Physician and Nurse Practitioner Attitudes on Generic Prescribing of Oral Contraceptive Pills and Antidepressants.

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 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 female (p < 0.001), and differed in the race (p < 0.001). According to the GSI, 16% (n = 138/862) were identified as generic skeptics (18.5% of NPs and 12.7% of physicians, p = 0.023). Generic skeptics had lower odds of willingness to discuss switching (OR 0.22, 95% CI (0.14-0.35), p < 0.001) or prescribe (OR 0.18, 95% CI (0.11-0.28), p < 0.001) generic OCPs. Participants had lower odds of willingness to prescribe generic drugs to patients with brand preference compared with brand-neutral patients (OR 0.64, 95% CI 0.50-0.82, p < 0.001). CONCLUSIONS AND RELEVANCE: Generic skepticism was associated with lower willingness to discuss or prescribe generic drugs. Clinicians reported lower willingness to discuss switching or prescribe generics for OCPs than for ADs. Patient brand preference hindered generic prescribing. Message source and message type were not significantly associated with outcomes.

Development and testing of a web module to IMPROVE generic prescribing of oral contraceptives among primary care physicians.

WHAT IS KNOWN AND OBJECTIVE: The use of generic oral contraceptives (OCPs) can improve adherence and reduce healthcare costs, yet scepticism of generic drugs remains a barrier to generic OCP discussion and prescription. An educational web module was developed to reduce generic scepticism related to OCPs, improve knowledge of generic drugs and increase physician willingness to discuss and prescribe generic OCPs. METHODS: A needs assessment was completed using in-person focus groups at American College of Physicians (ACP) Annual Meeting and a survey targeting baseline generic scepticism. Insights gained were used to build an educational web module detailing barriers and benefits of generic OCP prescription. The module was disseminated via email to an ACP research panel who completed our baseline survey. Post-module evaluation measured learner reaction, knowledge and intention to change behaviour along with generic scepticism. RESULTS AND DISCUSSION: The module had a response rate of 56% (n = 208/369). Individuals defined as generic sceptics at baseline were significantly less likely to complete our module compared to non-sceptics (responders 9.6% vs non-responders 16.8%, P = 0.04). The majority (85%, n = 17/20) of baseline sceptics were converted to non-sceptics (P < 0.01) following completion of the module. Compared to non-sceptics, post-module generic sceptics reported less willingness to discuss (sceptic 33.3% vs non-sceptic 71.5%, P < 0.01), but not less willingness to prescribe generic OCPs (sceptic 53.3% vs non-sceptic 67.9%, P = 0.25). Non-white physicians and international medical graduates (IMG) were more likely to be generic sceptics at baseline (non-white 86.9% vs white 69.9%, P = 0.01, IMG 13.0% vs USMG 5.0% vs unknown 18.2%, P = 0.03) but were also more likely to report intention to prescribe generic OCPs as a result of the module (non-white 78.7% vs white 57.3%, P < 0.01, IMG 76.1% vs USMG 50.3% vs unknown 77.3%, P = 0.03). WHAT IS NEW AND CONCLUSION: A brief educational web module can be used to promote prescribing of generic OCPs and reduce generic scepticism.

Genetic diversity of Plasmodium vivax clinical isolates from southern Pakistan using pvcsp and pvmsp1 genetic markers.

BACKGROUND: Plasmodium vivax is the prevalent malarial species accounting for 70% of malaria burden in Pakistan; however, there is no baseline data on the circulating genotypes. Studies have shown that polymorphic loci of gene encoding antigens pvcsp and pvmsp1 can be used reliably for conducting molecular epidemiological studies. Therefore, this study aimed to bridge the existing knowledge gap on population structure on P. vivax from Pakistan using these two polymorphic genes. METHODS: During the period January 2008 to May 2009, a total of 250 blood samples were collected from patients tested slide positive for P. vivax, at the Aga Khan University Hospital, Karachi, or its collection units located in Baluchistan and Sindh Province. Nested PCR/RFLP was performed, using pvcsp and pvmsp1 markers to detect the extent of genetic diversity in clinical isolates of P. vivax from southern Pakistan. RESULTS: A total of 227/250 (91%) isolates were included in the analysis while the remainder were excluded due to negative PCR outcome for P.vivax. Pvcsp analysis showed that both VK 210 (85.5%, 194/227) and VK 247 type (14.5%, 33/227) were found to be circulating in P. vivax isolates from southern Pakistan. A total of sixteen and eighty-seven genotypes of pvcsp and pvmsp-1 were detected respectively. CONCLUSION: This is the first report from southern Pakistan on characterization of P. vivax isolates confirming that extensively diverse pvcsp and pvmsp1 variants are present within this region. Results from this study provide valuable data on genetic diversity of P. vivax that will be helpful for further epidemiological studies.

Drug-eluting balloon (DEB) for de-novo coronary artery disease and in-stent restenosis: immediate and intermediate term results from a prospective registry.

OBJECTIVES: To study the safety and short and intermediate term efficacy of drug-eluting balloon (DEB) in the treatment of de-novo and in-stent restenotic coronary artery disease (CAD). METHODS: Of the total 100 patients so far enrolled in a prospective DEB registry using a Paclitaxel-coated balloon at our hospital, 36 patients were studied for short and intermediate term i.e. 12 months outcomes. All patients with symptomatic coronary artery disease (CAD) including de-novo lesions or in-stent restenosis (ISR) requiring percutaneous intervention (PCI) with a DEB were included. Clinical follow-up was conducted at 3, 6 and 12 months. Primary outcome was a composite of major adverse cardiac events (MACE). RESULTS: Procedural success was achieved in all (100%) patients. Mean age was 53.2 +/- 12 years, 61.1% presented with acute coronary syndrome (ACS) and 47.2% had triple vessel CAD. Sixty six percent were classified as having ACC/AHA B-2 or C type coronary arteries including 22.2% with bifurcation lesions. DEB intervention for de-novo CAD was done in 77.7% patients and 22.2% for ISR. All de-novo lesions required a bare- metal stent (BMS) after DEB dilatation. Mean DEB diameter was 2.73 +/- 0.06 mm and mean length was 19.58 +/- 0.81 mm. Coronary dissections occurred in 5 patients which were successfully treated with additional stents. At 3 (n=36), 6 (n=31) and 12 (n=31) months follow-up, no MACE was observed in any patient. CONCLUSION: The short and intermediate term outcomes from this prospective DEB registry showed excellent results with 0% target lesion revascularization (TLR) for both de-novo and ISR lesions.

Assessing the need for training: general practitioners' knowledge, attitude and practice concerning dengue and malaria in Karachi, Pakistan.

Changing environmental conditions have increased the transmission period for both dengue and malaria. Annual incidence of malaria in 2006 alone was 247 million cases leading to nearly 881 000 deaths; whereas another 50 to 100 million dengue infections, associated with an overall mortality of 2.5%, are expected each year. In Pakistan, like many developing nations with endemic malaria, an empirical clinical diagnosis is usually made, due to a lack of resources and availability of diagnostic facilities. Since both diseases are endemic in the same population and presenting symptoms are similar a thorough knowledge of both diseases is essential for improving diagnosis on clinical grounds. Thus our study aims were to evaluate knowledge, attitudes and practices of family medicine practitioners with regard to dengue and malaria and thereby assess the need for further training. Ninety consenting general practitioners (GPs) in different towns of Karachi, Pakistan were administered an extensive questionnaire of 50 questions regarding their knowledge, attitudes and practices on management of dengue and malaria. The authors concluded that despite possessing basic knowledge of the disease, the majority of GPs in the area needed training regarding both diseases and their management. Key targets identified for training programs included clinical diagnosis and management of endemic vector borne diseases.

Maternal neonate and child health (MNCH) research in Pakistan: trend and transition.

Pakistan's MNCH (Maternal, Neonatal & Child Health) indicators are showing a slow progress in achieving Millennium Development Goals (MDG) targets. Relevant research is necessary for evidence-based interventions. This paper attempts to identify trends of published work and research in MNCH according to levels of health service delivery and their areas of focus in terms of policy and/or programmatic approach. A total of 342 published papers and documents relevant to MNCH from 1995-2008 were reviewed and categorized according to the level and type of research. Most of the published work specifically focusing on MNCH has been conducted in the tertiary level care facilities (48%) with maximum focus on clinical/diagnostic interventions (52.3%). A surge in publication of MNCH related articles has been observed from the year 2000 onwards. This paper illustrates that most of the research conducted is at tertiary level care facilities with focus on clinical/diagnostic interventions while lesser research was done with focus on policy and strategic planning. Where a number of commendable materials are available on 'policy and strategic planning' but these are not always based on evidence and scientific rigor and on widely disseminated lessons learnt. Thus there is a dire need to carry-out and promote more researches in the area of policy and strategic planning in MNCH.

Impact of information sources on the knowledge of adolescents about hepatitis B.

OBJECTIVE: To assess the impact of various sources of information on school going adolescents (belonging to higher social strata between ages 14-19 years) regarding Hepatitis B; its various types, importance, symptoms and cures. METHODS: A self-administered survey was conducted among the secondary school students (9-12 grades) of a private school for this purpose. RESULTS: A total of 160 students were approached from which 158 (98%) agreed to take part in the survey. Overall 98% students claimed to know something about Hepatitis B. But only 52% of all had comprehensive and correct knowledge about symptoms, causes and measures for prevention of Hepatitis B. Their major sources of knowledge were parents (57%) and television (56%) followed by newspapers and books (31%), doctors (30%) teachers and peers (29%). CONCLUSION: Only half of the adolescents had correct knowledge about Hepatitis B, which infers that an average person's level of knowledge would have many misperceptions and myths. Television and parents are the most influential sources of imparting health education to adolescents. Thus it is imperative that these sources of knowledge strengthened to provide correct information to adolescents.