Patient views of therapeutic interchange of ACE inhibitors in Australian primary care: a qualitative study

Marshall, Tessa; Lim, Hok; Lau, Phyllis

OBJECTIVES: In Australia, therapeutic interchange of angiotensin-converting enzyme (ACE) inhibitors could generate savings for patients and the Pharmaceutical Benefits Scheme (PBS). The PBS subsidises nine drugs in the ACE inhibitor class. These drugs are therapeutically equivalent, but the price varies between each drug. Patients are key players in successful therapeutic interchange programmes, but little is known about their views. This study aims to explore patient views of therapeutic interchange of ACE inhibitors in Australian primary care. DESIGN: Qualitative exploratory research study using semi-structured interviews, asking participants about therapeutic interchange and their attitude towards hypothetically switching ACE inhibitors. Data were analysed thematically. SETTING: Australian primary care. PARTICIPANTS: Fourteen adults in Australia currently taking an ACE inhibitor, recruited via general practices and pharmacies, social media and professional networks. FINDINGS: Five key themes were identified: participants’ limited understanding of medication; the expectation that a new drug would be ‘the same’; the view that choice, convenience and fear of change outweigh the cost; altruism; and trust in health professionals, particularly participants’ own general practitioner (GP). CONCLUSIONS: Patients’ limited understanding of medication changes poses a barrier to therapeutic interchange. Clinicians should explore patients’ understanding and expectations of therapeutic interchange. Counselling from trusted health professionals, particularly GPs, could ameliorate concerns. Policymakers implementing therapeutic interchange programmes should ensure a trusted GP directs medication changes.