Araştırma Makalesi
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Bir üniversite hastanesinde çalışan tıpta uzmanlık öğrencilerinin eşdeğer ilaçlar hakkında bilgi, düşünce ve tutumlarının değerlendirilmesi

Yıl 2019, Cilt: 33 Sayı: 2, 109 - 119, 27.09.2019

Öz

Amaç: Bu çalışmada tıpta uzmanlık öğrencileri (TUÖ)’nin eşdeğer ilaç (Eİ)’a dair bilgi düzeylerinin, bilgi düzeylerini etkileyebilecek faktörlerin, Eİ hakkında düşünce ve reçeteleme tutumlarının değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Tanımlayıcı, kesitsel türde olan araştırma, Haziran-Ağustos 2018 tarihleri arasında Dokuz Eylül Üniversitesi Araştırma Uygulama Hastanesi’nde çalışan, reçete yazan TUÖ’leri arasında yürütüldü (n=506). Araştırma verileri 6 bölümden oluşan ve TUÖ’nin Eİ’lara dair bilgi, düşünce ve tutumlarının değerlendirildiği anket formu ile toplandı, tanımlayıcı istatistik, t-testi ve korelasyon analizi ile değerlendirildi.
Bulgular: Tıpta uzmanlık öğrencilerinin %66,0’sı anketi yanıtladı (n=334; yaş: 27,9±2,4; %51,5’i kadın). Eşdeğer ilaçlara dair bilgi puanları 16 üzerinden 8,2±2,9 bulundu; Eİ’lar hakkında eğitim alma, daha genç hekim olma, dahili bilimlerde çalışıyor olma bilgi puanını artıran etmenler olarak saptandı (p<0,05).  Çalışmamız, TUÖ’nin neredeyse yarısının (%48,3) reçete yazarken Eİ olmasına dikkat etmediğini, bunda da etkililik ve kaliteye dair olumsuz düşüncelerinin rol oynamış olabileceğini ortaya çıkardı.  Hastanın gelir durumu ve hastalığın ciddiyeti ilaç seçimini etkilemekteydi. Tıpta uzmanlık öğrencilerinin %25,2’si Eİ üretimi sırasında Sağlık Bakanlığı denetimlerini yeterli buluyor, %47,2’si ise bu konuda fikri olmadığını bildiriyordu. Eşdeğer ilacın güvenli ve ucuz olduğunu düşünen TUÖ oranı sırasıyla %53,2 ve %61,8 idi. Tıpta uzmanlık öğrencilerinin %86,6’sı Eİ’lar ile ilgili olarak hekimlere eğitim verilmesi gerektiğini düşünüyordu.
Sonuç: Bu çalışma, gerek tıp fakültesi eğitiminde gerekse tıpta uzmanlık eğitiminde Eİ’lara yönelik hedeflerin müfredata eklenmesi, halen müfredatlarında bulunan tıp fakültelerinin de eğitim programı yeterliliğini gözden geçirmeleri gerekliliğini ortaya çıkarmıştır.

Teşekkür

Anketin hazırlık aşamasında yardımlarından dolayı Tıp Eğitimi Anabilim Dalı Öğretim Üyesi Prof. Dr. Sema OZAN’a teşekkür ederiz.

Kaynakça

  • Kwo EC, Kamat P, Steinman MA. Physician use of brand versus generic drug names in 1993-1994 and 2003-2004. Ann Pharmacother 2009;43:459-68.
  • IMS Institute for Healthcare Informatics. The role of generic medicines in sustaining healthcare systems: A European perspective 2015. Available from: URL: http://www.apmgr.org/docs/IIHI_Generics_Healthcare_Brief.pdf (Erişim tarihi: 25 Ocak 2019).
  • Sacks CA, Lee CC, Kesselheim AS, Avorn J. Medicare spending on brand-name combination medications vs their generic constituents. JAMA 2018;320:650-6.
  • Wouters OJ, Kanavos PG, McKEE M. Comparing generic drug markets in Europe and the United States: prices, volumes, and spending. Milbank Q 2017;95:554-601.
  • Warraich HJ, Salami JA, Khera R, Valero-Elizondo J, Okunrintemi V, Nasir K. Trends in use and expenditures of brand-name atorvastatin after introduction of generic atorvastatin. JAMA Intern Med 2018;178:719-21.
  • Kjoenniksen I, Lindbaek M, Granas AG. Patients' attitudes towards and experiences of generic drug substitution in Norway. Pharm World Sci 2006;28:284-9.
  • Straka RJ, Keohane DJ, Liu LZ. Potential clinical and economic impact of switching branded medications to generics. Am J Ther 2017;24:e278-e289.
  • Colgan S, Faasse K, Martin LR, Stephens MH, Grey A, Petrie KJ. Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review. BMJ Open 2015;5:e008915.
  • Domeyer PJ, Aletras V, Anagnostopoulos F, Katsari V, Niakas D. Development and validation of a tool to assess knowledge and attitudes towards generic medicines among students in Greece: The ATtitude Towards GENerics (ATTOGEN) questionnaire. PLoS One 2017;12:e0188484.
  • Dunne SS, Shannon B, Cullen W, Dunne CP. Beliefs, perceptions and behaviours of GPs towards generic medicines. Fam Pract 2014;31:467-74.
  • Fabiano V, Mameli C, Cattaneo D, et al. Perceptions and patterns of use of generic drugs among Italian Family Pediatricians: First round results of a web survey. Health Policy 2012;104:247-52.
  • Flood D, Mathieu I, Chary A, Garcia P, Rohloff P. Perceptions and utilization of generic medicines in Guatemala: a mixed-methods study with physicians and pharmacy staff. BMC Health Serv Res 2017;17:27.
  • Lewek P, Smigielski J, Kardas P. Factors affecting the opinions of family physicians regarding generic drugs - a questionnaire based study. Bosn J Basic Med Sci 2015;15:45-50.
  • Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. “No generics, Doctor!” The perspective of general practitioners in two French regions. BMC Health Serv Res 2017;17:707.
  • Banahan BF, Kolassa EM. A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med 1997;157:2080-8.
  • Howard JN, Harris I, Frank G, Kiptanui Z, Qian J, Hansen R. Influencers of generic drug utilization: A systematic review. Res Social Adm Pharm 2018;14:619-27.
  • Liou WS, Hsieh SC, Chang WY, Wu GHM, Huang HS, Lee C. Brand name or generic? What are the health professionals prescribed for treating diabetes? A longitudinal analysis of the National Health Insurance reimbursement database. Pharmacoepidemiol Drug Saf 2013;22:752-9.
  • Shrank WH, Liberman JN, Fischer MA, Girdish C, Brennan TA, Choudhry NK. Physician perceptions about generic drugs. Ann Pharmacother 2011;45:31-8.
  • Mondelo-García C, Mendoza E, Movilla-Fernández MJ, Coronado C. Perceptions of pharmacists and physicians on generic substitution in a financial crisis context in Northwestern Spain: A qualitative study. Health Policy 2018;122:1316-25.
  • Hassali MA, Wong ZY, Alrasheedy AA, Salem F, Yahaya AHM, Aljadhey H. Perspectives of physicians practicing in low and middle income countries towards generic medicines: A narrative review. Health Policy 2014;117:297-310.
  • https://www.istanbuleczaciodasi.org.tr/upload/pdf/20090618_es_deger_ilac.pdf (Erişim tarihi: 25 Ocak 2019).
  • Toklu HZ, Dülger GA, Hıdıroğlu S, et al. Knowledge and attitudes of the pharmacists, prescribers and patients towards generic drug use in Istanbul - Turkey. Pharm Pract (Granada) 2012;10:199-206.
  • Bilginer E, Ozçelikay G. A survey to evaluate the opinions of Turkish Physicians’ on bioequivalence. Turkish Journal of Pharmaceutical Sciences 2007;4:79-87.
  • Dosedel M, Maly J, Kubena A, Vicek J. Opinions of Czech general practitioners on generic drugs and substitution. Cent Eur J Med 2014;9:830-8.
  • Jamshed SQ, Ibrahim MIM, Hassali MA, et al. Perception and attitude of general practitioners regarding generic medicines in Karachi, Pakistan: A questionnaire based study. South Med Rev 2012;5;1:22-30.
  • Türkiye İlaç ve Tıbbi Cihaz Kurumu. Beşeri Tıbbi Ürünler İmalathaneleri İyi İmalat Uygulamaları (GMP) Kılavuzu. Erişim: URL: http://www.titck.gov.tr/PortalAdmin/Uploads/UnitPages/%C4%B0%C4%B0U%20KILAVUZU%20V.2017-01.pdf (Erişim tarihi: 02 Ekim 2019).
  • Türkiye İlaç ve Tıbbi Cihaz Kurumu. Farmasötik Müstahzarların Biyoyararlanım ve Biyoeşdeğerliliğinin Değerlendirilmesi Hakkında Yönetmelik. Erişim: URL: http://www.mevzuat.gov.tr/Metin.Aspx?MevzuatKod=7.5.4916&MevzuatIliski=0 (Erişim tarihi: 25 Ocak 2019).
  • Hassali MA, Shafie AA, Awaisu A, Ibrahim MI, Ping CC, Jamshed S. Physicians’ views on generic medicines: A narrative review. J Generic Med 2010;7:30-9.
  • Chua GN, Hassali MA, Shafie AA, Awaisu A. A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia. Health Policy 2010;95:229-35.
  • Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol 2013;14:1.
  • Kersnik J, Peklar J. Attitudes of Slovene general practitioners towards generic drug prescribing and comparison with international studies. J Clin Pharm Ther 2006;31:577-83.

EVALUATION OF THE KNOWLEDGE, PERCEPTION AND ATTITUDE OF RESIDENTS IN MEDICINE WORKING IN A UNIVERSITY HOSPITAL ABOUT GENERIC DRUGS

Yıl 2019, Cilt: 33 Sayı: 2, 109 - 119, 27.09.2019

Öz

Objective: To evaluate the level of knowledge of the residents in medicine (RIM) about generic drugs (GDs), the factors that might influence their knowledge, and their perception and prescription attitudes towards GDs.
Material and Method: A cross-sectional study was conducted among RIM (prescribers) working in Dokuz Eylul University Research and Application Hospital during the period between June-August 2018 (n=506). Data was retrieved using questionnaire consisting of 6 sections evaluating the knowledge, perception and attitudes of RIM towards GDs. Descriptive statistics, t-test and correlation analysis were used.
Results: Questionnaire response was 66.0% (n=334). Knowledge score was 8.2±2.9 (maximum: 16); the factors increasing the score were prior training about GDs, working in internal medicine departments, being younger physician. This study found that almost half of the RIM did not prioritize GD’s during prescription, and the reason for this might be the distrust for the effectiveness and quality of GDs. The level of income of the patient and the seriousness of the disease influenced their choice. The rate of RIM who thought that audit of Ministry of Health during GD production adequate was 25.2%, while 47.2% did not comment this issue. The proportion of RIM who thought that GDs were safe and cheap were 53.2% and 61.8%, respectively. The majority of RIM believed that the physicians should be trained about GDs (86.6%).
Conclusion: This study revealed the necessity that teaching objectives related to GDs should be added to the undergraduate and postgraduate medical faculty curriculums and that sufficiency of existing curriculums should be scrutinized.

Kaynakça

  • Kwo EC, Kamat P, Steinman MA. Physician use of brand versus generic drug names in 1993-1994 and 2003-2004. Ann Pharmacother 2009;43:459-68.
  • IMS Institute for Healthcare Informatics. The role of generic medicines in sustaining healthcare systems: A European perspective 2015. Available from: URL: http://www.apmgr.org/docs/IIHI_Generics_Healthcare_Brief.pdf (Erişim tarihi: 25 Ocak 2019).
  • Sacks CA, Lee CC, Kesselheim AS, Avorn J. Medicare spending on brand-name combination medications vs their generic constituents. JAMA 2018;320:650-6.
  • Wouters OJ, Kanavos PG, McKEE M. Comparing generic drug markets in Europe and the United States: prices, volumes, and spending. Milbank Q 2017;95:554-601.
  • Warraich HJ, Salami JA, Khera R, Valero-Elizondo J, Okunrintemi V, Nasir K. Trends in use and expenditures of brand-name atorvastatin after introduction of generic atorvastatin. JAMA Intern Med 2018;178:719-21.
  • Kjoenniksen I, Lindbaek M, Granas AG. Patients' attitudes towards and experiences of generic drug substitution in Norway. Pharm World Sci 2006;28:284-9.
  • Straka RJ, Keohane DJ, Liu LZ. Potential clinical and economic impact of switching branded medications to generics. Am J Ther 2017;24:e278-e289.
  • Colgan S, Faasse K, Martin LR, Stephens MH, Grey A, Petrie KJ. Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review. BMJ Open 2015;5:e008915.
  • Domeyer PJ, Aletras V, Anagnostopoulos F, Katsari V, Niakas D. Development and validation of a tool to assess knowledge and attitudes towards generic medicines among students in Greece: The ATtitude Towards GENerics (ATTOGEN) questionnaire. PLoS One 2017;12:e0188484.
  • Dunne SS, Shannon B, Cullen W, Dunne CP. Beliefs, perceptions and behaviours of GPs towards generic medicines. Fam Pract 2014;31:467-74.
  • Fabiano V, Mameli C, Cattaneo D, et al. Perceptions and patterns of use of generic drugs among Italian Family Pediatricians: First round results of a web survey. Health Policy 2012;104:247-52.
  • Flood D, Mathieu I, Chary A, Garcia P, Rohloff P. Perceptions and utilization of generic medicines in Guatemala: a mixed-methods study with physicians and pharmacy staff. BMC Health Serv Res 2017;17:27.
  • Lewek P, Smigielski J, Kardas P. Factors affecting the opinions of family physicians regarding generic drugs - a questionnaire based study. Bosn J Basic Med Sci 2015;15:45-50.
  • Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. “No generics, Doctor!” The perspective of general practitioners in two French regions. BMC Health Serv Res 2017;17:707.
  • Banahan BF, Kolassa EM. A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med 1997;157:2080-8.
  • Howard JN, Harris I, Frank G, Kiptanui Z, Qian J, Hansen R. Influencers of generic drug utilization: A systematic review. Res Social Adm Pharm 2018;14:619-27.
  • Liou WS, Hsieh SC, Chang WY, Wu GHM, Huang HS, Lee C. Brand name or generic? What are the health professionals prescribed for treating diabetes? A longitudinal analysis of the National Health Insurance reimbursement database. Pharmacoepidemiol Drug Saf 2013;22:752-9.
  • Shrank WH, Liberman JN, Fischer MA, Girdish C, Brennan TA, Choudhry NK. Physician perceptions about generic drugs. Ann Pharmacother 2011;45:31-8.
  • Mondelo-García C, Mendoza E, Movilla-Fernández MJ, Coronado C. Perceptions of pharmacists and physicians on generic substitution in a financial crisis context in Northwestern Spain: A qualitative study. Health Policy 2018;122:1316-25.
  • Hassali MA, Wong ZY, Alrasheedy AA, Salem F, Yahaya AHM, Aljadhey H. Perspectives of physicians practicing in low and middle income countries towards generic medicines: A narrative review. Health Policy 2014;117:297-310.
  • https://www.istanbuleczaciodasi.org.tr/upload/pdf/20090618_es_deger_ilac.pdf (Erişim tarihi: 25 Ocak 2019).
  • Toklu HZ, Dülger GA, Hıdıroğlu S, et al. Knowledge and attitudes of the pharmacists, prescribers and patients towards generic drug use in Istanbul - Turkey. Pharm Pract (Granada) 2012;10:199-206.
  • Bilginer E, Ozçelikay G. A survey to evaluate the opinions of Turkish Physicians’ on bioequivalence. Turkish Journal of Pharmaceutical Sciences 2007;4:79-87.
  • Dosedel M, Maly J, Kubena A, Vicek J. Opinions of Czech general practitioners on generic drugs and substitution. Cent Eur J Med 2014;9:830-8.
  • Jamshed SQ, Ibrahim MIM, Hassali MA, et al. Perception and attitude of general practitioners regarding generic medicines in Karachi, Pakistan: A questionnaire based study. South Med Rev 2012;5;1:22-30.
  • Türkiye İlaç ve Tıbbi Cihaz Kurumu. Beşeri Tıbbi Ürünler İmalathaneleri İyi İmalat Uygulamaları (GMP) Kılavuzu. Erişim: URL: http://www.titck.gov.tr/PortalAdmin/Uploads/UnitPages/%C4%B0%C4%B0U%20KILAVUZU%20V.2017-01.pdf (Erişim tarihi: 02 Ekim 2019).
  • Türkiye İlaç ve Tıbbi Cihaz Kurumu. Farmasötik Müstahzarların Biyoyararlanım ve Biyoeşdeğerliliğinin Değerlendirilmesi Hakkında Yönetmelik. Erişim: URL: http://www.mevzuat.gov.tr/Metin.Aspx?MevzuatKod=7.5.4916&MevzuatIliski=0 (Erişim tarihi: 25 Ocak 2019).
  • Hassali MA, Shafie AA, Awaisu A, Ibrahim MI, Ping CC, Jamshed S. Physicians’ views on generic medicines: A narrative review. J Generic Med 2010;7:30-9.
  • Chua GN, Hassali MA, Shafie AA, Awaisu A. A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia. Health Policy 2010;95:229-35.
  • Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol 2013;14:1.
  • Kersnik J, Peklar J. Attitudes of Slovene general practitioners towards generic drug prescribing and comparison with international studies. J Clin Pharm Ther 2006;31:577-83.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Pelin Tahirler Bu kişi benim 0000-0001-8751-4239

Şeyma Öncü Bu kişi benim 0000-0003-2468-2416

M. Aylin Arıcı Bu kişi benim 0000-0003-2221-9356

Reyhan Uçku 0000-0003-0254-571X

Ayşe Gelal Bu kişi benim 0000-0003-1910-7847

Yayımlanma Tarihi 27 Eylül 2019
Gönderilme Tarihi 29 Ocak 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 33 Sayı: 2

Kaynak Göster

Vancouver Tahirler P, Öncü Ş, Arıcı MA, Uçku R, Gelal A. Bir üniversite hastanesinde çalışan tıpta uzmanlık öğrencilerinin eşdeğer ilaçlar hakkında bilgi, düşünce ve tutumlarının değerlendirilmesi. DEU Tıp Derg. 2019;33(2):109-1.