Objectives: Generic substitution for reimbursed drugs was introduced in Sweden on 1 October 2002. This study aimed to evaluate how Swedish drug consumers experience generic substitution, 5 years after implementation. Methods: Pharmacy customers over 18 years of age and presenting a prescription for one of the 2688 included drugs were interviewed. The data were collected at 58 Swedish pharmacies. Outcome measures were perceived difficulties related to generic substitution and their degree of seriousness, potential positive experiences, incidence of reported medication errors and consumers' suggestions for improvements to the system of generic substitution. Key findings: Of 1551 respondents (602 male, 949 female), 40% reported at least one difficulty related to substitution, partly resulting in medication errors. A perceived lack of efficacy, a different safety profile and a general confusion regarding the use of generics were the concerns most often reported. Thirty-five per cent (n=536) reported one or more positive experiences, the most common being the lower drug price. Twenty-two per cent (n=342) offered suggestions for improvement. The most common suggestions were to revise the criteria for assessing interchangeability between brand name and generic alternatives and to abolish substitution. Conclusion: A sizeable minority of respondents experience difficulties related to generic substitution, partly resulting in medication errors. The reported concerns seem to be more frequent within some therapeutic groups, but this finding needs to be studied further. Future system changes should consider the importance of revised criteria for generic and brand-name interchangeability. © 2011 The Authors. JPHSR © 2011 Royal Pharmaceutical Society.
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