantitative using SPSS (version 20) and NVivo (version 9), as appropriate. Evaluation of websites was completed with a novel Website Quality Assessment (WQA) tool, developed as part of this thesis. Websites most likely to be used by searchers looking for online information about generic medicines in five Englishspeaking geographical regions (US, UK, Ireland, Canada and Australia) were assessed for quality and accessibility (in terms of readability and understandability) of information provided. Results Analysis of survey data showed that there was a hierarchy of understanding and acceptance of generic medicines in Ireland. In summary, pharmacists had the greatest understanding of generic medicines and the processes associated with their regulation and safety, followed by GPs and then patients. Notably, GPs had less confidence in generics than pharmacists; indeed 5/34 (15%) of GPs would prefer not to use a generic medicine if provided an originator alternative versus 3/44 (7%) of pharmacists. Patients expressed the lowest level of confidence with 9/38 (24%) stating a preference for the branded medication in addition to a belief that generics were of poorer quality than originator medicines. Use of the WQA tool, following peer review and validation of its design, demonstrated clearly that readability and understandability of healthcare information influenced the Google search ranking of generic medicine-related websites. In Ireland, analogous to other jurisdictions, none of the websites most likely to be seen by a searcher demonstrated the desired combination of scoring highly for both quality of information and readability. Conclusions: In summary, these investigations impart new insights regarding knowledge, attitudes and behaviours in Ireland towards generic medicines, determine and evaluate the Internet resources likely to be accessed by those seeking knowledge on this topic across a number of English-speaking regions, and provide a unique tool to enhance the promotion and provision of relevant information.