Hospitalized Elderly Lack Understanding of Generic Drug Equivalence

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Rosemary Frei, MSc
Medical Writer

Results of a new study have shown that fewer than 50% of a sample of elderly hospitalized people think that generic drugs are as effective or as safe as brand-name medications.1 This is sure to add to the increasing clamour for more patient and physician education about generic equivalence and the cost benefits to the consumer, as well as to the health plan in utilizing these therapeutic options.

The study involved 315 nondemented, Medicare-enrolled patients aged 65 years or older who were in 2 primary care practices of a tertiary care hospital in Harlem, New York. Their beliefs about generic medications were measured in a 1-hour interview using 2 scales, one relating to generics versus brand-name drugs and the other dealing with physician communication skills.

Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Inadequate health literacy is defined as struggling with basic medical information such as reading prescription bottles. 

The investigators found that more than 50% of the patients believed generics are less effective, less tolerable, or less safe than brand-name drugs; however, only 3.8% disagreed that generics were less expensive than brand-name medications.

Unfavorable views of generics were more common among people at lower socioeconomic levels. Multivariate regression analysis showed that inadequate health literacy was significantly associated with misconceptions about generics (P = .001). People with inadequate health literacy were only 37% as likely as those with adequate health literacy to agree that generics are less expensive than brand-name drugs, 39% as likely to believe that generics work as well, and 32% as likely to feel they’re as safe.

The association between poor physician communication and negative beliefs about generics was not statistically significant. “Physicians should at some point in their interaction with individual patients let them know that generics are available as substitutes for the more expensive brand-name medications, and that they are equivalent in terms of their effectiveness and safety,” said lead investigator Alex Federman, MD, MPH, Assistant Professor of Medicine, Division of General Internal Medicine, Mount Sinai School of Medicine, New York. “I don’t think that happens routinely.”


1. Iosifescu A, Halm EA, McGinn T, et al. Beliefs about generic drugs among elderly adults in hospital-based primary care practices. Patient Educ Couns. 2008 Aug 13. [Epub ahead of print.]
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Last modified: February 14, 2019
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