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      Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India

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          Abstract

          Introduction

          Generic medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines.

          Methods

          The study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system.

          Results

          The generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients’ and health workers’ perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system.

          Conclusion

          Negative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.

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          Most cited references39

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          Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?

          Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.
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            Impact of poor-quality medicines in the ‘developing’ world

            Since our ancestors began trading several millennia ago, counterfeit and substandard medicines have been a recurring problem, with history punctuated by crises in the supply of anti-microbials, such as fake cinchona bark in the 1600s and fake quinine in the 1800s. Unfortunately this problem persists, in particular afflicting unsuspecting patients in ‘developing’ countries. Poor-quality drugs are a vital (but neglected) public health problem. They contribute to a ‘crevasse’ between the enormous effort in therapeutic research and policy decisions and implementation of good-quality medicines.
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              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              People-centred science: strengthening the practice of health policy and systems research

              Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context. Change occurs at many layers of a health system, shaped by social, political, and economic forces, and brought about by different groups of people who make up the system, including service users and communities. The seeds of transformative practice in HPSR lie in amplifying the breadth and depth of dialogue across health system actors in the conduct of research – recognizing that these actors are all generators, sources, and users of knowledge about the system. While building such a dialogic practice, those conducting HPSR must strive to protect the autonomy and integrity of their ideas and actions, and also clearly explain their own positions and the value-basis of their work. We conclude with a set of questions that health policy and systems researchers may wish to consider in making their practice more people-centred, and hence more oriented toward real-world change.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2017
                13 January 2018
                : 2
                : Suppl 3
                : e000644
                Affiliations
                [1 ]Institute of Public Health , Bangalore, Karnataka, India
                [2 ]Alliance for Health Policy and Systems Research, World Health Organization , Geneva, Switzerland
                Author notes
                [Correspondence to ] Dr Prashanth N Srinivas; prashanthns@ 123456iphindia.org
                Author information
                http://orcid.org/0000-0003-0968-0826
                Article
                bmjgh-2017-000644
                10.1136/bmjgh-2017-000644
                5844374
                820b68f6-4f4c-4088-87f1-9093b9c3cbcf
                © World Health Organization [2018]. Licensee BMJ.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial IGO License (CC BY-NC 3.0 IGO), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL. See: https://creativecommons.org/licenses/by-nc/3.0/igo

                History
                : 11 November 2017
                : 19 November 2017
                : 24 November 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100007855, Alliance for Health Policy and Systems Research;
                Categories
                Research
                1506
                1359
                Custom metadata
                unlocked

                health systems,public health,diabetes,hypertension,qualitative study

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