PS-C20-10: HYPERTENSIVE PATIENTS BELIEFS, PERCEPTION AND EXPERIENCE OF GENERIC SUBSTITUTION, AND ADHERENCE AT A LARGE TEACHING HOSPITAL IN GHANA
Authors: Akolgo Marilyn , Harrison Mark Amankwa , Dzabeng Francis , Kyei Charles , Apraku Edward Anane , Ankrah Daniel Nii Amoo , Owusu Helena , Kretchy Irene 
Published: January 2023

Objective:
The objective of this study was to investigate hypertensive patient beliefs, perception and experience about generic antihypertensive drug substitution and the relationship with adherence.

Design and Methods:
A prospective cross-sectional study was conducted among 351 hypertensive out-patients at the polyclinic/Family Medicine Department of Korle Bu Teaching hospital using a validated structured questionnaire. Systematic sampling was used to include participants. Patients were 18years and had been on antihypertensive drugs for at least 6 months. Beliefs about generic medicines were collected using an adapted form of the belief about generic medicines scale developed by Figueiras et al and was scored on a 5-point likert scale. Perception about generic substitution was scored using a likert scale. Experiences were measured as experience of side effects. Medication adherence was measured using the Medication Adherence Report Scale-5 (MARS 5). Data were analysed using STATA.

Results:
Majority of patients were females (n = 269; 76.6) and aged between 60–79 years (n = 191; 54.4%). A majority (n = 261; 74.64%) reported favourable views about the efficacy of generics being the same as the originator medicines generics (mean score: 1.980 ± 1.162). They generally did not believe that generics were of lower quality (n = 188; 53.6%; mean score: 3.524 ± 1.00). Half were of the perception that physicians needed not to ask about their preference for generic or originator (n = 178; 50.8%; mean score: 3.627 ± 1.426). Most patients did not mind generic substitution to an equivalent local antihypertensive (n = 289; 82.3%; mean score: 1.946 ± 1.061). Majority believed that generics did not reduce adherence to their medicines (n = 262; 74.6%; mean score: 3.960 ± 1.170). Majority preferred generic substitution with a cheaper type (n = 213; 60.6%; mean score: 2.536 ± 1.399). Ninety five patients (27.1%) experienced side effects. Majority of patients were adherent to medication (193; 55%). Belief about generic medication and experience of generic substitution were not associated with adherence to antihypertensive medication (X2 = 2.117; p = 0.710; X2 = 0.187; p = 0.911). Educational level and income bracket were associated with perception of generic substitution (X2: 32.64; p: < 0.001; X2: 17.48; p: < 0.001). Patients who received sufficient information about generic substitution were more likely to adhere to medication (X2 = 9.199; p = 0.010; aOR:1.7; 1.1–2.5; p = 0.022).

Conclusion:
Majority of patients had a favourable belief and perception about generic antihypertensive drug substitution but there was notable experience of side effects although it was not associated with adherence. These findings appear to highlight the value of generics in improving treatment rates of hypertension and treatment monitoring need, as well as shape interactions of healthcare practitioners during generic substitution.