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Menon A, Schroth RJ, Hai-Santiago K, Yerex K, Bertone M. The Canadian dental care plan and the senior population. FRONTIERS IN ORAL HEALTH 2024; 5:1385482. [PMID: 38933118 PMCID: PMC11199732 DOI: 10.3389/froh.2024.1385482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Anil Menon
- Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Robert J. Schroth
- Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Shared Health Manitoba, Winnipeg, MB, Canada
| | | | - Katherine Yerex
- School of Dental Hygiene, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Mary Bertone
- Childrens Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Rebić N, Law MR, Brotto LA, Cragg JJ, De Vera MA. The Intersectional Impact of Cost-Related Non-Adherence and Depression: A Cross-Sectional Analysis of the Canadian Community Health Survey by Sex, Race, and Indigeneity. Community Ment Health J 2024; 60:515-524. [PMID: 37930467 DOI: 10.1007/s10597-023-01202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
We evaluated the relationship between cost-related non-adherence (CRNA) and depressive symptoms. Pooling data from the 2015, 2016, 2018, and 2019 annual Canadian Community Health Survey, we analyzed the relationship between CRNA and moderate to severe depressive symptoms, assessed by the Patient Health Questionnaire (PHQ-9). Among the sample, 4.9% experienced CRNA and 6.8% experienced moderate to severe depressive symptoms. Respondents who reported CRNA had 1.51 (95% confidence interval [CI], 1.51-1.52) greater odds of experiencing moderate to severe depressive symptoms. Stratified analysis by sex and race showed the association between CRNA and depressive symptoms was greatest among racialized males (aOR: 1.83, 95% CI: 1.81- 1.85). Stratified analysis by sex and Indigeneity showed this association was greatest for Indigenous males (aOR: 2.16, 95% CI: 2.10-2.22). Forgoing prescribed medications due to cost is associated with more severe depressive symptoms among Canadians, particularly racialized and Indigenous males.
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Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael R Law
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Arnet I, Sahm LJ, Gregório J, Tuula A, Krüger M, Wurmbach VS, Hoti K, Schulz M, Eickhoff C. Development and validation of the 15-STARS - A novel self-report pharmacy-based questionnaire to screen for medication non-adherence. Res Social Adm Pharm 2024; 20:308-320. [PMID: 38042709 DOI: 10.1016/j.sapharm.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Published scales measuring medication adherence are myriad. There is a need for a tool that guides towards downstream adherence interventions. OBJECTIVE To develop and validate a self-report questionnaire able to detect modifiable determinants of medication non-adherence. METHODS Workshops, surveys and meetings were used to identify items. Validation was performed in French and German (Switzerland) between March and April 2022. Face validation, content validation, construct validation, internal consistency and test-retest reliability were assessed. The questionnaire was finalized in August 2022. RESULTS The first draft in English included 13 items divided into four areas. Following translation, validation was performed with 144 patients (63 German-, 81 French-speaking) who were recruited in 35 community pharmacies. Acceptability was good (<5% missing data). Psychometric properties were acceptable with good content validity and moderate construct validity. Internal consistency was acceptable for the French version (Cronbach's alpha = 0.71 [item 1-5] - 0.61 [item 6-9]) and less acceptable for the German version (Cronbach's alpha = 0.43 [item 1-5] - 0.45 [item 6-9]). Test-retest was given for all items (r = 0.52 to 1.0) except item 10 in French (r = 0.25). The final instrument is a 15-item questionnaire called the 15-STARS (Screening Tool for AdheRence to medicineS) that assesses practical difficulties with medicine use, reasons for non-adherence, doses missed, and need for further help. CONCLUSIONS Our findings support the validity and clinical utility of the 15-STARS questionnaire. Reliability was inconclusive due to incoherent internal consistency, but explainable by the single-item nature of the scale. This new tool will enable the detection of patients who experience difficulties that negatively influence medication adherence. Pharmacists will be able to propose specific and tailored adherence interventions to the patients. Next steps will focus on evaluating its usefulness for developing targeted interventions that optimize medication adherence in routine care and research settings.
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Affiliation(s)
- Isabelle Arnet
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Switzerland.
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland.
| | - João Gregório
- CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal.
| | - Anita Tuula
- Institute of Pharmacy, University of Tartu, Tartu, Estonia.
| | - Manfred Krüger
- Chamber of Pharmacists North Rhine, Düsseldorf, Germany.
| | - Viktoria S Wurmbach
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital and Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany.
| | - Kreshnik Hoti
- Division of Pharmacy, Faculty of Medicine, University of Prishtina, Kosovo.
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany; Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany.
| | - Christiane Eickhoff
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.
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Del Pino-Sedeño T, Infante-Ventura D, Hernández-González D, González-Hernández Y, González de León B, Rivero-Santana A, Hurtado I, Acosta Artiles FJ. Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis. Front Pharmacol 2024; 15:1327155. [PMID: 38318137 PMCID: PMC10839896 DOI: 10.3389/fphar.2024.1327155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | | | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
| | - Isabel Hurtado
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Health care Programs, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Xu J, Rathkopf MM. The cost of medication costs: Cost-related medication nonadherence in patients with asthma in the United States. Ann Allergy Asthma Immunol 2023; 131:538-539. [PMID: 37923545 DOI: 10.1016/j.anai.2023.08.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Jennifer Xu
- Division of Allergy and Immunology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Melinda M Rathkopf
- Division of Allergy and Immunology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Desai V, Cottrell J, Sowerby L. No longer a blank cheque: a narrative scoping review of physician awareness of cost. Public Health 2023; 223:15-23. [PMID: 37595425 DOI: 10.1016/j.puhe.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness. STUDY DESIGN A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar. RESULTS An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention. CONCLUSIONS Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.
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Affiliation(s)
- V Desai
- School of Medicine, Queen's University, Kingston, ON, Canada.
| | - J Cottrell
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
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Hedden L, McGrail K. The best defence is a good offence: Ensuring equitable access to primary care in Canada. Healthc Manage Forum 2023; 36:293-298. [PMID: 37500185 PMCID: PMC10448912 DOI: 10.1177/08404704231182260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Ensuring access to primary care is a persistent challenge in Canada, and the COVID-19 pandemic exacerbated existing gaps. Public policy reform that only partially addresses these access issues, technological opportunities, workforce desires, or patient preferences creates an opportunity for private, investor-owned corporations to take ownership of primary care delivery systems. This article summarizes the history of the "public-private" conversation as it pertains to primary care, with a particular focus on investor-owned corporations. We outline how profit-driven, corporate healthcare impacts equitable access to care, increases spending on low-value services, and undermines the underlying values of Canadian healthcare systems. All of healthcare delivery requires rapid regulation and oversight by policy-makers, which would increase transparency of corporate care. There also must be parallel efforts placed on addressing the long-standing issues in publicly funded delivery of primary care that created the space for corporate care to grow.
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Affiliation(s)
- Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kimberlyn McGrail
- The University of British Columbia, Vancouver, British Columbia, Canada
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Almarwani AM, Almarwani BM. Factors predicting medication adherence among coronary artery disease patients in Saudi Arabia: A descriptive study. Saudi Med J 2023; 44:904-911. [PMID: 37717959 PMCID: PMC10505289 DOI: 10.15537/smj.2023.44.9.20230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES To measure medication adherence among coronary artery disease (CAD) patients and identify sociodemographic factors that are medication adherence predictors. METHODS A cross-sectional correlation design was carried out, following the STROBE guidelines. The study was carried out in a specialized cardiac center in the western region of Saudi Arabia between March 2019 and January 2020. A total of 278 patients completed the study survey. RESULTS The majority of participants (59.4%) reported moderate medication adherence, and the remainder reported poor (30.6%) and good (10%) medication adherence. It was found that women patients, patients with higher education levels, non-smokers, patients who regularly followed-up with their cardiologist, and patients with family support showed significantly higher medication adherence. Four of the sociodemographic variables (gender, number of doctor visits, family support, and education level) predicted medication adherence. CONCLUSION Approximately 30% of the participants reported poor medication adherence. The number of cardiologist visits and the level of family support were 2 of the factors found to be associated with medication adherence.
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Affiliation(s)
- Abdulaziz M. Almarwani
- From the Department of Psychiatric Nursing (A. M. Almarwani), College of Nursing; and from the Department of Internal Medicine (B. M. Almarwani), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Bayan M. Almarwani
- From the Department of Psychiatric Nursing (A. M. Almarwani), College of Nursing; and from the Department of Internal Medicine (B. M. Almarwani), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
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Kutnik P, Wichowska O, Sysiak-Sławecka J, Szczukocka M, Rypulak E, Piwowarczyk P, Borys M, Czuczwar M. Malnutrition risk in elective surgery patients and effectiveness of preoperative nutritional interventions at a pre-anaesthetic clinic: a 4-year apart, single-centre, observational study. Anaesthesiol Intensive Ther 2023; 55:179-185. [PMID: 37728445 PMCID: PMC10496095 DOI: 10.5114/ait.2023.130632] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/27/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Approximately 44% of all patients hospitalised for an elective surgical procedure have a malnutrition risk. In this study, we assessed the prevalence of malnutrition risk at a pre-anaesthetic clinic and the feasibility of introducing nutritional support. The primary objective of this study was to assess malnutrition risk prevalence in patients referred to a pre-anaesthetic clinic. MATERIAL AND METHODS This was a prospective observational study. The study was divided into two phases: one in 2020 and the other in 2023. Consecutive patients scheduled for an elective surgical procedure at a pre-anaesthetic clinic were asked to participate in the study by filling out the questionnaire. We divided the patients into two groups based on the GLIM criteria. RESULTS We included a total of 467 patients, including 214 from 2020 and 253 from 2023. In the total sample, 93 (19.9%) patients met the GLIM criteria for malnutrition risk, and 37 (7.9 %) fulfilled the ESPEN criteria for preoperative nutritional support. Out of 93 patients at malnutrition risk, 41 (44%) had BMI > 25 kg m -2 . The number of patients with indications for preoperative nutritional support in all departments remained similar across both time points. However, the number of patients receiving preoperative ONS almost doubled over the study period (36.8% in 2020 vs. 72.2% in 2023). CONCLUSIONS Malnutrition risk was consistently high among our elective surgery patients. Not all patients with indications for preoperative nutritional support received it. As such, pre-anaesthetic clinics might be one of the major links in the nutritional programme chains of hospitals.
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Affiliation(s)
- Paweł Kutnik
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
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Makarevičius G, Rinkūnienė E, Badarienė J. National Trends in Statin Use in Lithuania from 2010 to 2021. Medicina (B Aires) 2022; 59:medicina59010037. [PMID: 36676661 PMCID: PMC9864999 DOI: 10.3390/medicina59010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
Objective: In Lithuania, no comprehensive national research on statin utilization and trends has yet been undertaken. Nonetheless, this knowledge is critical for the healthcare system to identify key areas for development. We aimed to analyze trends in statin utilization in Lithuania from the past 12 years considering changes in reimbursement policies and the publication of updated international CVD prevention guidelines. Methods: We performed a retrospective, descriptive study of statin utilization in Lithuania from 2010 to 2021. The data were obtained from PharmaZOOM LT, an independent software supplier with nationwide coverage on pharmaceutical market data. The data coverage was 95%. We used anatomical therapeutic chemical (ATC) classification for data extraction and calculated defined daily doses (DDDs) according to the ATC/DDD Toolkit of World Health Organization according to statin dose in a pill. Results: Statin use increased overall from 8.28 DDD/TID in 2010 to 96.06 DDD/TID in 2021. The annual growth rate in sales of statin DDD/TID was 22.28%. The increase was mostly due to the increase in moderate- and high-intensity statins. The increases coincided with changes in reimbursement policy or the publication of international guidelines. Polypill use in Lithuania began steadily increasing after 2016 and reached 19.37% of the total DDD/TID of statins in 2021. Conclusions: The use of statins has increased dramatically in Lithuania over the last decade. Changes in statin reimbursement regulations in the country, as well as worldwide cardiovascular preventive recommendations aiming at lower LDL-C objectives, fueled the progress.
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Affiliation(s)
- Gytis Makarevičius
- Centre for Neurology, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: (G.M.); (J.B.)
| | - Egidija Rinkūnienė
- Clinic of Cardiac and Vascular Diseases, Medical Faculty, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Jolita Badarienė
- Clinic of Cardiac and Vascular Diseases, Medical Faculty, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: (G.M.); (J.B.)
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Larsen RE, Pripp AH, Krogstad T, Johannessen Landmark C, Holm LB. Development and validation of a new non-disease-specific survey tool to assess self-reported adherence to medication. Front Pharmacol 2022; 13:981368. [PMID: 36569319 PMCID: PMC9768604 DOI: 10.3389/fphar.2022.981368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Patients' non-adherence to medication affects both patients themselves and healthcare systems. Consequences include higher mortality, worsening of disease, patient injuries, and increased healthcare costs. Many existing survey tools for assessing adherence are linked to specific diseases and assessing medication-taking behavior or identifying barriers or beliefs. This study aimed to develop and validate a new non-disease-specific survey tool to assess self-reported medication-taking behavior, barriers, and beliefs in order to quantify the causes of non-adherence and measure adherence. Methods: The survey tool was developed after literature searches and pilot testing. Validation was conducted by assessing the psychometric properties of content, construct, reliability, and feasibility. Content validity was assessed by subject matter experts and construct validity by performing exploratory factor analysis. Reliability assessment was performed by calculating internal consistency, Cronbach's alpha and test/retest reliability, intraclass correlation coefficient (ICC), and standard error of measurement (SEm). A receiver operating characteristic (ROC) curve and the Lui method were used to calculate the statistical cut-off score for good versus poor adherence. Survey responses from Norwegian medication users over 18 years recruited via social media were used for the factor analysis and Cronbach's alpha. Results: The final survey tool contains 37 causes of non-adherence connected to medication-taking behavior and barriers to adherence and beliefs associated with adherence. The overall result for all 37 items demonstrated reliable internal consistency, Cronbach's alpha = 0.91. The factor analysis identified ten latent variables for 29 items, explaining 61.7% of the variance. Seven of the latent variables showed reliable internal consistency: medication fear and lack of effect, conditional practical issues, pregnancy/breastfeeding, information issues, needlessness, lifestyle, and avoiding stigmatization (Cronbach's alpha = 0.72-0.86). Shortage showed low internal consistency (Cronbach's alpha = 0.59). Impact issues and personal practical issues showed poor internal consistency (Cronbach's alpha = 0.51 and 0.48, respectively). The test/retest reliability ICC = 0.89 and SEm = 1.11, indicating good reliability. The statistical cut-off score for good versus poor adherence was 10, but the clinical cut-off score was found to be 2. Conclusion: This survey tool, OMAS-37 (OsloMet Adherence to medication Survey tool, 37 items), demonstrated to be a valid and reliable instrument for assessing adherence. Further studies will examine the ability of the tool for measuring adherence enhancing effect following interventions.
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Affiliation(s)
- Rønnaug Eline Larsen
- Department of Life Sciences and Health, Faculty of Health Sciences, Norway And The Research Group Medicines and Patient Safety, Oslo Metropolitan University, Oslo, Norway,*Correspondence: Rønnaug Eline Larsen,
| | - Are Hugo Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway,Department of Biostatistics, Oslo Centre of Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Tonje Krogstad
- Department of Life Sciences and Health, Faculty of Health Sciences, Norway And The Research Group Medicines and Patient Safety, Oslo Metropolitan University, Oslo, Norway
| | - Cecilie Johannessen Landmark
- Department of Life Sciences and Health, Faculty of Health Sciences, Norway And The Research Group Medicines and Patient Safety, Oslo Metropolitan University, Oslo, Norway,The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway,Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Lene Berge Holm
- Department of Life Sciences and Health, Faculty of Health Sciences, Norway And The Research Group Medicines and Patient Safety, Oslo Metropolitan University, Oslo, Norway,Center for Connected Care, Oslo University Hospital, Oslo, Norway
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Miregwa BN, Holbrook A, Law MR, Lavis JN, Thabane L, Dolovich L, Wilson MG. The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis. CMAJ Open 2022; 10:E848-E855. [PMID: 36167420 PMCID: PMC9578752 DOI: 10.9778/cmajo.20210295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2018, Ontario implemented a pharmacare program (Ontario Health Insurance Plan Plus [OHIP+]) to provide children and youth younger than 25 years with full coverage for prescription medications in the provincial formulary. We aimed to assess the use of public drug plans and costs of publicly covered prescriptions before and after the program's implementation and modification. METHODS We conducted a population-based, interrupted time-series analysis using data on prescription drug claims, from the Canadian Institute for Health Information's National Prescription Drug Utilization Information System, for people younger than 25 years from January 2016 to October 2019 in Ontario, using British Columbia as the control. We assessed changes in the level and trend of publicly covered prescriptions and expenditures after the introduction of OHIP+ in January 2018 and after program modifications in April 2019. We also assessed plan use and expenditures for publicly covered prescriptions for diabetes and asthma. RESULTS Publicly covered prescriptions in Ontario increased by 290%, from 756 per 1000 people before OHIP+ to 2952 per 1000 (p < 0.001) after its implementation. After program modification, prescriptions decreased by 52% to 1421 per 1000 (p < 0.001). Similarly, total public drug expenditures increased by 254%, from $379 million in 2017 to $839 million in 2018, then reduced by 49% to $204 million in 2019. Monthly public plan expenditures increased by $115.94 (95% confidence interval [CI] $100.93 to $130.94) post-OHIP+ implementation and decreased by $99.97 (95% CI -$119.79 to -$80.15) per person per month after April 2019. INTERPRETATION Adopting OHIP+ increased use of public drug plans and expenditures for publicly funded prescription medicines, and the program modification was associated with decreases in both outcomes. This study's findings can inform the national pharmacare debate; future research should investigate associations with health outcomes.
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Affiliation(s)
- Benard N Miregwa
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont.
| | - Anne Holbrook
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Michael R Law
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - John N Lavis
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Lehana Thabane
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Lisa Dolovich
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Michael G Wilson
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
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Tang KL, Sajobi T, Santana MJ, Lawal O, Tesorero L, Ghali WA. Development and validation of a social vulnerabilities survey for medical inpatients. BMJ Open 2022; 12:e059788. [PMID: 36691233 PMCID: PMC9171274 DOI: 10.1136/bmjopen-2021-059788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Our objective was to validate a Social Vulnerabilities Survey that was developed to identify patient barriers in the following domains: (1) salience or priority of health; (2) social support; (3) transportation; and (4) finances. DESIGN Cross-sectional psychometric study.Questions for one domain (health salience) were developed de novo while questions for the other domains were derived from national surveys and/or previously validated questionnaires. We tested construct (ie, convergent and discriminative) validity for these new questions through hypothesis testing of correlations between question responses and patient characteristics. Exploratory factor analysis was conducted to determine structural validity of the survey as a whole. SETTING Patients admitted to the inpatient internal medicine service at a tertiary care hospital in Calgary, Canada. PARTICIPANTS A total of 406 patients were included in the study. RESULTS The mean age of respondents was 55.5 (SD 18.6) years, with the majority being men (55.4%). In feasibility testing of the first 107 patients, the Social Vulnerabilities Survey was felt to be acceptable, comprehensive and met face validity. Hypothesis testing of the health salience questions revealed that the majority of observed correlations were exactly as predicted. Exploratory factor analysis of the global survey revealed the presence of five factors (eigenvalue >1): social support, health salience, drug insurance, transportation barriers and drug costs. All but four questions loaded to these five factors. CONCLUSIONS The Social Vulnerabilities Survey has face, construct and structural validity. It can be used to measure modifiable social vulnerabilities, such that their effects on health outcomes can be explored and understood.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Oluwaseyi Lawal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - William A Ghali
- Office of the Vice President (Research), University of Calgary, Calgary, Alberta, Canada
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Gupta AK, Salway T. Prescription Drug Insurance and Cost-Related Medication Nonadherence Among Lesbian, Gay, and Bisexual Individuals in Canada. LGBT Health 2022; 9:426-435. [PMID: 35537531 DOI: 10.1089/lgbt.2021.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study estimates the frequency of uninsurance for prescription drugs and cost-related medication nonadherence (CRNA) among lesbian, gay, and bisexual (LGB) persons in Canada, compared with the heterosexual population. Methods: Logistic regression was used to quantify associations between sexual orientation, insurance status, and CRNA within the national probability-based Canadian Community Health Survey, 2015-2016. This sample included 98,413 individuals aged 15-80 years, including 2803 LGB individuals. Results: From our sample of Canadians, 22.2% of LGB respondents reported being uninsured for prescription drugs, compared with 20.0% of heterosexual persons (unadjusted odds ratio [UOR] 1.00, 95% confidence interval [CI] 0.75-1.33). LGB individuals had more than twice the odds of reporting CRNA compared with heterosexual individuals (UOR 2.48, 95% CI 1.99-3.10). This disparity was most pronounced among bisexual respondents, who had over three times the odds of reporting CRNA in comparison to heterosexual respondents (UOR 3.45, 95% CI 2.65-4.51). The odds ratio (OR) for CRNA comparing bisexual with heterosexual individuals remained statistically significant after adjustment for race/ethnicity, gender/sex, and age (OR 2.67, 95% CI 1.97-3.61) and was further attenuated with adjustment for partnership status, employment status, income, educational attainment, prescription drug insurance status, general health status, and immigration status (OR 2.09, 95% CI 1.51-2.89). Conclusion: LGB Canadians reported more CRNA but comparable prescription drug insurance frequencies to heterosexual persons. Factors pertaining to medication access (e.g., income, partnership status) and health needs appear to be the most important contributors to disparities.
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Affiliation(s)
- Amit K Gupta
- British Columbia Centre for Disease Control, Vancouver, Canada.,Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
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15
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Giruparajah M, Everett K, Shah BR, Austin PC, Fuchs S, Shulman R. Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis. CMAJ Open 2022; 10:E519-E526. [PMID: 35700995 PMCID: PMC9343121 DOI: 10.9778/cmajo.20210214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We evaluated the impact of publicly funded pharmacare (Ontario Health Insurance Plan [OHIP]+), which was introduced in Ontario on Jan. 1, 2018, for youth less than 25 years of age, on temporal trends in hemoglobin A1c (HbA1c, a measure of glycemic management) and the differential effect on the change in temporal trends in HbA1c according to socioeconomic status (SES). METHODS We conducted a trend analysis using administrative data sets. We included youth aged 21 years, 9 months or younger, residing in Ontario on Jan. 1, 2016, with diabetes diagnosed before age 15 years and before Jan. 1, 2015. We used claims for insulin to measure pharmacare use. We evaluated the change in HbA1c (%) per 90 days before (Jan. 1, 2016, to Dec. 31, 2017) the introduction of and during (Apr. 1, 2018, to Mar. 31, 2019) OHIP+ coverage, and the difference in the change in HbA1c according to SES, using segmented regression analysis. RESULTS Of 9641 patients, 7041 (73.0%) made an insulin claim. We found a negligible difference in the temporal change in HbA1c during compared with before OHIP+ coverage that was not statistically significant (β estimate -0.0002, 95% confidence interval [CI] -0.0004 to 0.0000). The size of the effect was slightly greater in those individuals with the lowest SES than in those with the highest SES (β estimate -0.0008, 95% CI -0.0015 to -0.0001). INTERPRETATION We found that the effect of OHIP+ on the change in HbA1c was slightly greater for youth in the lowest SES than for those in the highest SES. Our findings suggest that publicly funded pharmacare may be an effective policy tool to combat worsening socioeconomic disparities in diabetes care and outcomes.
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Affiliation(s)
- Mohana Giruparajah
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Karl Everett
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Baiju R Shah
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Peter C Austin
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Shai Fuchs
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Rayzel Shulman
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.
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16
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Guindon GE, Fatima T, Garasia S, Khoee K. A systematic umbrella review of the association of prescription drug insurance and cost-sharing with drug use, health services use, and health. BMC Health Serv Res 2022; 22:297. [PMID: 35241088 PMCID: PMC8895849 DOI: 10.1186/s12913-022-07554-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing spending and use of prescription drugs pose an important challenge to governments that seek to expand health insurance coverage to improve population health while controlling public expenditures. Patient cost-sharing such as deductibles and coinsurance is widely used with aim to control healthcare expenditures without adversely affecting health. METHODS We conducted a systematic umbrella review with a quality assessment of included studies to examine the association of prescription drug insurance and cost-sharing with drug use, health services use, and health. We searched five electronic bibliographic databases, hand-searched eight specialty journals and two working paper repositories, and examined references of relevant reviews. At least two reviewers independently screened the articles, extracted the characteristics, methods, and main results, and assessed the quality of each included study. RESULTS We identified 38 reviews. We found consistent evidence that having drug insurance and lower cost-sharing among the insured were associated with increased drug use while the lack or loss of drug insurance and higher drug cost-sharing were associated with decreased drug use. We also found consistent evidence that the poor, the chronically ill, seniors and children were similarly responsive to changes in insurance and cost-sharing. We found that drug insurance and lower drug cost-sharing were associated with lower healthcare services utilization including emergency room visits, hospitalizations, and outpatient visits. We did not find consistent evidence of an association between drug insurance or cost-sharing and health. Lastly, we did not find any evidence that the association between drug insurance or cost-sharing and drug use, health services use or health differed by socioeconomic status, health status, age or sex. CONCLUSIONS Given that the poor or near-poor often report substantially lower drug insurance coverage, universal pharmacare would likely increase drug use among lower-income populations relative to higher-income populations. On net, it is probable that health services use could decrease with universal pharmacare among those who gain drug insurance. Such cross-price effects of extending drug coverage should be included in costing simulations.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Economics, McMaster University, Hamilton, ON, Canada.
| | - Tooba Fatima
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sophiya Garasia
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kimia Khoee
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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17
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Liu L, Huang W, Huang Z, Liu J, Zheng X, Tang J, Wu Y, Wang X, Liao Y, Cong L. Relationship Between Family Caregiver Burden and Medication Adherence in Patients with Mechanical Valve Replacement: A Structural Equation Model. Patient Prefer Adherence 2022; 16:3371-3382. [PMID: 36573227 PMCID: PMC9789713 DOI: 10.2147/ppa.s383269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Oral anticoagulant is a necessary long-term treatment after mechanical valve replacement (MVR), and medication adherence has a great impact on patients with MVR. Although family caregiver burden is negatively correlated with medication adherence, little is known about the underlying mechanism. PURPOSE To test whether family caregiver burden influences medication adherence through post-traumatic growth or medication literacy in patients with MVR. PATIENTS AND METHODS A total of 206 patients after MVR were included in this cross-sectional study from July 2021 to December 2021. Data regarding medication adherence, family caregiver burden, post-traumatic growth, and medication literacy were collected by questionnaires. Data were analyzed through SPSS, and pathway analysis was conducted by using AMOS, based on the bootstrapping method. RESULTS Post-traumatic growth was positively associated with medication adherence (r = 0.284, P < 0.05). Post-traumatic growth independently mediated the association of family caregiver burden on medication adherence [β = 0.32, 95% confidence intervals: (-0.016, -0.008)]. The mediated effect value for post-traumatic growth was 0.07, accounting for 24.14% of the total effect. The model's fit indices were adequate. CONCLUSION The mediating effect of post-traumatic growth between family caregiver burden and medication adherence existed in patients with MVR. Interventions considering post-traumatic growth may be useful to increase medication adherence and improve patient rehabilitation.
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Affiliation(s)
- Lijuan Liu
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Wenzhuo Huang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Zhuoer Huang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Xiangya School of Nursing, Central South University, Changsha, People’s Republic of China
| | - Jiaxin Liu
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Xiangya School of Nursing, Central South University, Changsha, People’s Republic of China
| | - Xiaoyuan Zheng
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
| | - Jing Tang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Ying Wu
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
| | - Xiaohui Wang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
| | - Yongzhen Liao
- Shunde Polytechnic, Foshan, People's Republic of China
| | - Li Cong
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Correspondence: Li Cong, School of Medicine, Hunan Normal University, Changsha, People’s Republic of China, Tel/Fax +86-0731-88912446, Email
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18
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Ahmad A, Abbas M, Miregwa B, Holbrook AM. Variability in Prescription Medication Coverage for Children and Youth Across Canada: A Scoping Review. Health Policy 2022; 126:269-279. [DOI: 10.1016/j.healthpol.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
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19
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Alefan Q, Cheekireddy VM, Blackburn D. Cost-Related Nonadherence Can be Explained by A General Non-Adherence Framework. J Am Pharm Assoc (2003) 2022; 62:658-673. [DOI: 10.1016/j.japh.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
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20
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Buys YM, Kagan D, Jin YP, Trope GE. Cost-related nonadherence with glaucoma medications in Ontario. Can J Ophthalmol 2021; 56:379-384. [PMID: 33548175 DOI: 10.1016/j.jcjo.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/16/2020] [Accepted: 01/09/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the proportion of glaucoma patients in Ontario aged 25-64 who lack insurance coverage for glaucoma medications and to assess the frequency of cost-related nonadherence to glaucoma medications. DESIGN Cross-sectional study. PARTICIPANTS Glaucoma patients on medication from 2 glaucoma clinics in Toronto, Ontario. METHODS 100 consecutive glaucoma patients aged 25-64 (not entitled to provincial drug benefit) and 100 consecutive glaucoma patients aged 65+ (entitled to provincial drug benefit), all on topical glaucoma therapy, completed a standardized questionnaire. Questions included insurance coverage for glaucoma medications, cost concerns when paying for glaucoma medications, cost-related nonadherence, and sociodemographics. RESULTS 25.8% of those aged 25-64 express concerns about the cost of their glaucoma medications compared to 7.1% of those aged 65+ (p < 0.001). Patients aged 25-64 were also significantly more likely to report at least one form of cost-related nonadherence (15.5% vs 2.0%, p = 0.001) and significantly more likely to report missing eye drops in a given week than patients aged 65+ (32.0% vs 16.7%, p = 0.01). 17% (95% confidence interval 11%-26%) of patients aged 25-64 self-reported having no insurance coverage for their glaucoma medications. Of those with coverage, the most common source of insurance was employer-sponsored (68.6%) with 44% requiring a copayment. The average copayment was $18 (range $2-$250) for those aged 25-64 compared with $5 in the 65+ group (range $0.62-$100). CONCLUSIONS 17% of glaucoma patients aged 25-64 do not have coverage for their drops. One in four expressed concerns about the cost of their glaucoma medications, and 15.5% reported cost-related nonadherence.
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Affiliation(s)
| | - Dov Kagan
- Department of Ophthalmology and Vision Sciences
| | - Ya-Ping Jin
- Department of Ophthalmology and Vision Sciences; Dalla Lana School of Public Health University of Toronto, Toronto, Ont
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21
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Emoto N, Okazaki-Hada M, Yamaguchi Y, Okajima F, Goto R, Sugihara H. Risk Preferences, Rationality of Choices, and Willingness to Pay for Preventive Medicine in Patients with Graves' Thyrotoxicosis. Patient Prefer Adherence 2021; 15:1971-1979. [PMID: 34522090 PMCID: PMC8434921 DOI: 10.2147/ppa.s323472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Patients with thyrotoxicosis show neuropsychological changes, and these may damage the quality of informed consent in clinical practice. Therefore, we examined patients' real-life preferences to assess whether change in risk preferences was dependent on thyroid function state. PATIENTS AND METHODS The participants were 86 patients who were newly diagnosed with Graves' thyrotoxicosis between 1 January and 31 December 2018 (group A), and an additional 33 euthyroid patients diagnosed before 2018 (group B). In a survey conducted via a questionnaire based on the concept of behavioral economics, we sought to determine risk preferences, rationality of choices, and other relevant factors. An identical second survey was completed 6-12 months later by 36 patients in group A after their thyroid functions had been normalized by treatment, and by 11 euthyroid patients in group B. We performed paired analysis of the first and second surveys in 32 patients of group A and single regression analysis of a total of 140 surveys obtained from 119 patients by combining the first and second surveys of groups A and B with serum level of FT3 as an independent variable. RESULTS The paired analysis indicated that there was no significant difference in any survey item. The single regression analysis revealed that willingness-to-pay (WTP) for preventive medicine and monthly average out-of-pocket (OOP) expenditure on medical care were both significantly positively associated with serum level of FT3. Patients in the hyperthyroid state tend to have high WTP for preventive medicine, which may be accelerated by the anchoring effect of OOP expenditure. CONCLUSION Almost all risk preferences of patients with Graves' disease are constant, rational, and reproducible in the hyperthyroid and euthyroid states. However, medical professionals should be aware that the willingness of patients with thyrotoxicosis to pay for medical costs may change after the normalization of thyroid function.
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Affiliation(s)
- Naoya Emoto
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Chiba, Japan
- Correspondence: Naoya Emoto Diabetes & Thyroid Clinic, Sakura Chuo Hospital, 20-4, Sakaecho, Sakura City, Chiba, 285-0014, JapanTel +81-43-486-1311Fax +81-43-486-1314 Email
| | - Mikiko Okazaki-Hada
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuji Yamaguchi
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Fumitaka Okajima
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| | - Hitoshi Sugihara
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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