A mixed-methods study investigating the potential and challenges of generic substitution of controlled substances in community pharmacies

TL;DR

This study explores the lower substitution rate of generic controlled substances in pharmacies and the challenges pharmacists face, suggesting better collaboration and education to improve patient care.

Contribution

The study provides new insights into the specific challenges and support needs for substituting generic controlled substances in community pharmacies.

Findings

Controlled substances had a significantly lower substitution rate (37%) compared to non-controlled substances (74%).

Pharmacists cited high administrative workload and legal regulations as major challenges.

Physicians prescribed originals and generics at similar rates for both controlled and non-controlled substances.

Abstract

Using generics became an established practice. Studies about dispensing practices of generic controlled substances are scarce.

We investigated dispensing practices of generic controlled substances compared to non-controlled substances, challenges community pharmacists face when substituting them, and how they can be better supported.

A mixed-methods approach was employed. We descriptively analyzed prescribing and dispensing rates of originals and generics of controlled and non-controlled substances. Ten community pharmacists were interviewed to investigate challenges and support options.

Seven hundred eight prescriptions were included in the data analysis. Physicians prescribed 54 % (167/307) of originals for controlled substances and 50 % (202/401) of originals for non-controlled substances (p > 0.05). A total of 37 % (62/167) of prescriptions for original controlled substances were substituted with generics in community pharmacies in contrast to 74 % (149/202) of prescriptions for original non-controlled substances (p < 0.001). Challenges mentioned by the interviewees included gaining trust in the context of generic controlled substance use, meeting patients' needs, and legal regulations. They named support measures, such as patient education by physicians, and reduction of the administrative workload.

The analysis revealed a significantly lower substitution rate for controlled substances compared to non-controlled substances in pharmacies. Yet, physicians showed similar prescribing rates of originals and generics. The findings support the need to strengthen the collaboration between healthcare providers, and to improve education as well as awareness to ensure adequate patient care when substituting generic controlled substances.

•Mixed-methods approach enabled a comprehensive multi-faceted insight.•Lower substitution rate for controlled substances compared to other medicines.•Most frequently named challenge by pharmacists was the high administrative workload.•More patient education by physicians is needed about generic controlled substances.

Mixed-methods approach enabled a comprehensive multi-faceted insight.

Lower substitution rate for controlled substances compared to other medicines.

Most frequently named challenge by pharmacists was the high administrative workload.

More patient education by physicians is needed about generic controlled substances.

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