Consumer knowledge, attitudes and perceptions, towards generic medicines - a perspective from the Northern Suburbs of Johannesburg, South Africa

Zigomo, Tinashe
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In South Africa’s current healthcare structure, about 8.3% of GDP is spent on healthcare. This is well above the WHO recommended 5% of GDP spend. Despite the heavy spending, health outcomes remain poor when compared to similar middle-income countries. Solutions need to be found to cut back on healthcare costs. Approximately half (4.1%) of the healthcare spend is consumed by the private sector which benefits a very small segment (16%) of the population. This segment is largely on medical schemes. Using generic medicines can aid in cutting back on drug costs but are generics being adequately assimilated by the consumers of healthcare in the private sector? The objective of the study was to evaluate the perceptions attitudes and knowledge of the consumers of healthcare in the Northern suburbs of Johannesburg towards generic medicines. A survey was conducted on a sample of 402 respondents across 9 randomly selected pharmacies in the Johannesburg north region between November 2012 and February 2013. A researcher administered questionnaire was the sole data collection tool. Questions asked covered the research objectives and also included demographic data and other explanatory variables. Data analysis was carried out in SAS. The 5% significance level was used throughout, unless specified otherwise. The chi-squared (Χ2 ) test was used to assess the relationships between categorical variables. Fisher’s exact test was used for 2 x 2 tables or where the requirements for the Χ2 test could not be met. The strength of the associations was measured by Cramer’s V and the phi coefficient respectively. Key results on respondent demographics included high representation of the higher income earning groups (78% >R10 000); furthermore 44% had completed tertiary education, 60% were comprehensively insured, 61% regularly visited a pharmacy, 38% were on prescription medication and 24% on chronic medicine. On knowledge, 5% of respondents were able to most accurately define generic medicines. On attitudes, 78% had used generics however the level of agreement was lower for the highest education category (p<0.0001; Cramer’s V=0.18). Trends favoured brands over generics with increasing severity of illness as generics were chosen by 10% in major illness and 5% in chronic illness. 80% perceived generics as safe while 95% perceived brands as safe. 75% of respondents felt that generic medicines were as effective as branded medicines. 15% indicated that branded medicines have fewer side effects. 64% showed positive perceptions of quality of generics compared to 93% for brands. Bowker’s test of symmetry was significant (p<0.0001) showing a shift towards slightly more negative perceptions towards generic medicines amongst those who thought highly of brand quality. Knowledge of generics was overall low. Perceptions regarding safety, quality, efficacy, and side effects of generic medicines were generally positive but responses proved more positive for brands. Attitudes towards generic medicines were mostly positive however willingness to use generics lessened with increasing severity of illness. Household income, health insurance (medical aid) status, level of education, experience with medicines and racial demographics played a key role in explaining consumer beliefs and behaviours. Pharmacists and Doctors had a positive influence on generic use patterns amongst other factors.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Medicine (Pharmaceutical Affairs) Johannesburg, 29 August 2014