Zhi Yen Wong

General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications

Background: Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance. Aim: Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011. Results: One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions could be appreciably reduced. Conclusion: Further programs are needed to educate GPs and patients about antibiotics building on current initiatives.

Malaysian generic pharmaceutical industries: perspective from healthcare stakeholders

The objectives were to document the published literature related to healthcare stakeholders’ knowledge, attitudes, views and perceptions towards generic medicines or generic substitution in Malaysia and to suggest recommendations to improve generic medicines utilization in Malaysia according to different healthcare stakeholders’ need.

Knowledge and perceptions of physicians from private medical centres towards generic medicines: a nationwide survey from Malaysia

ObjectivesGeneric medicine prescribing has become a common practice in public hospitals. However, the trend in private medical centres seems to be different. The objective of this study was to investigate knowledge, perceptions and behavior of physicians from private medical centres in Malaysia regarding generic medicines.MethodsThis study was a cross-sectional nationwide survey targeting physicians from private medical centres in Malaysia. The survey was conducted using questionnaire having (i) background and demographic data of the physicians, volume of prescription in a day, stock of generic medicines in their hospital pharmacy etc. (ii) their knowledge about bioequivalence (iii) prescribing behavior (iv) physicians’ knowledge of quality, safety and efficacy of generic medicines, and their cost (v) perceptions of physicians towards issues pertaining to generic medicines utilization.ResultsA total of 263 questionnaires out of 735 were received, giving a response rate of 35.8%. Of the respondents, 214 (81.4%) were male and 49 (18.6%) were females. The majority of the participants were in the age range of 41–50 years and comprised 49.0% of the respondents. Only 2.3% of physicians were aware of the regulatory limits of bioequivalence standards in Malaysia. Of the respondents, 23.2% agreed that they ‘always’ write their prescriptions using originator product name whereas 50.2% do it ‘usually’. A number of significant associations were found between their knowledge, perceptions about generic medicines and their demographic characteristics.ConclusionsThe majority of the physicians from private medical centres in Malaysia had negative perceptions about safety, quality and the efficacy of generic medicines. These negative perceptions could be the cause of the limited use of generic medicines in the private medical centres. Therefore, in order to facilitate their use, it is recommended that the physicians need to be reassured and educated about the drug regulatory authority approval system of generic medicines with regard to their bioequivalence, quality, efficacy and safety. Apart from the policy on generic substitution, it would also be recommended to have a national medicine pricing policy, which controls drug prices, in both the public and private sector. These efforts are worthwhile to reduce the drug expenditure and improve the medicine affordability in Malaysia.

Does educational intervention improve doctors' knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia

Objectives: To investigate the impact of an educational intervention on doctors’ knowledge and perceptions towards generic medicines and their generic (international non-proprietary name) prescribing practice. Methods: This is a single-cohort pre-/post-intervention pilot study. The study was conducted in a tertiary care hospital in Perak, Malaysia. All doctors from the internal medicine department were invited to participate in the educational intervention. The intervention consisted of an interactive lecture, an educational booklet and a drug list. Doctors’ knowledge and perceptions were assessed by using a validated questionnaire, while the international non-proprietary name prescribing practice was assessed by screening the prescription before and after the intervention. Results: The intervention was effective in improving doctors’ knowledge towards bioequivalence, similarity of generic medicines and safety standards required for generic medicine registration (p = 0.034, p = 0.034 and p = 0.022, respectively). In terms of perceptions towards generic medicines, no significant changes were noted (p > 0.05). Similarly, no impact on international non-proprietary name prescribing practice was observed after the intervention (p > 0.05). Conclusion: Doctors had inadequate knowledge and misconceptions about generic medicines before the intervention. Moreover, international non-proprietary name prescribing was not a common practice. However, the educational intervention was only effective in improving doctors’ knowledge of generic medicines.

Patients´ beliefs about generic medicines in Malaysia

Background: Acceptance of generic medicines by patients is an essential factor given that they are the end users of these medicines. In fact, adequate knowledge and positive perceptions are prerequisite to patients’ acceptance and use of generic medicines. Objective: To assess the current belief and views of patients about generic medicines in Malaysia. Method: This was a self-administered questionnaire-based study. The study was conducted with patients visiting outpatient pharmacy department at a tertiary care hospital in Malaysia. The Malaysian version of Generic Medicines Scale (GMS) was used. The GMS consists of two subscales: efficacy and similarity of generic medicines to original brand medicines. The efficacy subscale consists of 10 items while the similarity subscale consists of 6 items. The responses to the items were framed as a five-point Likert scale (1=strongly disagree to 5=strongly agree). Results: A total of 202 out of 300 patients participated in the study, giving a response rate of 67.3%. In this study, only 49% of them (n=99) knew the term ‘generic medicine’. Moreover, only 53.5% of the respondents (n=108) believed that the efficacy of generic medicines was the same as original brand medicines. In terms of quality, only 44% of the respondents (n=89) disagreed that generic medicines were of a lower quality. About one third (n=65, 32.2%) believed that generic medicines were cheaper because they were less efficacious. In terms of side effects, 44.5% of the respondents (n=90) believed that generic medicines had the same side effect profile as original brand medicines. Conclusions: The study finding showed that almost half of the respondents had negative belief in generic medicines. Similarly, many patients were not aware of the similarities and differences between generic and original brand medicines. Therefore, there is a need to provide patients with adequate information about generic medicines.

Pharmaceutical Pricing in Malaysia

Malaysia’s healthcare system consists of two sectors namely public and private sector. Ministry of Health (MOH) is the main agency providing healthcare services in public sector.

Pharmaceutical Policy in Saudi Arabia

Saudi Arabia has a well-developed national medicine policy as well as a well-established drug regulatory framework. Moreover, there is a well-defined pharmaceutical pricing policy, and the medicine prices are strictly controlled. The Saudi Pharmaceutical market is the largest market in the Middle East and African (MEA) region. Moreover, it is heavily dependent on imported medicines and dominated by patented and original medicines. Regarding rational use of medicines, there are several issues that need to be addressed. These include unrestricted access to medicines in the community pharmacies. Moreover, the involvement of community pharmacists in promoting rational use of medicines is currently limited. Additionally, generic medicines are still underutilized in the healthcare system. The way forward is the full implementation of these policies and the stricter enforcement of the laws governing medicines sales and dispensing.

Translation and validation of the Malaysian version of generic medicines scale

The study aims to translate and validate the generic medicine scale (GMS) among the Malaysian population. A standard “forward–backward” procedure of translation was used and the translated version was then validated on a convenience sample of 202 patients. Face validity of translated GMS was confirmed with pilot testing. Content validity of the translated GMS was evaluated by eight postgraduate students who are experts in the field. For reliability, the instrument demonstrated good internal consistency (Cronbach’s α = 0.734) with correlation coefficient ranging from 0.198 to 0.500. Alpha value for efficacy dimension of the scale was 0.623 and for similarity dimension was 0.716. The test–retest reliability of the GMS indicates good reliability and stability of the instrument with Spearman’s rank correlation coefficient of 0.532 (rs = 0.532, n = 202, p = 0.005). In conclusion, the Malaysian version of the GMS is a reliable and valid measure of patients’ belief about generic medicines.

Chapter 12 – Overcoming Challenges of Generic Medicines Utilization in Low- and Middle-Income Countries: Lessons Learned From International Experiences

Abstract The major challenge faced by many healthcare providers and policy makers in the world is the ever escalating pharmaceutical expenditure. The situation is worse in developing countries where pharmaceuticals account for 20%–60% of healthcare expenditure. In this challenging scenario of healthcare provision, greater use of generic medicine was encouraged as it was one of the effective mechanisms to curb the escalating healthcare cost especially pharmaceutical expenditure. Different countries have different health policies and healthcare systems, as well as different regulations and policies related to generic medicine utilization. There is a large body of previous literature on pro-generic medicine pharmaceutical policies in the United States and Europe. However, there is relatively less study on generic medicines utilization in low- and middle-income countries (LMICs). This chapter describes achievements and challenges of generic medicines utilization in LMICs. The authors attempt to characterize challenges to generic medicines utilization in LMICs according to “supply-side” and “demand-side” policies and future recommendations were suggested to improve the generic medicines use in LMICs based on international experiences.

Goods and Services Tax on Pharmaceuticals in Malaysia

In Malaysia, the goods and services tax (GST) was implemented in 2015. Within this context, medicines are subjected to GST. However, essential medicines are exempted. In fact, exempting essential medicines from tax is in line with the Malaysian National Medicines Policy which aims to promote equitable access to affordable essential medicines of good quality to improve health outcomes of the people. The implementation of GST on medicines can generate a stable source of revenue for the nation. However, there are some ways/actions that could be considered to ensure the affordability and accessibility of all medicines post-implementation of GST in Malaysia.