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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 4  |  Page : 308-312

Perception toward low-cost generic medicines and their usage among dental patients visiting community outreach programs in the peripheral areas of Bangalore South: An exploratory cross-sectional survey


Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission24-May-2020
Date of Decision21-Sep-2020
Date of Acceptance05-Oct-2020
Date of Web Publication16-Dec-2020

Correspondence Address:
Nigy Johnson
Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru - 560 074, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_80_20

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  Abstract 


Background: The burden and prevalence of oral diseases are higher in developing countries, especially among the poor and disadvantaged populations. These people may suffer from various dental and systemic illnesses. Hence, provision of reducing the out-of-pocket money by purchasing generic drugs might enable better oral and general health-care-seeking behavior. Objectives: The objective was to assess the perception toward low-cost generic medicines available through the Pradhana Manthri Bhartiya Janaushadhi Pariyojana and their usage among dental patients visiting community dental outreach programs conducted in the villages near a tertiary care dental teaching hospital, Bangalore South. Materials and Methods: An exploratory descriptive cross-sectional survey was carried out over a period of 3 months among 200 residents participating in the dental outreach programs in 15 villages of Bangalore South. Data were collected using a prevalidated closed-ended interviewer-administered questionnaire. Results: Most respondents (82.5%) were not aware of Prime Minister Jan Aushadhi Kendra (PMJAK) and only 17.5% knew about the nearest PMJAK. The majority (96.5%) were not aware of the availability of dental-related medicines in PMJAK and (95.5%) preferred to buy Jan Aushadhi drugs over branded medicine if the quality of generic and branded medicine is the same. Most respondents (98%) liked to have more awareness through mass media about PMJAKs/medicines. Conclusion: The results indicate that more awareness must be created, and strict laws implemented about the Jan Aushadhi scheme to save health cost expenditure; if the quality of generic and branded medicine is the same, most people are willing to use the medicines sold at PMJA Kendras.

Keywords: Branded medicine, Jan Aushadhi generic medicine, Jan Aushadhi Kendras


How to cite this article:
Johnson N, Somasundara Y S, Bhat PK, Kumar S, Nayana M. Perception toward low-cost generic medicines and their usage among dental patients visiting community outreach programs in the peripheral areas of Bangalore South: An exploratory cross-sectional survey. J Indian Assoc Public Health Dent 2020;18:308-12

How to cite this URL:
Johnson N, Somasundara Y S, Bhat PK, Kumar S, Nayana M. Perception toward low-cost generic medicines and their usage among dental patients visiting community outreach programs in the peripheral areas of Bangalore South: An exploratory cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2021 Nov 28];18:308-12. Available from: https://www.jiaphd.org/text.asp?2020/18/4/308/303641




  Introduction Top


Several socioepidemiological studies have pointed out that the burden and prevalence of oral diseases are higher in developing countries, especially among the poor and disadvantaged population.[1] Dental treatment is costly, averaging 5% of total health expenditure and 20% of out-of-pocket (OOP) health expenditure in most high-income countries.[2] Drugs and medicines form a substantial portion of OOP spending on health among households in India and have become a major source of catastrophic expenditure for both out-patient services and inpatient (hospitalization) charges.[3] An ideal solution to decrease the OOP expenditure due to medicines would be free distribution of medicines, but its financial feasibility for the union government is very poor in India.[3]

To counter this, the Government of India in 2008 launched the Jan Aushadhi Campaign to provide quality generic medicines.[4] The Prime Minister of India realizing the socioeconomic value of the project adopted the generic Jan Aushadhi Kendras which is now known as Prime minister Jan Aushadhi Kendra (PMJAK).[5] A few studies have investigated the quality of generic medicines provided at such outlets and found generic medicines to be of similar quality to their branded equivalents.[6] The drugs prescribed by dentists including antibiotics, analgesics, and mouthwashes are available at very low cost from the Jan Aushadhi stores.[5] Hence, decreased health-care expenses might enable better oral health-seeking behavior. To the best of our knowledge, there are no studies that have reported the awareness of affordable medicines available through the Jan Aushadhi Scheme among the villages of South Bangalore.

With this background, the current study was done to assess the perception toward the low-cost generic medications available through Pradhana Manthri Bhartiya Janaushadhi Pariyojana in the nearest Pradhana Manthri Bhartiya Janaushadhi Pariyojana and their usage in the peripheral areas of Bangalore South, among the dental patients visiting community outreach programs from the villages nearby a tertiary care dental teaching hospital.


  Materials and Methods Top


Study design and study setting

This was an exploratory descriptive cross-sectional survey conducted in community settings, in peripheral (peri-urban) areas nearby a tertiary care dental teaching hospital from July to September 2019. The eligibility criteria included male and female patients aged 18 and above residing in any of the 15 villages in the peripheral region of Bangalore South. These patients were selected based on convenience sampling from among the dental patients visiting the community outreach program.

Ethical approval for the study was obtained from the Institutional Review Board of the Dental College and Hospital, Bangalore, and informed consent was obtained from all the participants.

Sample size determination

The sample size was determined using the following formula: n = Z2(1−α)pq/e2.

Z (1−α) = 1.96 (for 95% confidence interval)

P = 0.15 (based on the probability, 10%–15% is the usage of generic medicines by the patients visiting community centers in urban periphery in India, as per the previous literature[7]).

q = 1 − p

e (margin of error) = 0.05

n = 195.92, rounded off to 200

Thus, the sample size was estimated to be 200.

Data collection

A pilot survey was carried out among 20 residents of one of the villages nearby a tertiary care dental teaching hospital, who were not included in the final survey, to test the interviewer-administered questionnaire for comprehensibility, acceptance, and time required per person. A pilot study was carried out twice with a gap of 2 weeks on the same 20 participants, which showed the similarity of individual responses. Required changes to the questionnaire were made before actual use.

Data collection was done maintaining anonymity and confidentiality by not recording the names of the participants on the questionnaire. A pretested interviewer-administered questionnaire was used to collect the data from the participants. Questions from previously published literature were included in the questionnaire.[6],[8] Face validity was established by a consultative process with experts. The general information of the participants include age, gender, educational level, marital status, and monthly family income. The questionnaire consisted of 28 closed-ended items assessing participant's perception about the generic medicines provided through Jan Aushadhi.

Statistical analysis

Data analysis was performed using the Statistical Package for the Social Sciences for Windows, version 22.0. Released in 2013. Armonk, NY: IBM Corp. Chi-square goodness of fit test was used and the level of significance (P value) was set at P < 0.05.


  Results Top


A total of 200 residents participated in the study, with a slightly higher percentage of males (n = 104, 52%) than females (n = 96, 48%). Majority of participants, (n = 118, 59%) were of age group 21–40 years and most (n = 116, 58%) of them were married. Majority (n = 83, 41%) of participants were with an education level of secondary and most of them reported (n = 75, 37.5%) a monthly income of INR 21,000–25,000.

[Table 1] shows that only less than a fifth (n = 33, 16.5%) of the participants knew about the price difference between generic and branded medicine. Only six participants (3%) felt that generic medicines will not be inferior to expensive branded drugs. Most (n = 166, 83%) of the respondents reported having received free generic medicines at government health-care facilities.
Table 1: Perceptions toward low-cost generic medication by the study participants

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[Table 2] shows that majority of the participants were neither aware of the term Jan Aushadhi (n = 165, 82.5%) nor knew that Jan Aushadhi Kendras were now called as Pradhan Mantri Bhartiya Jan Aushadhi Kendra (PMJAK) (n = 191, 95.5%). Most of the study population had not purchased low-cost generic drugs from PMJAK (n = 166, 83.5%), neither knew where the nearest PMJAK was located (n = 165, 82.5%) nor were aware of the PM Jan Aushadhi Kendra located at the community health-center (CHC) in Kengeri (n = 165, 82.5%).
Table 2: Awareness of the study participants about Jan Aushadhi

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[Table 3] shows that the majority (n = 193, 96.5%) of the study population were not aware of the availability of generic medicines needed to treat dental problems, at very low cost at PMJAK. All the participants agreed that the government should come up with more strict laws for implementation of Jan Aushadhi scheme. Most (n = 197, 98.5%) of them prefer to buy Jan Aushadhi medicine over branded drugs if the quality was as branded medicine. All the participants agreed that Jan Aushadhi medicine would help to save health cost expenditure and agreed that they need more awareness regarding the use of Jan Aushadhi medicine from doctors. All the findings were found statistically significant.
Table 3: Perception and utility of the study participants toward Jan Aushadhi scheme

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  Discussion Top


It has been our observation and experience that many of the rural dental patients often do not comply with completion of the course of medication prescribed as they cannot afford to buy expensive branded medications that are commonly available and also pay for the dental procedures that they need to undergo. This prompted the need to explore the awareness of patients about the low-cost generic medicines that are available at the PMJAK nearest to our dental teaching institution; hence, the present study was carried out among the villages in South Bangalore, surrounding our dental teaching Institution.

Most of the respondents were educationally and financially constrained reflecting in the low percentage that majority (n = 167, 83.5%) of the respondents in our study were not aware that there was a price difference between generic and branded medicines and all of them thought that branded drugs are costlier than generic drugs, similar to the results reported from earlier studies in Lucknow (2018)[7] and Jammu (2017).[8]

In this study, the majority of the participants (n = 194, 97%) believed that the cheaper generic medicines would be inferior to expensive branded Drugs. In a systematic review[9] and a study conducted in Tumkur,[6] it was found that a significant portion of laypeople hold negative perceptions of generic medicines. There is a clear need for a targeted information campaign to dispel the misperception of inferior quality, safety, and efficacy of generic medicines.[9]

In the present study, all participants agreed to know about other cheaper alternatives of medicines to branded medicines. Similar results were found in a study conducted in Jammu (2017), wherein all the participants wanted alternative cheaper medicines to be provided to them.[8] This presents an opportunity for creating awareness among the general population about existing provisions such as PMJAK scheme to procure cheaper bio-equivalent generic medicines.

In this study, majority of the respondents (n = 165, 82.5%) were neither aware of Jan Aushadhi nor knew where the nearest Jan Aushadhi medical store was located, and the study conducted in Jammu (2017) had similar results.[8] The government has opened the PMJAK stores in cities rather than in villages and small towns where availability and affordability of medicines is a bigger challenge.[10] Mass education and awareness programs on the generics and their quality sold at the Jan Aushadhi stores may help to instil confidence among the patients as well as health-care providers.[10]

Only a few proportion of the study population (n = 35, 17.5%) knew where the nearest PMJAK was located at the CHC in Kengeri and all the participants agreed there should be an information board outside PMJAK. Absence of informative boards outside PMJAK stores was one of the major reasons for the unawareness reported in Chandigarh (2016) also.[11] There is a strong felt need for signage pointing to the location of the PMJAK on the roads where it is located.

Majority of the participants (n = 165, 82.5%) do not know about the type of medicines sold at PMJAK and only about (n = 34, 17%) of them had purchased from PMJAK. According to previous reports (Chandigarh 2016),[11] people thought that they sell “Aushadhi” or Ayurvedic medicines and there is unavailability of all medicines at most stores. In the present study, most of the respondents (n = 193, 96.5%) were not aware that generic medicines needed to treat dental problems such as toothache, tooth/gum infections, and mouthwashes were available at very low cost in PMJAK. Dental teaching institutions can also step into play a role in creating awareness about the availability of these medicines at the nearest PMJAK. However, for this to happen, the Government of India must sensitize the governing bodies such as the Dental Council of India to encourage the prescription of generic medicines by the dental health professionals.

All the participants in this study agreed that the government should come up with strict laws for the implementation of PMJAK medicine scheme similar to that reported in previous studies from Jammu (2017).[8] There is a need for systematic and significant investment in promoting and building the reputation of while simultaneously investing in popular schemes such as Janaushadhi.[5]

All the participants in the present study agreed that they would like to get information on PMJAK through media, newspapers, magazines, etc., and the study conducted in Jammu (2017) had similar results.[8] By doing so, both rural and urban population will become more aware of these PMJAK and the affordable drugs would bring down the expenditure of medicines for government and public.[5]

In the present study, only a few (n = 2, 1%) respondents had asked their doctor about Prime Minister Jan Aushadhi (PMJA) medicines which is grossly less than that reported from earlier from Jammu (2017)[8] and Lucknow (2018).[7]

One special advantage of writing the generic name is that it helps the pharmacist to select other brand names which are suitable for the patient's pocket. Here, the pharmacist can open a dialogue with patients regarding the advantages of generic medicines.[5]

Majority of the study population, i.e., 197 (98.5%) agreed to buy PMJA medicines over Branded drugs if the quality of generic and branded medicine is the same. In the study conducted in Manipal (2019), a small percentage (4.6%) of the total study population had switched from branded to generic medicines in the past 6 months as generic medicines were less expensive compared to their branded counterparts.[4] All participants in this study agreed that using PMJA medicine will help to save health cost expenditure.

At present, there are over 4100 (2018) Jan Aushadhi drug stores across the country. Jan Aushadhi centers in these states provide generic medicines of 230 different kinds of drug formulations. However, the intended intentions of the government have not still met with total success as still the patients feel hesitant to buy the generic medicines from these centers and even doctors are doing no good as some of them are reluctant to prescribe them.[12]

The present study was limited to the villages surrounding a dental teaching institution in South Bangalore which were located within 10 km range of the nearest PMJAK. We acknowledge the small sample size of this exploratory cross-sectional survey carried out in about 15 villages that were covered by our institution. Our intent was to know the awareness about the Jan Aushadhi drugs among the local people so that we can disseminate information about it, as part of our weekly camps conducted in these villages on an ongoing basis. Further studies could be taken up on a larger scale to explore the utilization of the low-cost generic medicines including those used to treat dental problems available under the Jan Aushadhi scheme. People can be educated to spend the money saved on availing the required dental treatments, thereby improving oral health-seeking behavior.


  Conclusion Top


This study revealed that the majority of the respondents from the villages were not aware about generic medicines required to treat the dental problems available through the Jan Aushadhi Scheme at the PMJAK located near dental teaching institution. However, almost all of them liked to get more information about the PMJAKs through local signboards, mass media, and their doctors. Hence, there is an urgent need for setting up of PMJAKs near tertiary care institutions like dental and medical colleges and also rural areas to ensure easier access to the low-cost generic medicines. Further, policymakers must be informed of the need for awareness campaigns to inspire trust in the low-cost generic medicines of Jan Aushadhi scheme to encourage utilization of these pocket-friendly measures by the common people.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Grameen Foundation India. Research on Triggers and Barriers to Uptake of Dental Healthcare Services among Low Income Households in Urban India. Available from: http://www.file:///C:/Users/14q-cs0006tu/Desktop/Report-Dental-Healthcare-Access-Urban-Low-Income-Households-India.pdf. [Last accessed on 2019 Dec 07].  Back to cited text no. 1
    
2.
World Health Organization. Fact Sheet on Oral Health. Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health. [Last accessed on 2019 Dec 07].  Back to cited text no. 2
    
3.
Mukherjee K. A cost analysis of the Jan Aushadhi scheme in India. Int J Health Policy Manag 2017;6:253-6.  Back to cited text no. 3
    
4.
Ballala K, Rao CR, Chaudhary AS, Bidnurmath AS, Pandey AK. Knowledge, attitude and practices regarding generic medicines and its usage: A community-based study. Int J Community Med Public Health 2019;6:2182-8.  Back to cited text no. 4
    
5.
Chikkamath V, Nagappa AN. Pradhan Mantri Jan Aushadi Kendra-demonetarization of medicine prices in India. J Gen Pract (Los Angeles) 2016;4:1-5.  Back to cited text no. 5
    
6.
Aivalli PK, Elias MA, Pati MK, Bhanuprakash S, Munegowda C, Shroff ZC, et al. Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India. BMJ Glob Health 2017;2:e000644.  Back to cited text no. 6
    
7.
Tripathi S, Bhattacharya S. Patient perception about generic vs. branded medicines prescribed in a tertiary care hospital in Northern India-a descriptive study. Indian J Pharm Pract 2018;11:91-5.  Back to cited text no. 7
    
8.
Sadiq S, Khajuria V, Khajuria K. Knowledge, attitude, and practices toward Jan Aushadhi scheme. Natl J Physiol Pharm Pharmacol 2017;7:977-82.  Back to cited text no. 8
    
9.
Colgan S, Faasse K, Martin LR, Stephens MH, Grey A, Petrie KJ. Perceptions of generic medication in the general population, doctors and pharmacists: A systematic review. BMJ Open 2015;5:e008915.  Back to cited text no. 9
    
10.
Singhal GL, Anita K, Arun N. Jan Aushadhi stores in India and quality of medicines therein. Int J Pharm Pharm Sci 2011;3:204-7.  Back to cited text no. 10
    
11.
Chibber C. Lack of Awareness among Patients Ails Jan Aushadhi Stores. Chandigarh; 2016. Available from: https://www.tribuneindia.com/news/chandigarh/community/lack-of-awareness-among-patients-ails-jan-aushadhi-stores/230353.html. [Last accessed on 2019 Dec 07].  Back to cited text no. 11
    
12.
Aushadhi J. Government of India, BPPI. Available from: http://www.janaushadhi.gov.in. [Last accessed on 2019Dec 07].  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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