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Brand name or generic? What are the health professionals prescribed for treating diabetes? A longitudinal analysis of the National Health Insurance reimbursement database

Authors

  • Wen-Shyong Liou,

    1. Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
    2. College of Pharmacy, China Medical University, Taichung, Taiwan
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  • Shu-Ching Hsieh,

    1. Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Canada
    2. School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
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  • Wai-Yuan Chang,

    1. School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
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  • Grace Hui-Min Wu,

    1. Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
    2. Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
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  • Hsu-Shan Huang,

    1. School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
    2. Department of Pharmacy Practice Tri-Service General Hospital, Taipei, Taiwan
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  • Chuanfang Lee

    Corresponding author
    1. School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
    • Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
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Correspondence to: C. Lee, Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; Address: No. 325, Sec. 2, Cheng-Gong Rd., Nei-Hu Dist., Taipei 114, Taiwan. E-mail: leecf67@gmail.com

ABSTRACT

Objective

This study aimed to explore whether physicians prescribe more brand-name oral hypoglycemic agents (OHA) for diabetic patients with medical training background (MP) than for general patients (GP).

Research design and methods

A longitudinal analysis of 1 000 000 National Health Insurance cohorts of 1998–2008 was conducted. Univariate and multivariate models were performed to assess the associations of the outcome (the ratio of brand-name/generic odds in the MP group to that in the GP group) and the covariates, including patient medical training background, characteristics of patient, prescriber, and medical settings, and market competition. A generalized estimating equation method was used to control the dependency of longitudinal data.

Results

A total of 46 850 diabetic patients were prescribed with 2 703 149 OHA prescriptions during the study period. Compared with GP, MP had 1.37 times greater odds of being prescribed with brand-name instead of generic OHA, among whom pharmacists and physicians had the highest odds ratios of 2.78 (95%CI, 1.05–7.36) and 1.68 (95%CI, 0.99–2.85), respectively. Patients' diabetes severity, prescribers' level of experience, medical settings that were publicly owned, had a higher accreditation level, and were located in a higher urbanized area, lower market competition, and earlier dates of prescription were positively associated with brand-name prescription. Among all medical sub-specialties, cardiologists were more likely to prescribe brand-name OHA.

Conclusions

This study is the first to demonstrate how a patients' medical training background, in addition to the characteristics of patients, prescribers, and medical settings, and market competition might influence physicians' prescribing choice of brand-name or generic OHA. Copyright © 2013 John Wiley & Sons, Ltd.

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