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Morgan SG. When will Canada have national pharmacare? BMJ 2024; 385:q887. [PMID: 38649176 DOI: 10.1136/bmj.q887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
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Zeitouny S, McGrail K, Tadrous M, Wong ST, Cheng L, Law M. Impact of the COVID-19 pandemic on prescription drug use and costs in British Columbia: a retrospective interrupted time series study. BMJ Open 2024; 14:e070031. [PMID: 38176877 PMCID: PMC10773331 DOI: 10.1136/bmjopen-2022-070031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on prescription drug use and costs. DESIGN Interrupted time series analysis of comprehensive administrative health data linkages in British Columbia, Canada, from 1 January 2018 to 28 March 2021. SETTING Retrospective population-based analysis of all prescription drugs dispensed in community pharmacies and outpatient hospital pharmacies and irrespective of the drug insurance payer. PARTICIPANTS Between 4.30 and 4.37 million individuals (52% women) actively registered with the publicly funded medical services plan. INTERVENTION COVID-19 pandemic and associated mitigation measures. MAIN OUTCOME MEASURES Weekly dispensing rates and costs, both overall and stratified by therapeutic groups and pharmacological subgroups, before and after the declaration of the public health emergency related to the COVID-19 pandemic. Relative changes in post-COVID-19 outcomes were expressed as ratios of observed to expected rates. RESULTS After the onset of the pandemic and subsequent COVID-19 mitigation measures, overall medication dispensing rates dropped by 2.4% (p<0.01), followed by a sustained weekly increase to return to predicted levels by the end of January 2021. We observed abrupt level decreases in antibacterials (30.3%, p<0.01) and antivirals (22.4%, p<0.01) that remained below counterfactuals over the first year of the pandemic. In contrast, there was a week-to-week trend increase in nervous system drugs, yielding an overall increase of 7.3% (p<0.01). No trend changes in the dispensing of respiratory system agents, ACE inhibitors, antidiabetic drugs and antidepressants were detected. CONCLUSION The COVID-19 pandemic impact on prescription drug dispensing was heterogeneous across medication subgroups. As data become available, dispensing trends in nervous system agents, antibiotics and antivirals warrant further monitoring and investigation.
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Affiliation(s)
- Seraphine Zeitouny
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mina Tadrous
- University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Waqar M, Kuuire VZ. "The Critical Services Are Out of Reach": Diabetes Management and the Experiences of South Asian Immigrants in Ontario. J Prim Care Community Health 2024; 15:21501319241240635. [PMID: 38523416 PMCID: PMC10962024 DOI: 10.1177/21501319241240635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Type 2 diabetes is a serious chronic condition affecting millions of people worldwide. South Asians (individuals originating from Pakistan, India, Bangladesh, Sri Lanka, and Nepal) represent a high-risk ethnicity for developing type 2 diabetes (T2D) and experience a high prevalence of the disease, even in migrant populations. The objective of this study was to investigate perceptions and experiences of South Asians living with T2D in Ontario, and their utilization of diabetes related services within the provincial healthcare system. Data were obtained from 20 in-depth interviews with South Asian participants diagnosed with T2D and living in the Greater Toronto Area. Our findings indicate a dissatisfaction with Ontario's coverage for diabetes services; varying uptake of recommended health tests, exams, and monitoring equipment; low utilization of additional resources (diabetes centers); and a need for primary care physicians to better facilitate awareness and utilization of available coverages and resources in the community. This study provides support for the fact that even in Canada's universal healthcare system, disparities exist, particularly for ethnic minorities, and that a universal prescription drug coverage component is a crucial step forward to ensure equitable access to health services utilization for all.
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Affiliation(s)
- Minal Waqar
- Department of Geography, Geomatics & Environment, University of Toronto – Mississauga, Mississauga, ON, Canada
| | - Vincent Z. Kuuire
- Department of Geography, Geomatics & Environment, University of Toronto – Mississauga, Mississauga, ON, Canada
- Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto – St. George, Toronto, ON, Canada
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Graul EL, Stone PW, Massen GM, Hatam S, Adamson A, Denaxas S, Peters NS, Quint JK. Determining prescriptions in electronic healthcare record data: methods for development of standardized, reproducible drug codelists. JAMIA Open 2023; 6:ooad078. [PMID: 37649988 PMCID: PMC10463548 DOI: 10.1093/jamiaopen/ooad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
Objective To develop a standardizable, reproducible method for creating drug codelists that incorporates clinical expertise and is adaptable to other studies and databases. Materials and Methods We developed methods to generate drug codelists and tested this using the Clinical Practice Research Datalink (CPRD) Aurum database, accounting for missing data in the database. We generated codelists for: (1) cardiovascular disease and (2) inhaled Chronic Obstructive Pulmonary Disease (COPD) therapies, applying them to a sample cohort of 335 931 COPD patients. We compared searching all drug dictionary variables (A) against searching only (B) chemical or (C) ontological variables. Results In Search A, we identified 165 150 patients prescribed cardiovascular drugs (49.2% of cohort), and 317 963 prescribed COPD inhalers (94.7% of cohort). Evaluating output per search strategy, Search C missed numerous prescriptions, including vasodilator anti-hypertensives (A and B:19 696 prescriptions; C:1145) and SAMA inhalers (A and B:35 310; C:564). Discussion We recommend the full search (A) for comprehensiveness. There are special considerations when generating adaptable and generalizable drug codelists, including fluctuating status, cohort-specific drug indications, underlying hierarchical ontology, and statistical analyses. Conclusions Methods must have end-to-end clinical input, and be standardizable, reproducible, and understandable to all researchers across data contexts.
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Affiliation(s)
- Emily L Graul
- School of Public Health, Imperial College London, London W12 0BZ, United Kingdom
| | - Philip W Stone
- School of Public Health, Imperial College London, London W12 0BZ, United Kingdom
- National Heart & Lung Institute, Imperial College London, London W12 0BZ, United Kingdom
| | - Georgie M Massen
- National Heart & Lung Institute, Imperial College London, London W12 0BZ, United Kingdom
| | - Sara Hatam
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, United Kingdom
| | - Alexander Adamson
- School of Public Health, Imperial College London, London W12 0BZ, United Kingdom
- National Heart & Lung Institute, Imperial College London, London W12 0BZ, United Kingdom
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London NW1 2DA, United Kingdom
- British Heart Foundation Data Science Centre, Health Data Research UK, London NW1 2DA, United Kingdom
| | - Nicholas S Peters
- National Heart & Lung Institute, Imperial College London, London W12 0BZ, United Kingdom
| | - Jennifer K Quint
- School of Public Health, Imperial College London, London W12 0BZ, United Kingdom
- National Heart & Lung Institute, Imperial College London, London W12 0BZ, United Kingdom
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Naipaul R, Marques C, Ng J, Barbour S, Lo C, Hildebrand AM, Siu V, Prasad B, Laurin LP, Wazny LD, Armstrong S, Tran J, Sheffield M, Jauhal A, Hladunewich MA. Focused Jurisdictional Scan of Glomerulonephritis Medication Access in Canada: A Program Report. Can J Kidney Health Dis 2023; 10:20543581231190227. [PMID: 37581108 PMCID: PMC10423446 DOI: 10.1177/20543581231190227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/23/2023] [Indexed: 08/16/2023] Open
Abstract
Purpose of Program Glomerulonephritis (GN) is a group of rare kidney diseases that is increasingly being managed with higher cost immunosuppressive (IS) agents in Canada. Ontario Health's Ontario Renal Network (ORN) oversees the management and delivery of GN services in the province. Stakeholder surveys previously conducted by ORN identified that both clinicians and patients do not perceive access to GN medications as comprehensive or timely. The program conducted a focused jurisdictional scan among 7 provinces to inform ORN initiatives to improve access to GN medications. Specifically, the program examined clinician experience with GN access, public drug coverage criteria, and timelines for public coverage for select IS agents (ie, tacrolimus, cyclosporine, mycophenolate mofetil [MMF], mycophenolate sodium, rituximab, and eculizumab) used to manage GN in adults who live in Canada. Methods For the selected IS agents, a focused jurisdictional scan on medication access was conducted by ORN in 2018 and updated in July 2022. Information was obtained by searching the gray literature and/or credible online sources for public funding policies and eligibility criteria. Findings were supplemented by personal communications with provincial drug programs and consulting GN clinical experts from 7 provinces (ie, Alberta, British Columbia, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Quebec). Key Findings Clinicians from different provinces prescribe IS agents similarly for GN indications, despite distinctions in public drug funding policies. While patients can obtain public funding for many IS agents, for GN, most provinces rely on case-by-case review processes. In addition, provinces can vary in their funding criteria and which IS agents are listed on the public formulary. For IS agents that require prior authorization or case-by-case review, timelines vary by province with decisions taking a few days to weeks. British Columbia, with a GN-specific drug formulary, had the most integrated and efficient system for patients and prescribers. Limitations This scan primarily relied on publicly available information for drug coverage criteria and clinician experience with access in their province. Since this scan was conducted, public drug coverage criteria and/or application processes may have changed. Implications While patients in most provinces have similar needs and nephrologists similar prescribing patterns, gaps still exist for publicly funded GN medications. Interprovincial differences in the drugs funded, funding criteria, and application process may affect timely and equitable access to GN medications across Canada. Given the rarity of GN, a pan-Canadian funding approach may be warranted to improve the current state.
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Affiliation(s)
| | | | - Jenny Ng
- Division of Nephrology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Nanji Family Kidney Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Sean Barbour
- Division of Nephrology, Department of Medicine, University of British Columbia, BC Renal, Vancouver, BC, Canada
| | - Clifford Lo
- Division of Nephrology, Department of Medicine, University of British Columbia, BC Renal, Vancouver, BC, Canada
| | - Ainslie M. Hildebrand
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Valerie Siu
- Pharmacy Services, Alberta Health Services, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bhanu Prasad
- Division of Nephrology, Department of Medicine, Regina General Hospital, Regina, SK, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QB, Canada
| | - Lori D. Wazny
- Manitoba Renal Program and Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Sean Armstrong
- Manitoba Renal Program and Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Jaclyn Tran
- Central Zone, Nova Scotia Health Renal Program, Halifax, NS, Canada
| | - Maneka Sheffield
- Central Zone, Nova Scotia Health Renal Program, Halifax, NS, Canada
| | - Arenn Jauhal
- Division of Nephrology, Department of Medicine, University Health Network, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle A. Hladunewich
- Ontario Health (Ontario Renal Network), Toronto, Canada
- Division of Nephrology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Nanji Family Kidney Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada
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Zhang Q, Laporte A. The impact of prescription drug insurance on cost related non-adherence to medications in Canada: A Heckman sample selection approach. PLoS One 2023; 18:e0289776. [PMID: 37556420 PMCID: PMC10411745 DOI: 10.1371/journal.pone.0289776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
Unlike some other high-income counties, Canada does not provide universal prescription drug coverage. The various extent of coverage may left some Canadians vulnerable to cost-related non-adherence (CRNA) to medications. Using data from the 2015 national cycle of the Canadian Community Health Survey, we examine the impact of having private and public drug coverage on mitigating the risk of CRNA with a logit model and a Heckman selection model. CRNA was only observed in respondents who had prescriptions to fill, and respondents did not randomly make decisions on whether to get a prescription. This results in a classic sample selection problem. We found a higher estimated probability of reporting CRNA for uninsured respondents from the Heckman selection model than from the logit model. Respondents with government coverage only had a slightly higher probability of reporting CRNA relative to respondents with private coverage. These findings suggest that, without accounting for sample selection, the risk of not having drug insurance coverage is likely to be underestimated. Moreover, despite covering a less healthy cohort of respondents, the government insurance plans reduce risk of CRNA to a comparable level with private insurance.
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Affiliation(s)
- Qi Zhang
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Canadian Center for Health Economics, Toronto, ON, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Canadian Center for Health Economics, Toronto, ON, Canada
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Ting SG, Lea-Banks H, Hynynen K. Physical Characterization to Improve Scalability and Potential of Anesthetic-Loaded Nanodroplets. Pharmaceutics 2023; 15:2077. [PMID: 37631291 PMCID: PMC10457791 DOI: 10.3390/pharmaceutics15082077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Drug-loaded perfluorocarbon nanodroplets (NDs) can be activated non-invasively by focused ultrasound (FUS) and allow for precise drug-delivery. Anesthetic-loaded NDs and transcranial FUS have previously achieved targeted neuromodulation. To assess the clinical potential of anesthetic-loaded NDs, in depth physical characterization and investigation of storage strategies and triggered-activation is necessary. Pentobarbital-loaded decafluorobutane nanodroplets (PBNDs) with a Definity-derived lipid shell (237 nm; 4.08 × 109 particles/mL) were fabricated and assessed. Change in droplet stability, concentration, and drug-release efficacy were tested for PBNDs frozen at -80 °C over 4 weeks. PBND diameter and the polydispersity index of thawed droplets remained consistent up to 14 days frozen. Cryo-TEM images revealed NDs begin to lose circularity at 7 days, and by 14 days, perfluorocarbon dissolution and lipid fragmentation occurred. The level of acoustic response and drug release decreases through prolonged storage. PBNDs showed no hemolytic activity at clinically relevant concentrations and conditions. At increasing sonication pressures, liquid PBNDs vaporized into gas microbubbles, and acoustic activity at the second harmonic frequency (2 f0) peaked at lower pressures than the subharmonic frequency (1/2 f0). Definity-based PBNDs have been thoroughly characterized, cryo-TEM has been shown to be suitable to image the internal structure of volatile NDs, and PBNDs can be reliably stored at -80 °C for future use up to 7 days without significant degradation, loss of acoustic response, or reduction in ultrasound-triggered drug release.
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Affiliation(s)
- Siulam Ginni Ting
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada;
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Harriet Lea-Banks
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada;
| | - Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada;
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Biomedical Imaging, University of Toronto, Toronto, ON M5S 1A1, Canada
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8
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Guindon GE, Stone E, Trivedi R, Garasia S, Khoee K, Olaizola A. The Associations of Prescription Drug Insurance and Cost-Sharing With Drug Use, Health Services Use, and Health: A Systematic Review of Canadian Studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1107-1129. [PMID: 36842717 DOI: 10.1016/j.jval.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/12/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES In Canada, public insurance for physician and hospital services, without cost-sharing, is provided to all residents. Outpatient prescription drug coverage, however, is provided through a patchwork system of public and private plans, often with substantial cost-sharing, which leaves many underinsured or uninsured. METHODS We conducted a systematic review to examine the association of drug insurance and cost-sharing with drug use, health services use, and health in Canada. We searched 4 electronic databases, 2 grey literature databases, 5 specialty journals, and 2 working paper repositories. At least 2 reviewers independently screened articles for inclusion, extracted characteristics, and assessed risk of bias. RESULTS The expansion of drug insurance was associated with increases in drug use, individuals who reported drug insurance generally reported higher drug use, and increases in and higher levels of drug cost-sharing were associated with lower drug use. Although a number of studies found statistically significant associations between drug insurance or cost-sharing and health services use, the magnitudes of these associations were generally fairly small. Among 5 studies that examined the association of drug insurance and cost-sharing with health outcomes, 1 found a statistically significant and clinically meaningful association. We did not find that socioeconomic status or sex were effect modifiers; there was some evidence that health modified the association between drug insurance and cost-sharing and drug use. CONCLUSIONS Increased cost-sharing is likely to reduce drug use. Universal pharmacare without cost-sharing may reduce inequities because it would likely increase drug use among lower-income populations relative to higher-income populations.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
| | - Erica Stone
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Riya Trivedi
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Sophiya Garasia
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Kimia Khoee
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Alexia Olaizola
- Department of Economics, Stanford University, Stanford, CA, USA
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Snell G, Marshall AD, van Gennip J, Bonn M, Butler-McPhee J, Cooper CL, Kronfli N, Williams S, Bruneau J, Feld JJ, Janjua NZ, Klein M, Cunningham N, Grebely J, Bartlett SR. Public reimbursement policies in Canada for direct-acting antiviral treatment of hepatitis C virus infection: A descriptive study. CANADIAN LIVER JOURNAL 2023; 6:190-200. [PMID: 37503523 PMCID: PMC10370724 DOI: 10.3138/canlivj-2022-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/28/2023] [Indexed: 07/29/2023]
Abstract
Background Direct-acting antiviral (DAA) therapies have simplified HCV treatment, and publicly funded Canadian drug plans have eliminated disease-stage restrictions for reimbursement of DAA therapies. However other policies which complicate, delay, or prevent treatment initiation still persist. We aim to describe these plans' existing reimbursement criteria and appraise whether they hinder treatment access. Methods We reviewed DAA reimbursement policies of 16 publicly funded drug plans published online and provided by contacts with in-depth knowledge of prescribing criteria. Data were collected from May to July 2022. Primary outcomes were: (1) if plans have arranged to accept point-of-care HCV RNA testing for diagnosis; testing requirements for (2) HCV genotype, (3) fibrosis stage, and (4) chronic infection; (5) time taken and method used to approve reimbursement requests; (6) providers eligible to prescribe DAAs; and (7) restrictions on re-treatment. Results Fifteen (94%) plans have at least one policy in place which limits simplified HCV treatment. Many plans continue to require results of genotype or fibrosis staging, limit eligible prescribers, and take longer than 1 day to approve coverage requests. One plan discourages treatment for re-infection. Conclusion Reimbursement criteria set by publicly funded Canadian drug plans continue to limit timely, equitable access to HCV treatment. Eliminating clinically irrelevant pre-authorization testing, expanding eligible prescribers, expediting claims processing, and broadening coverage of treatment for reinfection will improve access to DAAs. The federal government could further enhance efforts by introducing a federal HCV elimination strategy or federal high-cost drug PharmaCare program.
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Affiliation(s)
- Gaelen Snell
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Nova Scotia, Canada
| | | | - Curtis L Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Sarah Williams
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
| | - Julie Bruneau
- Centre Hospitalier de l’Université de Montréal Research Center, Quebec, Canada
| | - Jordan J Feld
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marina Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Nance Cunningham
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Grebely
- The Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Stewart AJ, Patten SB, Fiest KM, Williamson TS, Wick JP, Ronksley PE. Identifying Unique Subgroups of High-Cost Patients With Schizophrenia: A Population-Based Study Using Latent Class Analysis. Health Serv Insights 2023; 16:11786329231183317. [PMID: 37377884 PMCID: PMC10291413 DOI: 10.1177/11786329231183317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Schizophrenia does not present uniformly among patients and as a result this patient population is characterized by a diversity in the type and amount of healthcare supports needed for daily functioning. Despite this, little work has been completed to understand the heterogeneity that exists among these patients. In this work we used a data-driven approach to identify subgroups of high-cost patients with schizophrenia to identify potentially actionable interventions for the improvement of outcomes and to inform conversations on how to most efficiently allocate resources in an already strained system. Administrative health data was used to conduct a retrospective analysis of "high-cost" adult patients with schizophrenia residing in Alberta, Canada in 2017. Costs were derived from inpatient encounters, outpatient primary care and specialist encounters, emergency department encounters, and drug costs. Latent class analysis was used to group patients based on their unique clinical profiles. Latent class analysis of 1659 patients revealed the following patient groups: (1) young, high-needs males early in their disease course; (2) actively managed middle-aged patients; (3) elderly patients with multiple chronic conditions and polypharmacy; (4) unstably housed males with low treatment rates; (5) unstably housed females with high acute care use and low treatment rates. This taxonomy may be used to inform policy, including the identification of interventions most likely to improve care and reduce health spending for each subgroup.
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Affiliation(s)
- Andrew J Stewart
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
| | - Tyler S Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
| | - James P Wick
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
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Roohi E, Lo C, Martinusen D, Levin A. Structure and Function of a Provincial Renal Pharmacy Program: Applying the Chronic Care Model to Address Equitable Access to Medication and Pharmacy Services. Can J Kidney Health Dis 2023; 10:20543581231177840. [PMID: 37313363 PMCID: PMC10259110 DOI: 10.1177/20543581231177840] [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: 01/04/2023] [Accepted: 04/02/2023] [Indexed: 06/15/2023] Open
Abstract
Purpose We described the rationale, structure, design, and components of a provincial pharmacy services network for patients with kidney disease as a model for enabling equitable access and universal care to pharmacy services and medications across a wide range of clinical conditions, and geographic expanse in British Columbia (BC). Sources of Information These include minutes from 53 Pharmacy Services and Formulary (PS&F) Committee meetings held from 1999 to November 2022, documentation available on the British Columbia Renal (BCR) website, direct observation and participation in committee meetings, as well as interviews with key individuals involved in different aspects of the program. Methods We reviewed documents and data describing the evolution, rationale, and functioning of the BCR provincial pharmacy services system and used a variety of sources as mentioned above. In addition, a qualitative thematic synthesis of reports of chronic care models (CCMs) was conducted to map the program components into the chronic disease management models. Key Findings The components of the provincial pharmacy program (PPP) include (1) a PS&F committee, with interdisciplinary and geographical representation; (2) a community of dispensing pharmacies with standardized protocols and information; (3) a dedicated medication and pharmacy services budget, and regular evaluation of budget, outcomes, and performance; (4) provincial contracts for specific medications; (5) communication and education; and (6) information management system. Program components are described in the context of chronic disease management models. The PPP includes dedicated formularies for people with kidney disease at different points in the disease trajectory, including those on and off dialysis. Equitable access to medications is supported across the province. All medications and counseling services are provided to all patients registered in the program, through a robust distributed model, including community- and hospital-based pharmacies. Provincial contracts managed centrally ensure best economic value, and centralized education and accountability structures ensure sustainability. Limitations Limitations of the current report include lack of formal evaluation of the program on patient outcomes, but this is relative as the intention of this article is to describe the program which has existed for over 20 years and is fully functional. Formal evaluation of a complex system would include by costs, cost avoidance, provider, and patients' satisfaction. We are developing a formal plan for this reason. Implications The PPP is embedded in the provincial infrastructure of BCR and enables the provision of essential medications and pharmacy services for patients with kidney disease throughout the spectrum. The leveraging of local and provincial resources, knowledge, and expertise to implement a comprehensive PPP, ensures transparency and accountability and may serve as a model for other jurisdictions.
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Affiliation(s)
- Elnaz Roohi
- Department of Experimental Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Clifford Lo
- BC Renal Agency, Vancouver, Canada
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Dan Martinusen
- BC Renal Agency, Vancouver, Canada
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Royal Jubilee Hospital, Island Health, Victoria, Canada
| | - Adeera Levin
- BC Renal Agency, Vancouver, Canada
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
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12
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Li Y. Generic Price Regulation and Drug Expenditures: Evidence From Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:833-840. [PMID: 36706953 DOI: 10.1016/j.jval.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Rapid growth in pharmaceutical spending is a major challenge in Canada. To control rising costs, the Canadian government implemented a generic pricing policy in 2013, which reduced prices for some prescription generic drugs by roughly 50%. This article explores the effects of the Canadian pricing policy on drug expenditures and drug utilization among seniors. METHODS Using a unique prescription claims data, this article adopts a difference-in-differences methodology to estimate the policy effects, and it further investigates the mechanisms by exploring the demand-side incentives and the role of health insurance design with a triple-difference approach. RESULTS Exploiting the policy variation across drugs and provinces, the results suggest that the policy has reduced drug expenditure per capita, largely because of the inelastic demand among seniors. Although the policy leads to lower out-of-pocket costs for seniors facing coinsurance than for those with a fixed copayment, individual utilization and total demand display no differences across cost sharing. CONCLUSIONS The price regulation in Canada was successful in reducing drug expenditures per capita. The success rests on the interaction with demand-side regulations and demand incentives. The evidence of cost containment in Canada can provide some insights to other countries with similar needs and priority.
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Affiliation(s)
- Yang Li
- School of Economics, Faculty of Humanities and Social Sciences, The University of Nottingham Ningbo China, Ningbo, China.
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13
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Répásy B, Gazsó T, Elmer D, Pónusz-Kovács D, Kajos FL, Csákvári T, Kovács B, Boncz I. The long-term effect of generic price competition on the Hungarian statin market. BMC Health Serv Res 2023; 23:447. [PMID: 37147682 PMCID: PMC10163807 DOI: 10.1186/s12913-023-09431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Generic competition is a vital health policy tool used in regulating the pharmaceutical market. Drug group HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase) inhibitors, widely known as "statins," was the first drug group in Hungary in which generic prescriptions became mandatory. Our aim is to analyze the changes in the retail and wholesale margins through the generic competition regarding "statins". METHODS Data was derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration, the only health care financing agency in Hungary. We observed the turnover data regarding the HMG-CoA-reductase inhibitor "statins" from 2010 through 2019. As the drugs under review have a fixed price point in Hungary, we effectively calculated the margins. RESULTS In 2010, the consumer expenditure of statins was 30.7 billion HUF ($148 million), which decreased by 59%, to 12.5 billion HUF ($42.9 million) in 2019. In 2010, the annual health insurance reimbursement of statins was 23.7 billion HUF ($114 million), which underwent a 63% decrease to 8.6 billion HUF ($29.7 million) in 2019. In 2010, the DOT turnover was 287 million days, and it increased to above 346 million days for 2019, which reflects a 20% increase over the past nine years. The monthly retail margins decreased from 334 million HUF ($1.6 million), (January, 2010) to 176 million HUF ($0.61 million), (December, 2019). The monthly wholesale margins decreased from 96.3 million HUF ($0.46 million), (January, 2010) to 41.4 million HUF ($0.14 million), (December, 2019). The most significant downturn in margins was due to the introduction of the first two blind bids. The combined DOT turnover in reference to the examined 43 products consistently increased. CONCLUSIONS The decline in retail and wholesale margin and in health insurance expenditures was largely due to a reduction in the consumer price of generic medicines. DOT turnover of statins also increased significantly.
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Affiliation(s)
- Balázs Répásy
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Tibor Gazsó
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Diána Elmer
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Dalma Pónusz-Kovács
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Fanni Luca Kajos
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Tímea Csákvári
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Bettina Kovács
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary.
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary.
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Improving access to care for rheumatology services in Canada. Clin Rheumatol 2023; 42:1205-1211. [PMID: 36746833 PMCID: PMC9901822 DOI: 10.1007/s10067-023-06532-9] [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: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Rheumatic diseases are becoming increasingly prevalent in Canada, and its associated strain on the healthcare system is expected to increase over the next decades. Furthermore, there is an increasing body of evidence to suggest that access to rheumatology care is currently not meeting established quality of care benchmarks. To frame issues affecting access to care for rheumatology services in Canada, a proposed chronological framework from a rheumatology patient's perspective is proposed. Illustrating principles from a health policy lens including drawing from the stages heuristic framework and multiple streams theory, issues surrounding access to rheumatology assessment, to rheumatological investigations and lastly to appropriate treatment are explored. In particular, the current supply and demand mismatch within the rheumatology workforce presents challenges for patients in accessing rheumatic diseases providers. Potential policy solutions including increasing the pool of rheumatic diseases care providers, enhancing the clinical capacity with extended role providers and increasing uptake of virtual care are discussed. To ameliorate access to rheumatology investigations, the concept of provider education surrounding the appropriateness of investigations and merit-based funding are explored. Lastly, access to rheumatological treatment is framed using biologic therapies as an example, highlighting the policy challenges in biosimilar uptake and associated ethical and political considerations. By using a health policy lens to explore deficiencies within Canada's current system, the overarching goal of this analysis is to set the stage for reasoned and timely solutions in the future.
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15
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Lexchin J. Time to potential for listing of new drugs on public and private formularies in Canada: a cross-sectional study. CMAJ Open 2022; 10:E993-E999. [PMID: 36379586 PMCID: PMC9671297 DOI: 10.9778/cmajo.20220063] [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: 11/16/2022] Open
Abstract
BACKGROUND Information about the timing involved in various stages of making new drugs available to Canadians is important for understanding how a national pharmacare plan will affect timely access to new drugs. I explored the timing of the various steps between receiving a Notice of Compliance and a decision by the pan-Canadian Pharmaceutical Alliance (pCPA). METHODS I gathered data from various databases (Canadian and other) about new drugs approved between 2011 and 2020, including generic names, date of application for approval (New Drug Submission [NDS]), date of Notice of Compliance, date of marketing, dates when a submission was made to the Canadian Agency for Drugs and Technologies in Health (CADTH) and the pCPA, and when these agencies made a decision. RESULTS Marketing dates were available for 301 of the 337 new drugs approved. The median time from NDS to marketing was less than the time to a positive pCPA decision for all years between 2011 and 2020. There was no significant change in the difference between the 2 periods over time (p = 0.2). Additional therapeutic value did not make a difference in the delay (p = 0.3) and companies did not take full advantage of the opportunity to file early submissions with CADTH. INTERPRETATION The delay between when drugs could be listed on private compared with public formularies was at least 1 year. If a national pharmacare plan is instituted, one of the priorities should be to concentrate on consolidating and working to shorten the CADTH and pCPA processes.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University; Faculty of Medicine, University of Toronto, Toronto, Ont.
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16
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Ayodele B, Guo EX, Sweetman A, Guindon GE. Inequity in insurance coverage for prescription drugs in New Brunswick, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:504-518. [PMID: 35488147 PMCID: PMC9263015 DOI: 10.17269/s41997-022-00639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To describe the extent to which New Brunswick residents reported having drug insurance coverage supplementary to Canadian Medicare; to examine associations between socioeconomic and demographic characteristics, health status, language identity, and having reported such coverage; and to document any changes in coverage associated with the introduction of the New Brunswick Drug Plan in 2014. METHODS We used repeated cross-sectional data for New Brunswick from eight cycles of the Canadian Community Health Survey from 2007 to 2017 and undertook logistic regression analysis. RESULTS We found statistically significant, substantial and policy-relevant socioeconomic differences in the reporting of prescription drug insurance coverage among those 25-64 years and those ≥ 65 years of age, and an increasing reliance on private drug insurance over time. We found that individuals in the second decile of household income were particularly vulnerable to reporting neither public nor private drug coverage. The introduction of the New Brunswick Drug Plan in 2014 does not appear to have led to increased public drug coverage; however, from 2014, the decreasing trend in public drug coverage appears to have ceased. Those who reported lower health status usually had lower odds of reporting private drug coverage but higher odds of reporting public drug coverage. Driven by differences in private coverage, we found that relative to anglophones, francophones were less likely to report any drug coverage. CONCLUSION Our findings emphasize the shortcomings of drug insurance systems such as that introduced in New Brunswick and substantiate calls for a universal drug program. New Brunswick's increasing reliance on private drug insurance is of concern and warrants additional research.
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Affiliation(s)
- Busola Ayodele
- Centre for Health Economics and Policy Analysis, McMaster University, CRL Building, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | | | - Arthur Sweetman
- Centre for Health Economics and Policy Analysis, McMaster University, CRL Building, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Economics, McMaster University, Hamilton, ON, Canada
| | - G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, CRL Building, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Economics, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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17
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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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18
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MacPhail C, Snow S. Not All Canadian Cancer Patients Are Equal—Disparities in Public Cancer Drug Funding across Canada. Curr Oncol 2022; 29:2064-2072. [PMID: 35323366 PMCID: PMC8947051 DOI: 10.3390/curroncol29030166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Canada lacks a national drug insurance plan. The home province or territory of a patient determines which cancer drugs are available on the public formulary, who is eligible for public coverage and what portion of the financial burden of cancer care falls to the individual. This narrative review describes the current interprovincial disparities in access to cancer drugs across Canada. Health technology assessment (HTA) of drugs at a provincial and territory level is a closed process, does not necessarily follow the recommendations of national HTA and leads to further delays in drug access. The public coverage of take-home cancer drugs (THCDs) in Ontario and the Atlantic provinces is often fragmented, unnecessarily complex and a barrier to cancer drug access. Policy solutions to address inter-provincial formulary variation and poor access to THCDs are discussed.
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19
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Ward LM, Chambers A, Mechichi E, Wong-Rieger D, Campbell C. An international comparative analysis of public reimbursement of orphan drugs in Canadian provinces compared to European countries. Orphanet J Rare Dis 2022; 17:113. [PMID: 35246200 PMCID: PMC8895096 DOI: 10.1186/s13023-022-02260-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Canadian government has committed to developing a national strategy for drugs for rare diseases starting in 2022. Considering this announcement, we conducted a comparative analysis to examine patient access to therapies for rare disease in Canada relative to Europe and the U.S. METHODS Given its similarity to the Canadian health care system, we used Europe as the reference point to analyze all of the therapies with an orphan drug designation approved by the European Medicine Agency (EMA) from 1 January 2015 to 31 March 2020. We then contrasted access to these drugs in Canada (Health Canada) and the U.S. (Food and Drug Administration, FDA). We focused on: (1) the number of therapies for rare diseases entering the Canadian market; (2) the percentage of these therapies that are publicly available to Canadians; and (3) the timelines for patients to access these therapies in Canada. RESULTS Sixty-three approved therapies with an orphan drug designation from the EMA were identified. Fifty-three (84%) of these drugs had also been submitted to the FDA for approval, and 41 (65%) were submitted to Health Canada for approval. In Europe, Germany, Denmark, and the U.K. had the highest percentage of publicly reimbursed orphan drugs (84%, 70%, 68%, respectively). In comparison, Ontario (32%), Quebec (25%), and Alberta (25%) had the highest percentage of drugs reimbursed among the Canadian provinces. The shortest median duration (in months) from EMA approval to jurisdictional decision on reimbursement was in Austria (3.2), followed by Germany (4.1), and Finland (6.0). In Canada, the shortest median duration (in months) from regulatory approval to reimbursement was in British Columbia (17.3), Quebec (19.6) and Manitoba (19.6), while the longest duration was in P.E.I (38.5), followed by Nova Scotia (25.9), and Newfoundland (25.1). CONCLUSIONS Our comparative analysis found that relative to the EU Canadians had less frequent and timely access to therapies for rare diseases. This highlights the need for a rare disease strategy in Canada that allows for clear identification and transparent tracking of the pathway for rare disease drugs, and ultimately optimizes the number of patients with access to these therapies.
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Affiliation(s)
| | | | | | | | - Craig Campbell
- Children's Hospital, London Health Sciences Centre, London, ON, Canada
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20
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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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21
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Shakeri A, Hayes KN, Gomes T, Tadrous M. Comparison of public and private payments for direct-acting antivirals (DAAs) across Canada. CANADIAN LIVER JOURNAL 2021; 4:426-429. [PMID: 35989895 PMCID: PMC9235118 DOI: 10.3138/canlivj-2020-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 07/29/2023]
Affiliation(s)
- Ahmad Shakeri
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kaleen N Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mina Tadrous
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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22
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Chugh Y, De Francesco M, Prinja S. Systematic Literature Review of Guidelines on Budget Impact Analysis for Health Technology Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:825-838. [PMID: 33956308 DOI: 10.1007/s40258-021-00652-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objective of this systematic review was to review the recommendations for the conduct of a budget impact analysis in national or organisational guidelines globally. METHODS We searched several databases including MELDINE, EMBASE, The Cochrane Library, National Guideline Clearinghouse, HTA Database (International Network of Agencies for Health Technology Assessment), Econlit and IDEAS Database (RePEc, Research Papers in Economics). The OVID platform was used to run the search in all databases simultaneously. In addition, a search of the grey literature was also conducted. The timeframe was set from 2000 to 2020 with language of publication restricted to English. RESULTS A total of 13 publications were selected. All the countries where financing of health is predominantly tax funded with public provisioning recommend a healthcare payer (government) perspective. However, countries where a healthcare payer includes a mix of federal government, communities, hospital authorities and patient communities recommend a complementary analysis with a wider societal perspective. While four guidelines prefer a simple cost calculator for costing, the rest rely on a decision modelling approach. None of the guidelines recommend discounting except the Polish guidelines, which recommend discounting at 5%. Only two countries, Belgium and Poland, mention that indirect costs, if significant, should be included in addition to direct costs. CONCLUSIONS The comparative cross-country analysis shows that a standard set of recommendations cannot be directly useful for all as there are contextual differences. Thus, budget impact analysis guidelines must be carefully contextualised in the policy environment of a country so as to reflect the dynamics of health systems.
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Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Maria De Francesco
- International Decision Support Initiative (iDSI), Imperial College, London, United Kingdom
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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Tadrous M, Daniels B, Pearson SA, Gomes T. Comparison of claims from high-drug cost beneficiaries in Ontario, Canada, and Australia: a cross-sectional analysis. CMAJ Open 2021; 9:E1048-E1054. [PMID: 34815260 PMCID: PMC8612656 DOI: 10.9778/cmajo.20200291] [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: 12/02/2022] Open
Abstract
BACKGROUND Globally, payers are struggling with rising drug costs, driven primarily by the increasing number of high-cost medications used by their beneficiaries. We aimed to compare the annual drug spending on claims from high-drug cost beneficiaries in the province of Ontario, Canada, and Australia. METHODS We conducted a cross-sectional analysis of public drug claims in Ontario and Australia from fiscal years 2006 to 2017. We identified the total government costs for prescribed medications per beneficiary. During the study period, public drug coverage in Ontario was provided to all residents 65 years of age and older, those with financial needs, and those living in long-term care or in need of home care. Australia maintains a publicly funded, universal system covering all citizens. Based on annual spending, we divided beneficiaries into 4 cost groups, representing the top 1%, top 5%, top 10% and the remaining 90%. We reported the following for each cost group: medication cost and proportion of total government spending, number of unique drugs dispensed per person and the top 10 most costly drug classes. RESULTS In Ontario and Australia, the top 1% of beneficiaries accounted for a large and increasing proportion of all government drug costs, growing from 12% ($405 946 197) to 24% ($1 345 977 248) in Ontario, and from 14% ($86 565 586) to 34% ($416 097 984) in Australia between 2006 and 2017. The most costly drug classes among high-drug cost beneficiaries in both jurisdictions were biologics and hepatitis C treatments. INTERPRETATION In both Ontario and Australia, a small number of beneficiaries accounted for a large proportion of public drug spending, driven largely by the use of expensive medications. The current development of potential national pharmacare strategies in Canada must optimize the use of high-cost drugs to ensure the sustainability of the program.
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Affiliation(s)
- Mina Tadrous
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont.
| | - Benjamin Daniels
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Sallie-Anne Pearson
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont
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Osei JA, Peña-Sánchez JN, Fowler SA, Muhajarine N, Kaplan GG, Lix LM. Increasing Prevalence and Direct Health Care Cost of Inflammatory Bowel Disease Among Adults: A Population-Based Study From a Western Canadian Province. J Can Assoc Gastroenterol 2021; 4:296-305. [PMID: 34877469 PMCID: PMC8643630 DOI: 10.1093/jcag/gwab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Our study aimed to calculate the prevalence and estimate the direct health care costs of inflammatory bowel disease (IBD), and test if trends in the prevalence and direct health care costs of IBD increased over two decades in the province of Saskatchewan, Canada. Methods We conducted a retrospective population-based cohort study using administrative health data of Saskatchewan between 1999/2000 and 2016/2017 fiscal years. A validated case definition was used to identify prevalent IBD cases. Direct health care costs were estimated in 2013/2014 Canadian dollars. Generalized linear models with generalized estimating equations tested the trend. Annual prevalence rates and direct health care costs were estimated along with their 95% confidence intervals (95%CI). Results In 2016/2017, 6468 IBD cases were observed in our cohort; Crohn’s disease: 3663 (56.6%), ulcerative colitis: 2805 (43.4%). The prevalence of IBD increased from 341/100,000 (95%CI 340 to 341) in 1999/2000 to 664/100,000 (95%CI 663 to 665) population in 2016/2017, resulting in a 3.3% (95%CI 2.4 to 4.3) average annual increase. The estimated average health care cost for each IBD patient increased from $1879 (95%CI 1686 to 2093) in 1999/2000 to $7185 (95%CI 6733 to 7668) in 2016/2017, corresponding to an average annual increase of 9.5% (95%CI 8.9 to 10.1). Conclusions Our results provide relevant information and analysis on the burden of IBD in Saskatchewan. The evidence of the constant increasing prevalence and health care cost trends of IBD needs to be recognized by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.
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Affiliation(s)
- Jessica Amankwah Osei
- Department of Community Health and Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle A Fowler
- Department of Medicine, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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(Re)defining legitimacy in Canadian drug assessment policy? Comparing ideas over time. HEALTH ECONOMICS POLICY AND LAW 2021; 16:424-439. [PMID: 33557999 PMCID: PMC8460446 DOI: 10.1017/s1744133121000013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
How do experts judge the legitimacy of technical policy processes, and do their ideas change as these processes are opened to other stakeholders and the public? This research examines the adoption of public and patient involvement in pharmaceutical assessment in Canada. It finds tensions between scientific legitimacy that prioritizes rigor and objectivity, and democratic legitimacy that values inclusion and a broader range of evidence. In response to policy change, experts incorporate new ideas about democratic inputs and processes, while maintaining scientific policy goals. The research responds to calls for more precise measurement of ideas and ideational change and more evaluation of public and patient involvement in health policy. It helps us understand the significance of, and limits to, ideational change among experts in health policy domains that are highly technical and publicly salient. Understanding the way democratic and scientific legitimacy are negotiated in policy decisions has a wide applicability in health, but is particularly relevant during a global pandemic when evidence is being generated rapidly, decisions must be made quickly, and these decisions have a significant, immediate effect on the lives of all citizens.
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Noble JM, Vuong W, Surood S, Urichuk L, Greenshaw AJ, Agyapong VIO. Text4Support Mobile-Based Programming for Individuals Accessing Addictions and Mental Health Services-Retroactive Program Analysis at Baseline, 12 Weeks, and 6 Months. Front Psychiatry 2021; 12:640795. [PMID: 34122173 PMCID: PMC8192801 DOI: 10.3389/fpsyt.2021.640795] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Where traditional approaches fall short, widely accessible and accepted, yet under leveraged, digital technologies such as text messaging present novel opportunities to solve a range of health care solutions. The following provides a preliminary analysis of the Text4Support program, a text-messaging intervention using the principles of cognitive behavioral therapy, which seeks to support the health and well-being of individuals seeking support for addiction or mental health concerns. The goal of this study was to assess whether the Text4Support program improved the perceived overall mental well-being of participants. Methods: The evaluation analyzes survey responses of individuals who were enrolled in the Text4Support program beginning in July 2019, who had completed the 6-months program by May 2020. Participants were asked to provide responses to three surveys during their time in the program-at baseline, 12-weeks and 6-months, which included questions documenting demographic information, general satisfaction with the program, and a participants' level of "global distress" through use of the Clinical Outcomes Routine Evaluation System (CORE-10)-a validated brief 10-item assessment and outcome measurement tool used to assess conditions including anxiety, depression, physical problems, and risk to self. Results and Conclusions: This data set did not include a large enough sample of participants to reach statistical significance. Nevertheless, the study provides some preliminary analysis, and identifies opportunities for the future analysis and research.
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Affiliation(s)
- Jasmine M Noble
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Wesley Vuong
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Liana Urichuk
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
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Financial advantage or barrier when deprescribing for seniors: A ‘case based’ analysis. Res Social Adm Pharm 2020; 16:1792-1797. [DOI: 10.1016/j.sapharm.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022]
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Implications of the COVID-19 Pandemic for Cardiovascular Disease and Risk-Factor Management. Can J Cardiol 2020; 37:722-732. [PMID: 33212203 PMCID: PMC7667463 DOI: 10.1016/j.cjca.2020.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
COVID-19 and our public health responses to the pandemic may have far-reaching implications for cardiovascular (CV) risk, affecting the general population and not only survivors of COVID-19. In this narrative review, we discuss how the pandemic may affect general CV risk for years to come and explore the mitigating potential of telehealth interventions. From a health care perspective, the shift away from in-person office visits may have led many to defer routine risk- factor management and may have had unforeseen effects on continuity of care and adherence. Fear of COVID-19 has led some patients to forego care for acute CV events. Curtailment of routine outpatient laboratory testing has likely delayed intensification of risk-factor–modifying medical therapy, and drug shortages and misinformation may have negative impacts on adherence to antihypertensive, glucose-lowering, and lipid-lowering agents. From a societal perspective, the unprecedented curtailment of social and economic activities has led to loss of income, unemployment, social isolation, decreased physical activity, and increased frequency of depression and anxiety, all of which are known to be associated with worse CV risk-factor control and outcomes. We must embrace and evaluate measures to mitigate these potential harms to avoid an epidemic of CV morbidity and mortality in the coming years that could dwarf the initial health effects of COVID-19.
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Amoud R, Grindrod K, Cooke M, Alsabbagh MW. The Impact of Prescription Medication Cost Coverage on Oral Medication Use for Hypertension and Type 2 Diabetes Mellitus. Healthc Policy 2020; 16:82-100. [PMID: 33337316 PMCID: PMC7710965 DOI: 10.12927/hcpol.2020.26351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No previous study, to the best of our knowledge, has examined both the time trend and impact of not having insurance or prescription medication cost coverage (PMCC) on the usage of type 2 diabetes and hypertension oral medications in Ontario and New Brunswick, Canada. METHODS We used data from the Canadian Community Health Survey (CCHS) from 2007 to 2014 to examine the time trend and impact of PMCC. A multivariable-adjusted logistic regression model was fitted. RESULTS The pseudo-cohort included 23,215 individuals representing a population of approximately 8.7 million people. Overall, 20.0% of respondents reported absence of PMCC. This proportion increased slightly from 19.6% (95% confidence interval [CI] 95% CI [17.5, 22.5]) to 20.7% (95% CI [16.9, 23.1]). Adjusted odds ratios (OR) showed that uninsured individuals were 23% less likely to use their medications (OR = 0.77, 95% CI [0.657, 0.911]). CONCLUSION There was a slight decline in PMCC over time and this decline was associated with reduced use of medications for type 2 diabetes and hypertension.
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Affiliation(s)
- Razan Amoud
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
| | - Kelly Grindrod
- Associate Professor, School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
| | - Martin Cooke
- Associate Professor, School of Public Health and Health Systems, Faculty of Applied Health Sciences, Department of Sociology and Legal Studies, Faculty of Arts, University of Waterloo, Waterloo, ON
| | - Mhd Wasem Alsabbagh
- Assistant Professor, School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
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Raiche T, Pammett R, Dattani S, Dolovich L, Hamilton K, Kennie-Kaulbach N, Mccarthy L, Jorgenson D. Community pharmacists' evolving role in Canadian primary health care: a vision of harmonization in a patchwork system. Pharm Pract (Granada) 2020; 18:2171. [PMID: 33149795 PMCID: PMC7603659 DOI: 10.18549/pharmpract.2020.4.2171] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Canada's universal public health care system provides physician, diagnostic, and hospital services at no cost to all Canadians, accounting for approximately 70% of the 264 billion CAD spent in health expenditure yearly. Pharmacy-related services, including prescription drugs, however, are not universally publicly insured. Although this system underpins the Canadian identity, primary health care reform has long been desired by Canadians wanting better access to high quality, effective, patient-centred, and safe primary care services. A nationally coordinated approach to remodel the primary health care system was incited at the turn of the 21st century yet, twenty years later, evidence of widespread meaningful improvement remains underwhelming. As a provincial/territorial responsibility, the organization and provision of primary care remains discordant across the country. Canadian pharmacists are, now more than ever, poised and primed to provide care integrated with the rest of the primary health care system. However, the self-regulation of the profession of pharmacy is also a provincial/territorial mandate, making progress toward integration of pharmacists into the primary care system incongruent across jurisdictions. Among 11,000 pharmacies, Canada's 28,000 community pharmacists possess varying authority to prescribe, administer, and monitor drug therapies as an extension to their traditional dispensing role. Expanded professional services offered at most community pharmacies include medication reviews, minor/common ailment management, pharmacist prescribing for existing prescriptions, smoking cessation counselling, and administration of injectable drugs and vaccinations. Barriers to widely offering these services include uncertainties around remuneration, perceived skepticism from other providers about pharmacists' skills, and slow digital modernization including limited access by pharmacists to patient health records held by other professionals. Each province/territory enables pharmacists to offer these services under specific legislation, practice standards, and remuneration models unique to their jurisdiction. There is also a small, but growing, number of pharmacists across the country working within interdisciplinary primary care teams. To achieve meaningful, consistent, and seamless integration into the interdisciplinary model of Canadian primary health care reform, pharmacy advocacy groups across the country must coordinate and collaborate on a harmonized vision for innovation in primary care integration, and move toward implementing that vision with ongoing collaboration on primary health care initiatives, strategic plans, and policies. Canadians deserve to receive timely, equitable, and safe interdisciplinary care within a coordinated primary health care system, including from their pharmacy team.
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Affiliation(s)
- Taylor Raiche
- BSP. Medication Assessment Centre, University of Saskatchewan. Saskatoon, SK (Canada).
| | - Robert Pammett
- BSc, BSP, MSc. Northern Health, Prince George, Faculty of Pharmaceutical Sciences, University of British Columbia. Vancouver, BC (Canada).
| | - Shelita Dattani
- BScPhm, PharmD. Canadian Pharmacists Association. Ottawa, ON (Canada).
| | - Lisa Dolovich
- BScPhm, PharmD, MSc. Leslie Dan Faculty of Pharmacy, University of Toronto. Toronto, ON (Canada).
| | - Kevin Hamilton
- BSP, MSc. College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba. Winnipeg, MB (Canada).
| | - Natalie Kennie-Kaulbach
- BSc(Pharm), ACPR, PharmD. College of Pharmacy, Faculty of Health, Dalhousie University. Halifax, NS (Canada).
| | - Lisa Mccarthy
- BScPhm, PharmD, MSc. Leslie Dan Faculty of Pharmacy, University of Toronto. Toronto, ON (Canada).
| | - Derek Jorgenson
- BSP, PharmD. Medication Assessment Centre, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK (Canada).
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Rand LZ, Kesselheim AS. An International Review of Health Technology Assessment Approaches to Prescription Drugs and Their Ethical Principles. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:583-594. [PMID: 33021189 DOI: 10.1177/1073110520958885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In many countries, health technology assessment (HTA) organizations determine the economic value of new drugs and make recommendations regarding appropriate pricing and coverage in national health systems. In the US, recent policy proposals aimed at reducing drug costs would link drug prices to six countries: Australia, Canada, France, Germany, Japan, and the UK. We reviewed these countries' methods of HTA and guidance on price and coverage recommendations, analyzing methods and guidance documents for differences in (1) the methodologies HTA organizations use to conduct their evaluations and (2) considerations they use when making recommendations. We found important differences in the methods, interpretations of HTA findings, and condition-specific carve-outs that HTA organizations use to conduct evaluations and make recommendations. These variations have ethical implications because they influence the recommendations of HTA organizations, which affect access to the drug through national insurance and price negotiations with manufacturers. The differences in HTA approaches result from the distinct political, social, and cultural contexts of each organization and its value judgments. New cost-containment policies in the US should consider the ethical implications of the HTA reviews that they are considering relying on to negotiate drug prices and what values should be included in US pricing policy.
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Affiliation(s)
- Leah Z Rand
- Leah Z. Rand, D.Phil., is a post-doctoral fellow in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital and a research fellow at Harvard Medical School. Aaron S. Kesselheim, M.D., J.D., M.P.H., is Professor of Medicine at Harvard Medical School, a faculty member of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital, the Director of the Program on Regulation, Therapeutics, and Law (PORTAL), and a primary care physician. He is the Editor-in-Chief of the Journal of Law, Medicine & Ethics
| | - Aaron S Kesselheim
- Leah Z. Rand, D.Phil., is a post-doctoral fellow in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital and a research fellow at Harvard Medical School. Aaron S. Kesselheim, M.D., J.D., M.P.H., is Professor of Medicine at Harvard Medical School, a faculty member of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital, the Director of the Program on Regulation, Therapeutics, and Law (PORTAL), and a primary care physician. He is the Editor-in-Chief of the Journal of Law, Medicine & Ethics
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Mathews A, Ming LC, Che Rose FZ, Abbas SA. Cross-sectional Study on the Impact of Discount Pricing and Price Competition on Community Pharmacy Practice. Cureus 2020; 12:e9903. [PMID: 32839684 PMCID: PMC7440992 DOI: 10.7759/cureus.9903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Without stipulated legislation, a free pricing policy can lead to a disparity in prices among private healthcare setups. Competition is especially rampant among community pharmacies, especially in the Sabah state of Malaysia, where the recent years have witnessed the steady growth of pharmacy players from Peninsular Malaysia. Thus, this study aimed to examine the impact of price competition and discount pricing on the practice of community pharmacy in Sabah, Malaysia. Methods This was a cross-sectional study using an online questionnaire. Survey participants included community pharmacists practicing in Sabah. The validated and pilot-tested questionnaire consisted of three parts: background information of the pharmacy, attitudes and perception toward medicine prices, and practice of discount pricing. All required data were collected from community pharmacists practicing only in Sabah. Data were then analyzed by using descriptive, Chi-Square, and Kendall's tau-b tests. Results Of the 150 community pharmacists contacted, only 70 responded, providing a response rate of 47%. In terms of pharmacy type, 71% of the respondents were pharmacist-owned independent pharmacies, while 19% were pharmacy chains owned by community pharmacists. The remaining were pharmacies owned by non-pharmacists (10%). Sixty percent of the community pharmacies had been in existence for more than 10 years, with 12% in existence for less than two years, and 28% in existence for three to 10 years. More than 80% of the respondents stated that the business aspect of community pharmacy had overwhelmed the professional practice aspects and that community pharmacists have become providers of products instead of providers of care. In terms of professionalism, 87% also noted that they are being perceived as profiteering in the medicine business at the expense of patients. Conclusions The free market situation in Malaysia for medicine pricing has brought a detrimental consequence for community pharmacists with each one trying to undercut prices. Differing pricing mechanisms of medicines based on the quantity ordered contribute to the problem of discount pricing and price competition. Most community pharmacists, as indicated by this study, want the problem to be addressed.
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Affiliation(s)
- Allan Mathews
- Faculty of Pharmacy, Quest International University Perak, Ipoh, MYS
| | - Long C Ming
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, BRN
| | - Farid Z Che Rose
- Faculty of Science and Technology, Quest International University Perak, Ipoh, MYS
| | - Syed A Abbas
- Faculty of Pharmacy, Quest International University Perak, Ipoh, MYS
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Men F, Gundersen C, Urquia ML, Tarasuk V. Food Insecurity Is Associated With Higher Health Care Use And Costs Among Canadian Adults. Health Aff (Millwood) 2020; 39:1377-1385. [DOI: 10.1377/hlthaff.2019.01637] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Fei Men
- Fei Men is a postdoctoral fellow in the Department of Nutritional Sciences at the University of Toronto, in Toronto, Ontario, Canada
| | - Craig Gundersen
- Craig Gundersen is an ACES Distinguished Professor in the Department of Agricultural and Consumer Economics at the University of Illinois at Urbana-Champaign, in Urbana, Illinois
| | - Marcelo L. Urquia
- Marcelo L. Urquia is an associate professor in the Department of Community Health Sciences at the University of Manitoba, in Winnipeg, Manitoba, Canada. He is also a faculty member in Dalla Lana School of Public Health at the University of Toronto
| | - Valerie Tarasuk
- Valerie Tarasuk is a professor in the Department of Nutritional Sciences at the University of Toronto
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Tadrous M, Martins D, Mamdani MM, Gomes T. Characteristics of high-drug-cost beneficiaries of public drug plans in 9 Canadian provinces: a cross-sectional analysis. CMAJ Open 2020; 8:E297-E303. [PMID: 32345708 PMCID: PMC7207026 DOI: 10.9778/cmajo.20190231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Drugs are the fastest growing cost in the Canadian health care system, owing to the increasing number of high-cost drugs. The objective of this study was to examine the characteristics of high-drug-cost beneficiaries of public drug plans across Canada relative to other beneficiaries. METHODS We conducted a cross-sectional study among public drug plan beneficiaries residing in all provinces except Quebec. We used the Canadian Institute for Health Information's National Prescription Drug Utilization Information System to identify all drugs dispensed to beneficiaries of public drug programs in 2016/17. We stratified the cohort into 2 groups: high-drug-cost beneficiaries (top 5% of beneficiaries based on annual costs) and other beneficiaries (remaining 95%). For each group, we reported total drug costs, prevalence of high-cost claims (> $1000), median number of drugs, proportion of beneficiaries aged 65 or more, the 10 most costly reimbursed medications and the 10 medications most commonly reimbursed. We reported estimates overall and by province. RESULTS High-drug-cost beneficiaries accounted for nearly half (46.5%) of annual spending, with an average annual spend of $14 610 per beneficiary, compared to $1570 among other beneficiaries. The median number of drugs dispensed was higher among high-drug-cost beneficiaries than among other beneficiaries (13 [interquartile range (IQR) 7-19] v. 8 [IQR 4-13]), and a much larger proportion of high-drug-cost beneficiaries than other beneficiaries received at least 1 high-cost claim (40.9% v. 0.6%). Long-term medications were the most commonly used medications for both groups, whereas biologics and antivirals were the most costly medications for high-drug-cost beneficiaries. INTERPRETATION High-drug-cost beneficiaries were characterized by the use of expensive medications and polypharmacy relative to other beneficiaries. Interventions and policies to help reduce spending need to consider both of these factors.
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Affiliation(s)
- Mina Tadrous
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Diana Martins
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Muhammad M Mamdani
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Tara Gomes
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont
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Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study. BMC Public Health 2020; 20:419. [PMID: 32228526 PMCID: PMC7106680 DOI: 10.1186/s12889-020-08499-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
Background Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. Yet, evidence on the association between DPs and physical CDs in this population is limited. In the present study, we assessed the association between DPs and type and number of CDs in individuals experienced chronic homelessness and serious mental health problems. Methods We analyzed cross-sectional baseline data from 575 homeless adults with serious mental health problems participating in the Toronto site of the At Home/Chez Soi randomized controlled trial. Chronic DPs (lasting at least 6 months) were the primary exposure variable. Presence of self-reported CDs, including heart disease, effect of stroke, hypertension, diabetes, asthma, chronic bronchitis/emphysema, stomach or intestinal ulcer, inflammatory bowel disease, migraine, thyroid problems, arthritis, kidney/bladder problems, liver disease (other than hepatitis), and iron-deficiency anemia, were the primary outcomes. The total number of CDs was also analyzed as a secondary outcome. Logistic regression models were used to assess the association between DPs with each of the studied CDs, and negative binomial regression was used to test the association between DPs with the number of CDs. Results In our 575 homeless participants (68.5% males) with mean age 40.3 (11.8) years, a high proportion had DPs (42.5%). The presence of DPs was positively associated with heart disease (adjusted odds ratio (AOR):4.19,1.67–10.52), diabetes (AOR:2.17,1.13–4.17), chronic bronchitis (AOR:2.34,1.28–4.29), stomach or intestinal ulcer (AOR:3.48,1.80–6.73), inflammatory bowel disease (AOR:2.52,1.38–4.60), migraine (AOR:1.80,1.20–2.72), arthritis (AOR:2.71,1.71–4.29), kidney/bladder problems (AOR:2.43,1.30–4.54), and iron-deficiency anemia (AOR:3.28,1.90–5.65). DPs were also associated with a higher number of CDs (IRR: 1.62,1.38–1.90). Conclusion Dental health problems in homeless individuals with serious mental disorders are associated with several CDs. Dental care should be better integrated into existing social and health programs serving this population to improve their overall health status. The AH/CS study is registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).
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Guo EX, Sweetman A, Guindon GE. Socioeconomic differences in prescription drug supplemental coverage in Canada: A repeated cross-sectional study. Health Policy 2020; 124:252-260. [DOI: 10.1016/j.healthpol.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023]
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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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Lewis S. It Won't Be Easy: How to Make Universal Pharmacare Work in Canada. Int J Health Policy Manag 2020; 9:1-5. [PMID: 31902189 PMCID: PMC6943299 DOI: 10.15171/ijhpm.2019.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/28/2019] [Indexed: 01/08/2023] Open
Abstract
One of the glaring gaps in Canada’s universal healthcare system is the low level of public financing of prescription drugs - 42.7% of total spending in 2018. At the federal level there is renewed interest in moving towards universal coverage, supported by a recently commissioned report on how to achieve it. It will take superb political navigation to extract Canadian pharmaceutical policy and practice from the grasp of interests that profit handsomely from the status quo. This perspective suggests the conditions under which a genuinely fair, effective, and efficient pharmacare plan can emerge.
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Affiliation(s)
- Steven Lewis
- Simon Fraser University, Burnaby, BC, Canada.,University of Saskatchewan, Saskatoon, SK, Canada
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Men F, Gundersen C, Urquia ML, Tarasuk V. Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study. CMAJ Open 2019; 7:E590-E597. [PMID: 31551236 PMCID: PMC6759017 DOI: 10.9778/cmajo.20190075] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Food insecurity, defined as inadequate access to food owing to financial constraints, has been associated with poor disease management. Because cost-related nonadherence to prescription drugs is a possible explanation for such association, we examined the link between food insecurity and cost-related medication nonadherence in Canada. METHODS Drawing on data for adult respondents (age ≥ 18 yr) who participated in the Canadian Community Health Survey 2016 Rapid Response module on prescription medication use, we assessed the association between household food insecurity and cost-related nonadherence to prescription drugs in the previous 12 months. We further examined the self-perceived health consequences of cost-related nonadherence among nonadherents. We applied Poisson models with bootstrap weights adjusting for sociodemographic characteristics. RESULTS Of the 11 172 respondents in our sample, 930 (8.3%) reported cost-related nonadherence. Food insecurity affected 10.5% (95% confidence interval [CI] 9.1% to 11.8%) of adherents and 47.9% (95% CI 38.1% to 57.7%) of nonadherents. After adjustment for confounders, moderate and severe food insecurity were associated with 3.83 (95% CI 2.44 to 6.03) and 5.05 (95% CI 3.27 to 7.81) times higher prevalence of cost-related nonadherence, respectively, relative to food security. Despite being associated with lower probability of cost-related nonadherence, having drug insurance did not change the relation between food insecurity and cost-related nonadherence (p > 0.1 for all interactions). Severe food insecurity was correlated with higher prevalence of health deterioration and greater use of health care services as perceived consequences of cost-related nonadherence (p < 0.01 for both). INTERPRETATION Food-insecure adults in Canada have a higher likelihood of cost-related nonadherence to prescription medications than their food-secure counterparts, which may constitute a burden on their health and lead to greater use of health care services.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont.
| | - Craig Gundersen
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont
| | - Marcelo L Urquia
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont
| | - Valerie Tarasuk
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont
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