Physician and Nurse Practitioner Attitudes on Generic Prescribing of Oral Contraceptive Pills and Antidepressants
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Department of Medicine, University of Chicago Medicine, Chicago, IL, USA; 2Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Harris School of Public Policy, University of Chicago, Chicago, IL, USA; 4Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; 5American College of Physicians, Philadelphia, PA, USA; 6American Association of Nurse Practitioners, Austin, TX, USA; 7Clinovations Government + Health, Washington, DC, USA; 8Dell Medical School, University of Texas, Austin, TX, USA; 9Costs of Care, Boston, MA, USA; 10School of Pharmacy, University of California San Francisco, San Francisco, CA, USA; 11Harvard Medical School, Cambridge, MA, USA.
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IMPORTANCE: As prescription drug costs rise, it is important to understand attitudes among primary care physicians and nurse practitioners (NPs) towards generic drugs. OBJECTIVE: We aimed to examine the generic skepticism index (GSI) among primary care clinicians, and their willingness to discuss and prescribe generic antidepressants (ADs) and generic oral contraceptives (OCPs). DESIGN: We used a factorial vignette design survey to test 4 factors: message source, message, brand preference, and drug class. Participants were randomized to different combinations of factors. SETTING: This was a cross-sectional study. PARTICIPANTS: Physicians registered with the American College of Physicians (ACP) and NPs registered with the American Association of Nurse Practitioners (AANP) participated in the study. MAIN MEASURES: The primary outcomes were generic skepticism as measured using the generic skepticism Key Points Question: What attitudes do primary care clinicians have about generic drugs? What factors influence clinicians’ willingness to prescribe generic oral contraceptive pills (OCPs) and antidepressants (ADs)? Findings: In this vignette-based survey of 862 physicians and nurse practitioners, 16% were identified as generic skeptics using the generic skepticism index (GSI). These clinicians had lower odds of willingness to prescribe generic drugs. Clinicians had lower odds of willingness to discuss switching or prescribe generic OCPs compared with generic ADs. Meaning: As the primary care workforce diversifies, it is important to understand the factors that influence generic prescribing among different clinicians. Educational messaging to promote generic prescribing should target skepticism. Prior Presentations Part of this work was presented at the Academy Health Conference in June 2018 and Midwest Society of General Internal Medicine in September 2018. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06239-6) contains supplementary material, which is available to authorized users. Received January 9, 2020 Accepted September 11, 2020
index (GSI), and clinician willingness to discuss and prescribe generics. RESULTS: Surveys were completed by 56% of physicians (n = 369/661) and 60% of NPs (n = 493/819). Compared with physicians, NPs were younger (p < 0.001), predominantly fem
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