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Hajizadeh M, Edmonds S. Universal Pharmacare in Canada: A Prescription for Equity in Healthcare. Int J Health Policy Manag 2020; 9:91-95. [PMID: 32202091 PMCID: PMC7093046 DOI: 10.15171/ijhpm.2019.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/14/2019] [Indexed: 01/06/2023] Open
Abstract
Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.
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Affiliation(s)
- Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Sterling Edmonds
- Schulich School of Law, Dalhousie University, Halifax, NS, Canada
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Warth J, Puth MT, Tillmann J, Beckmann N, Porz J, Zier U, Weckbecker K, Weltermann B, Münster E. Cost-related medication nonadherence among over-indebted individuals enrolled in statutory health insurance in Germany: a cross-sectional population study. BMC Health Serv Res 2019; 19:887. [PMID: 31771583 PMCID: PMC6880370 DOI: 10.1186/s12913-019-4710-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Millions of citizens in high-income countries face over-indebtedness that implies being unable to cover payment obligations with available income and assets on an ongoing basis. Studies have shown an association between over-indebtedness and health outcomes, independent of standard socioeconomic status measures. Patterns of cost-related medication nonadherence (CRN) among over-indebted individuals are yet unclear. The aim of this study was to examine the frequency of nonadherence to prescribed medications due to cost, and to identify risk factors for CRN among over-indebted individuals in Germany. Methods In 2017, we conducted a cross-sectional survey among over-indebted individuals recruited in 70 debt advice agencies in North Rhine-Westphalia, Germany. Data on CRN in the last 12 months (i.e. not filling prescriptions, skipping or decreasing doses of prescribed medication due to financial problems) were collected by a survey using a self-administered written questionnaire that was returned by 699 individuals with a response rate of 50.2%. Prevalence of CRN was assessed using descriptive statistics. Multiple logistic regression analysis was performed to examine risk factors of CRN, including participants enrolled in statutory health insurance with complete data (n = 521). Results The prevalence of CRN was 33.6%. The chronically ill had significantly greater odds of cost-related medication nonadherence (aOR 1.96; 95% CI 1.27–3.03) than individuals without a chronic illness. CRN was more likely to occur in individuals who had discussed financial problems with their general practitioner (aOR 1.58; 95% CI 1.01–2.47). There was no association between CRN and other sociodemographic factors or socioeconomic status. Conclusions Medication nonadherence due to financial pressures is common among over-indebted citizens enrolled in statutory health insurance in Germany. Stakeholders in social policy, research and health care need to address over-indebtedness to develop strategies to safeguard access to relevant medications, especially among those with high morbidity. Trial registration Arzneimittelkonsum, insbesondere Selbstmedikation bei überschuldeten Bürgerinnen und Bürgern in Nordrhein-Westfalen (ArSemü), (engl. ‘Medication use, particularly self-medication among over-indebted citizens in North Rhine-Westphalia’), German Clinical Trials Register: DRKS00013100. Date of registration: 23.10.2017. Date of enrolment of the first participant: 18.07.2017, retrospectively registered.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Faculty of Medicine, Institute of General Practice, University of Düsseldorf, Düsseldorf University Hospital, Postfach 10 10 07, 40001, Düsseldorf, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Hedenrud T, Jakobsson A, El Malla H, Håkonsen H. "I did not know it was so important to take it the whole time" - self-reported barriers to medical treatment among individuals with asthma. BMC Pulm Med 2019; 19:175. [PMID: 31533679 PMCID: PMC6751752 DOI: 10.1186/s12890-019-0934-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is an extensive public health problem and inadequate disease control is not uncommon. Individuals' self-perceived barriers to medical treatment for the entire treatment chain (from seeking care for symptoms to using a medicine) have seldom been studied for chronic diseases such as asthma. The aim of this study was to explore self-perceived barriers to medical treatment among individuals with asthma within the framework of AAAQ (availability, accessibility, acceptability and quality). METHODS Individuals with asthma visiting the asthma nurse at a primary health care centre, and who currently had a prescription for anti-asthmatic medicines, were informed about the study. The nurse asked the persons for their consent to be contacted by an interviewer. The interview guide was constructed from the elements of AAAQ exploring self-perceived barriers to asthma treatment. Interviews were conducted in Swedish, English, Arabic and Persian. They were transcribed verbatim and a manifest content analysis was conducted. RESULTS Fourteen interviews were conducted. There was a large variation in both age and reported number of years with asthma. Self-perceived barriers to asthma treatment were experienced throughout the whole treatment chain. Barriers that emerged were health care accessibility, perceived quality of care, beliefs about medicines, life circumstances, knowledge gap about asthma and medicines, practical obstacles to using medicines, and experiences with treatment. The self-perceived barriers cover all four elements of AAAQ, but there are also some barriers that go beyond those elements (life circumstances and practical obstacles to using medicines). CONCLUSIONS Self-perceived barriers among individuals with asthma cover the whole treatment chain. We want to highlight the inadequate information/education of patients leading to knowledge gaps about both disease and the effect of medicines, and also the perceived unsatisfactory treatment at the PHCC, which could partly be counteracted if patients know what to expect from health care visits.
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Affiliation(s)
- Tove Hedenrud
- Department of Public Health and Community Medicine, University of Gothenburg, P.O. Box 453, 405 30, Gothenburg, Sweden.
| | - Annika Jakobsson
- Department of Public Health and Community Medicine, University of Gothenburg, P.O. Box 453, 405 30, Gothenburg, Sweden
| | - Hanan El Malla
- Department of Social Work, University of Gothenburg, P.O. Box 720, 405 30, Gothenburg, Sweden
| | - Helle Håkonsen
- Department of Public Health and Community Medicine, University of Gothenburg, P.O. Box 453, 405 30, Gothenburg, Sweden
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Abstract
The word ‘compliance' comes from the Latin word complire, meaning to fill up and hence to complete an action, transaction, or process and to fulfil a promise. In the Oxford English Dictionary, the relevant definition is ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc.; a consenting to act in conformity with; an acceding to; practical assent”. Compliance with therapy is simply patients understanding of medication, motivation toward having this medication is a prescribed manner with the belief that the prescriber and prescribed medicine will be beneficial for his well-being. Although this is often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate instructions or have not presented the instructions in such a manner that the patient understands them. Nothing should be taken for granted regarding the patient's understanding of how to use medication, and appropriate steps must be taken to provide patients with the information and counseling necessary to use their medications as effectively and as safely as possible. 20% to 30% of new prescriptions are never filled at the pharmacy. Medication is not taken as prescribed 50% of the time. For patients prescribed medications for chronic diseases, after six months, the majority take less medication than prescribed or stop the medication altogether. There are both federal and state laws that make using or sharing prescription drugs illegal. If someone take a pill that was prescribed to someone else or give that pill to another person, not only is it against the law, it's extremely dangerous.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh
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Carroll JK, Farah S, Fortuna RJ, Lanigan AM, Sanders M, Venci JV, Fiscella K. Addressing Medication Costs During Primary Care Visits: A Before-After Study of Team-Based Training. Ann Intern Med 2019; 170:S46-S53. [PMID: 31060055 DOI: 10.7326/m18-2011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Medications contribute to patients' out-of-pocket costs, yet most clinicians do not routinely screen for patients' cost-of-medication (COM) concerns. OBJECTIVE To assess whether a single training session improves COM conversations. DESIGN Before-after cross-sectional surveys of patients and qualitative interviews with clinicians and staff. SETTING 7 primary care practices in 3 U.S. states. PARTICIPANTS In total, 700 patients were surveyed from May 2017 to January 2018: 50 patients per practice before the intervention and another 50 patients per practice after the intervention. Eligibility criteria included age 18 years or older and taking 1 or more long-term medications. Qualitative interviews with 45 staff members were conducted. INTERVENTION A single 60-minute training session for clinicians and staff from each practice on COM importance, team-based screening, and cost-saving strategies. MEASUREMENTS Patient data (demographics, number of long-term medications, total monthly out-of-pocket medication costs, and history of cost-related medication nonadherence) were obtained immediately before and 3 months after the intervention. Practice staff were interviewed 3 months after the intervention. RESULTS A total of 700 patient surveys were completed. Frequency of COM discussion improved in 6 of the 7 practices and remained unchanged in 1 practice. Overall, COM conversations with patients increased from 17% at baseline to 32% postintervention (P = 0.00). There was substantial heterogeneity among sites in before-after differences in patient-reported out-of-pocket COM. Qualitative analyses from key informant interviews showed wide variation in implementation of screening approaches, workflow, adoption of a team-based approach, and strategies for addressing COM. LIMITATION It is not known whether improvements in COM conversations were sustained beyond 3 months. CONCLUSION A single team training to screen and address patients' medication cost concerns improved COM discussions over the short term. Further research is needed to assess sustained effects and impact on patient costs and medication adherence and to determine whether more intensive, scalable interventions are needed. PRIMARY FUNDING SOURCE Robert Wood Johnson Foundation.
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Affiliation(s)
| | - Subrina Farah
- University of Rochester, Rochester, New York (S.F., M.S.)
| | - Robert J Fortuna
- Center for Primary Care, University of Rochester, Rochester, New York (R.J.F.)
| | - Angela M Lanigan
- National Research Network, American Academy of Family Physicians, Leawood, Kansas (A.M.L.)
| | | | - Jineane V Venci
- University of Rochester Medical Center, Rochester, New York (J.V.V., K.F.)
| | - Kevin Fiscella
- University of Rochester Medical Center, Rochester, New York (J.V.V., K.F.)
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Miranda AC, Serag-Bolos ES, Cooper JB. Cost-related medication underuse: Strategies to improve medication adherence at care transitions. Am J Health Syst Pharm 2019; 76:560-565. [PMID: 31361859 DOI: 10.1093/ajhp/zxz010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Aimon C Miranda
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, FL
| | - Erini S Serag-Bolos
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, FL
| | - Julie B Cooper
- Department of Clinical Sciences, Fred Wilson School of Pharmacy at High Point University, High Point, NC
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Jackevicius CA, Ko DT. Medication Co-payment Vouchers, Adherence With Antiplatelet Therapy, and Adverse Cardiovascular Events After Myocardial Infarction. JAMA 2019; 321:37-39. [PMID: 30620355 DOI: 10.1001/jama.2018.20396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cynthia A Jackevicius
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
- ICES, Toronto, Ontario, Canada
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Campbell AM, Coley KC, Corbo JM, DeLellis TM, Joseph M, Thorpe CT, McGivney MS, Klatt P, Cox-Vance L, Balestrino V, Sakely H. Pharmacist-Led Drug Therapy Problem Management in an Interprofessional Geriatric Care Continuum: A Subset of the PIVOTS Group. AMERICAN HEALTH & DRUG BENEFITS 2018; 11:469-478. [PMID: 30746018 PMCID: PMC6322592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.
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Affiliation(s)
- Ashley M Campbell
- Assistant Professor, Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Kim C Coley
- Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, PA
| | - Jason M Corbo
- Clinical Pharmacy Specialist, South Texas Veterans Health Care System, San Antonio
| | - Teresa M DeLellis
- Assistant Professor, Pharmacy Practice, Manchester University College of Pharmacy, Natural & Health Sciences, Fort Wayne, IN
| | - Matthew Joseph
- Clinical Pharmacist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center (UPMC)
| | - Carolyn T Thorpe
- Associate Professor, Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, and Research Health Scientist, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Melissa S McGivney
- Associate Dean for Community Partnerships and Associate Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | | | - Lora Cox-Vance
- Chief, Geriatrics and Extended Care, Chillicothe VA Medical Center, OH
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Charbonneau M, Gagnon MA. Surviving niche busters: Main strategies employed by Canadian private insurers facing the arrival of high cost specialty drugs. Health Policy 2018; 122:1295-1301. [PMID: 30241797 DOI: 10.1016/j.healthpol.2018.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 08/03/2018] [Accepted: 08/20/2018] [Indexed: 11/20/2022]
Abstract
The Canadian patchwork system of prescription drug coverage and the employer sponsored private health benefits group plans appear vulnerable to cost growth due to insufficient balance of power between fragmented public and private buyers, and pharmaceutical manufacturers. The emergence of "bad" insurance risks caused by new and very expensive treatments featuring high cost specialty medicines - also known as niche buster drugs - exposes this vulnerability. This study fills a gap in knowledge by seeking to better understanding how Canadian private insurers face the arrival of specialty pharmaceuticals. It completes an overview of a body of grey literature composed of publicly available online articles from the employment benefits and group insurance consulting and administration industry; online documents from group benefits sector conferences; and online or on demand materials from Canadian life and health insurers. Claims for high cost specialty drugs generate new bad insurance risks that Canadian health insurers attempt to mitigate through isolated corporate initiatives, industry-wide strategies and calls for universal, public catastrophic coverage. The outcomes of these strategies are limited cost-control measures as well as risk and cost transfers onto plan sponsors, patients and provincial public programs.
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Affiliation(s)
- Mathieu Charbonneau
- Karl Polanyi Institute of Political Economy, Concordia University, Montreal, Canada.
| | - Marc-André Gagnon
- School of Public Policy and Administration, Carleton University (RH-5224), 1125 Colonel By Drive, Ottawa, Ontario, K1S 5B6, Canada.
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Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
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Dolinski D, Dolinska B, Bar-Tal Y. Mood, cognitive structuring and medication adherence. Health Care Women Int 2018; 39:808-820. [PMID: 29608418 DOI: 10.1080/07399332.2018.1458852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A study with a placebo was conducted. Healthy university students were given a placebo and were told to make one pill every day for a week. Participants were informed that the medicine improved mood. The extent to which they conformed to this instruction was treated as an index of compliance. Our results show that for women, but not for men, positive mood and cognitive structuring or negative mood and lack of cognitive structuring significantly predicted participants' compliance. A new model of medication adherence, based on the role of the patient's mood and cognitive structuring processes in decision making is presented in the paper.
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Affiliation(s)
- Dariusz Dolinski
- a SWPS University of Social Sciences and Humanities, Wroclaw Faculty Wroclaw , Poland
| | - Barbara Dolinska
- b Opole University , Faculty of Social Sciences , Opole , Poland
| | - Yoram Bar-Tal
- c Tel-Aviv University , Sackler Faculty of Medicine , Tel Aviv , Israel
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Soril LJJ, Adams T, Phipps-Taylor M, Winblad U, Clement F. Is Canadian Healthcare Affordable? A Comparative Analysis of the Canadian Healthcare System from 2004 to 2014. ACTA ACUST UNITED AC 2018; 13:43-58. [PMID: 28906235 PMCID: PMC5595213 DOI: 10.12927/hcpol.2017.25192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To compare cost-related non-adherence (CRNA), serious problems paying medical bills and average annual out-of-pocket cost over time in five countries. Methods: Repeated cross-sectional analysis of the Commonwealth Fund International Health Policy survey from 2004 to 2014. Responses were compared between Canada, the UK, Australia, New Zealand and the US. Results: Compared to the UK, respondents in Canada, Australia and New Zealand were two to three times and respondents in the US were eight times more likely to experience CRNA; these odds remained stable over time. From 2004 to 2014, Canadian respondents paid US $852–1,767 out-of-pocket for care. The US reported the largest risks of serious problems paying for care (13–18.5%), highest out-of-pocket costs (US $2,060–3,319) and greatest rise in expenditures. Interpretation: Over the 10-year period, financial barriers to care were identified in Canada and internationally. Such persistent challenges are of great concern to countries striving for equitable access to healthcare.
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Affiliation(s)
- Lesley J J Soril
- PhD Candidate, Department Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Ted Adams
- Staff Physician, Liverpool Women's Hospital NHS FT, Department of Obstetrics and Gynaecology, Liverpool, UK
| | | | - Ulrika Winblad
- Research Group Leader, Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Fiona Clement
- Department Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB
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Law MR, Cheng L, Kolhatkar A, Goldsmith LJ, Morgan SG, Holbrook AM, Dhalla IA. The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey. CMAJ Open 2018; 6:E63-E70. [PMID: 29440236 PMCID: PMC5878943 DOI: 10.9778/cmajo.20180008] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many Canadians face substantial out-of-pocket charges for prescription drugs. Prior work suggests that this causes some patients to not take their medications as prescribed; however, we have little understanding of whether charges for prescription medicines lead patients to forego basic needs or to use more health care services. Our study aimed to quantify the consequences of patient charges for medicines in Canada. METHODS As part of the 2016 Canadian Community Health Survey, we designed and fielded cross-sectional questions to 28 091 Canadians regarding prescription drug affordability, consequent use of health care services and trade-offs with other expenditures. We calculated weighted population estimates and proportions, and used logistic regression to determine which patient characteristics were associated with these behaviours. RESULTS Overall, 5.5% (95% confidence interval 5.1%-6.0%) of Canadians reported being unable to afford 1 or more drugs in the prior year, representing 8.2% of those with at least 1 prescription. Drugs for mental health conditions were the most commonly reported drug class for cost-related nonadherence. About 303 000 Canadians had additional doctor visits, about 93 000 sought care in the emergency department, and about 26 000 were admitted to hospital at the population level. Many Canadians forewent basic needs such as food (about 730 000 people), heat (about 238 000) and other health care expenses (about 239 000) because of drug costs. These outcomes were more common among females, younger adults, Aboriginal peoples, those with poorer health status, those lacking drug insurance and those with lower income. INTERPRETATION Out-of-pocket charges for medicines for Canadians are associated with foregoing prescription drugs and other necessities as well as use of additional health care services. Changes to protect vulnerable populations from drug costs might reduce these negative outcomes.
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Affiliation(s)
- Michael R Law
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Lucy Cheng
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Ashra Kolhatkar
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Laurie J Goldsmith
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Steven G Morgan
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Anne M Holbrook
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Irfan A Dhalla
- Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
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Morgan SG, Gagnon MA, Charbonneau M, Vadeboncoeur A. Evaluating the effects of Quebec's private-public drug insurance system. CMAJ 2017; 189:E1259-E1263. [PMID: 29018085 DOI: 10.1503/cmaj.170726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Steven G Morgan
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que.
| | - Marc-André Gagnon
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que
| | - Mathieu Charbonneau
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que
| | - Alain Vadeboncoeur
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que
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Goldsmith LJ, Kolhatkar A, Popowich D, Holbrook AM, Morgan SG, Law MR. Understanding the patient experience of cost-related non-adherence to prescription medications through typology development and application. Soc Sci Med 2017; 194:51-59. [PMID: 29065312 DOI: 10.1016/j.socscimed.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 01/05/2023]
Abstract
Many patients report skipping doses, splitting pills, or not filling prescriptions due to out-of-pocket costs-a phenomenon known as cost-related non-adherence (CRNA). This study investigated CRNA from the patient's perspective, and, to our knowledge, is the first study to undertake a qualitative investigation of CRNA specifically. We report the results from 35 semi-structured interviews conducted in 2014-15 with adults in four Canadian cities across two provinces. We used framework analysis to develop a CRNA typology to characterize major factors in patients' CRNA decisions. Our typology identifies four major components: (1) the insurance reason driving the drug cost, (2) the individual's overall financial flexibility, (3) the burden of drug cost on the individual's budget, and (4) the importance of the drug from the individual's perspective. The first two components set the context for CRNA and the final two components are the drivers for the CRNA decision. We also found four major patterns in CRNA experiences: (1) CRNA in individuals with low financial flexibility occurred for all levels of drug importance and all but the lowest level of cost burden; (2) CRNA for high importance drugs only occurred when the drug cost had a high burden on an individual's budget; (3) CRNA in individuals with more financial flexibility primarily occurred in drugs with medium importance but high or very high cost burdens; and (4) CRNA for low importance drugs occurred at almost all levels of drug cost burden. Our study furthers the understanding of how numerous factors such as income, insurance, and individual preferences combine and interact to influence CRNA and suggests that policy interventions must be multi-faceted or encourage significant insurance redesign to reduce CRNA.
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Affiliation(s)
- Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Ashra Kolhatkar
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominic Popowich
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Anne M Holbrook
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Evaluation of Medicines, Hamilton Health Science and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Doucet J. Cost-related nonadherence to medications and pharmacare. Can Oncol Nurs J 2017; 27:390-391. [PMID: 31148777 PMCID: PMC6516360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Joëlle Doucet
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5
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Doucet J. [Not Available]. Can Oncol Nurs J 2017; 27:392-393. [PMID: 31148654 PMCID: PMC6516345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Joëlle Doucet
- École des sciences infirmières, Université d'Ottawa, 451, route Smyth, Ottawa (Ontario) K1H 8M5
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University; University Health Network, Toronto, Ont.
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69
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Myths and Realities About Why Prescription Drug Prices in the United States Are So High. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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