Costs of medicines and health care: a concern for Australian women across the ages

One-Year Outcomes of Preserflo Microshunt for Primary Open Angle Glaucoma: A Systematic Review and Meta-Analysis

PRCIS

This systematic review and meta-analysis concludes that the PreserFlo Microshunt glaucoma drainage device significantly reduces intraocular pressure in primary open angle glaucoma patients at 12 months postinsertion.

PURPOSE

A systematic review and meta-analysis on the effect of the PRESERFLO MicroShunt (PF-MS) on intraocular pressure (IOP) at 12 months has been conducted.

METHOD

The PubMed/MEDLINE, Embase, CENTRAL, Google Scholar, Scopus, and Web of Science databases were searched. Inclusion criteria required a diagnosis of open angle glaucoma, PF-MS insertion, and examination of IOP over time. Meta-analyses were conducted on the primary outcome of IOP and the secondary outcome of glaucoma medication regime. Adverse events were also noted.

RESULTS

Fourteen studies were identified for inclusion in the meta-analyses, of which none had a high risk of bias. The meta-analyses found a significant mean reduction in IOP of 9.07 mm Hg (95% CI: 7.88-10.25; P <0.0001) and a significant mean reduction in mean glaucoma medication requirement of 2.37 medications (95% CI: 2.15-2.60; P <0.0001). Hypotony and hyphaema are common early complications.

CONCLUSIONS

The PF-MS device significantly reduced both IOP and glaucoma medication requirement at 12 months postinsertion in individuals with open angle glaucoma without a significant adverse event burden. Further research is required to determine the economic and environmental effects of widely implementing the PF-MS device into clinical practice.

The Efficacy, Adverse Effects and Economic Implications of Oral Versus Intravenous Methylprednisolone for the Treatment of Optic Neuritis: A Systematic Review

INTRODUCTION

Optic neuritis may occur in a variety of conditions, including as a manifestation of multiple sclerosis. Despite significant research into the efficacy of corticosteroids as a first-line treatment, the optimal route of administration has not been well defined. This review aims to explore the efficacy, adverse effects and economic implications of using oral versus intravenous methylprednisolone to treat acute optic neuritis.

METHODS

A systematic search of the databases PubMed/MEDLINE, Embase and CENTRAL was performed to July 2022, prior to data collection and risk of bias analysis in accordance with the PRISMA guidelines.

RESULTS

Six articles fulfilled the inclusion criteria. The results showed that in the treatment of acute optic neuritis, oral methylprednisolone has a non-inferior efficacy and adverse effect profile in comparison to intravenous methylprednisolone. In a cost analysis, oral methylprednisolone to be more cost-effective than intravenous methylprednisolone.

CONCLUSIONS

Oral methylprednisolone has comparable efficacy and adverse effect profiles to intravenous methylprednisolone for the treatment of optic neuritis. The analysis suggests oral administration is more cost-effective than intravenous administration; however, further analyses of the formal cost-benefit ratio are required.

Challenges for Medicare and universal health care in Australia since 2000

OBJECTIVES

To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening.

STUDY DESIGN

Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 - 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 - 14 August 2021. Program-, intervention- or provider-specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded.

DATA SOURCES

MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites.

RESULTS

The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out-of-pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system.

CONCLUSIONS

A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.

Frequent general practitioner visits are protective against statin discontinuation after a Pharmaceutical Benefits Scheme copayment increase

Objective This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. Methods The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. Results In December 2004, there were 22495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. Conclusions Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic? Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add? Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners? This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.

Exploring the experiences of people in Ontario, Canada who have trouble affording medicines: a qualitative concept mapping study

OBJECTIVES

The experiences of people who report cost-related medicine non-adherence are not well documented. We aimed to present experiences relating to accessing medicines reported by the participants in a randomised controlled trial of free medicine distribution.

METHODS

The trial consisted of primary care patients from a large urban family practice and three rural family practices who reported cost-related medicine non-adherence. Participants were randomly allocated to continue their poor access (control) or to receive free and easily accessible medicines (intervention). As part of data collection for the first year of the trial, participants were asked closed and open-ended questions to assess their adherence to medication, health outcomes and their experiences in relation to medicine accessibility. We conducted a qualitative concept mapping study in which we analysed and summarised participants' responses to the open-ended question on a concept map to visually present their experiences relating to accessing medicines.

RESULTS

Of the 524 trial participants contacted, 198 (38%) responded to the open-ended question. The concept map contains clusters that represent eight types of experiences of participants related to medicine access including stress, relationship with doctor, health impact, quality of life, sacrificing other essentials, medicines are expensive, financial impact and adherence. These experiences fall under two major themes, experiences relating to personal finances and experiences relating to well-being, which are bridged by a central cluster of adherence.

CONCLUSIONS

The experiences shared by the participants demonstrate that access to medicines impacts people's finances and well-being as well as their adherence to prescribed medicines. These results indicate that effects on personal finances and general well-being should be measured for interventions and policy changes aimed at improving medicine access.

TRIAL REGISTRATION NUMBER

This article is linked to the Carefully Selected and Easily Accessible at No Charge Medicines (CLEAN Meds) randomised controlled trial (trial registration number: NCT02744963).

The Fertility Management Experiences of Australian Women with a Non-communicable Chronic Disease: Findings from the Understanding Fertility Management in Contemporary Australia Survey

Introduction Despite the considerable and increasing proportion of women of reproductive age with a chronic non-communicable disease (NCD) and the potential adverse implications of many NCDs for childbearing, little is known about the fertility management experiences of women with an NCD, including their contraceptive use, pregnancy experiences and outcomes, and reproductive health care utilisation. The aim of this study was to investigate the fertility management experiences of women with an NCD and draw comparisons with women without an NCD. Method A sample of 18-50 year-old women (n = 1543) was randomly recruited from the Australian electoral roll in 2013. Of these women, 172 women reported a physical, chronic non-communicable disease: diabetes, arthritis, asthma, hypertension, heart disease, thyroid disorders, and cystic fibrosis. Respondents completed an anonymous, self-administered questionnaire. Factors associated with fertility management were identified in multivariable analyses. Results Women who reported having an NCD were significantly more likely than women who did not report an NCD to have ever been pregnant (75.9 vs. 67.5%, p = 0.034), have had an unintended pregnancy (33.47 vs. 25.5%, p = 0.026), and have had an abortion (20.3 vs. 14.2%, p = 0.044); they were less likely to consult a healthcare provider about fertility management (45.0 vs. 54.4%, p = 0.024). Similar proportions were using contraception (48.8 vs. 54.5%, p = 0.138). Conclusion The findings have implications for healthcare providers and women with an NCD and highlight the importance of addressing possible assumptions about the inability of women with an NCD to become pregnant, and ensuring women receive information about suitable methods of contraception and pre-pregnancy care.

Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression

Background

Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings.

Methods

Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression.

Results

We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012).

Conclusions

In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an undetectable viral load. Associations were with social/economic/cultural/patient engagement factors, but not ART regimen/clinical factors. These associations may help identify those at higher risk of future virological failure and guide patient education and support.

Factors predicting health services use among older people in China: An analysis of the China Health and Retirement Longitudinal Study 2013

Background

Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments.

Methods

Drawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China.

Results

The multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems.

Conclusions

As a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.

“I Wouldn’t Mind Trying It. I’m in Pain the Whole Time”: Barriers to the Use of Complementary Medicines by Older Australians in Residential Aged-Care Facilities

Older people living in the community use complementary medicine (CM) to manage the symptoms of chronic illness; however, little is known about CM use by older people living in care settings. Using focus groups and individual interviews, this study explored the use of CM from the perspective of 71 residents, families, and health professionals from six residential aged-care facilities in Victoria, Australia. Residents used CM to manage pain and improve mobility, often covertly, and only with the financial assistance of their families. Facility policies and funding restrictions constrained CM use at the individual and facility level. An absence of evidence to support safety and efficacy coupled with the risk of interactions made doctors wary of CM use in older people. These findings have relevance for the large number of CM using “baby-boomers” as they move into residential aged-care.