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Menon A, Schroth RJ, Hai-Santiago K, Yerex K, Bertone M. The Canadian dental care plan and the senior population. FRONTIERS IN ORAL HEALTH 2024; 5:1385482. [PMID: 38933118 PMCID: PMC11199732 DOI: 10.3389/froh.2024.1385482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Anil Menon
- Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Robert J. Schroth
- Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Shared Health Manitoba, Winnipeg, MB, Canada
| | | | - Katherine Yerex
- School of Dental Hygiene, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Mary Bertone
- Childrens Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Rebić N, Law MR, Brotto LA, Cragg JJ, De Vera MA. The Intersectional Impact of Cost-Related Non-Adherence and Depression: A Cross-Sectional Analysis of the Canadian Community Health Survey by Sex, Race, and Indigeneity. Community Ment Health J 2024; 60:515-524. [PMID: 37930467 DOI: 10.1007/s10597-023-01202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
We evaluated the relationship between cost-related non-adherence (CRNA) and depressive symptoms. Pooling data from the 2015, 2016, 2018, and 2019 annual Canadian Community Health Survey, we analyzed the relationship between CRNA and moderate to severe depressive symptoms, assessed by the Patient Health Questionnaire (PHQ-9). Among the sample, 4.9% experienced CRNA and 6.8% experienced moderate to severe depressive symptoms. Respondents who reported CRNA had 1.51 (95% confidence interval [CI], 1.51-1.52) greater odds of experiencing moderate to severe depressive symptoms. Stratified analysis by sex and race showed the association between CRNA and depressive symptoms was greatest among racialized males (aOR: 1.83, 95% CI: 1.81- 1.85). Stratified analysis by sex and Indigeneity showed this association was greatest for Indigenous males (aOR: 2.16, 95% CI: 2.10-2.22). Forgoing prescribed medications due to cost is associated with more severe depressive symptoms among Canadians, particularly racialized and Indigenous males.
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Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael R Law
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Britto J, Holbrook A, Sun H, Cserti-Gazdewich C, Prokopchuk-Gauk O, Hsia C, Khamisa K, Yenson PR, Sholzberg M, Olney HJ, Shivakumar S, Jones D, Merkeley H, Costello J, Jamula E, Arnold DM. Thrombopoietin Receptor Agonists and Other Second-Line Therapies for Immune Thrombocytopenia: A Narrative Review With a Focus on Drug Access in Canada. CLIN INVEST MED 2024; 47:13-22. [PMID: 38546381 DOI: 10.3138/cim-2024-2569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts and increased risk of bleeding. After corticosteroids with or without intravenous immune globulin (first-line treatment), second-line treatment options include rituximab, splenectomy, thrombopoietin receptor agonists (TPO-RAs), and fostamatinib. In Canada, the choice of second-line therapy is influenced by access to medications. The goals of this narrative review are to 1) summarize the evidence for the use of TPO-RAs and other second-line therapies in ITP and 2) highlight differences in public funding criteria for TPO-RAs across provinces and territories in Canada. METHODS We conducted a literature review of second-line therapies for ITP. We solicited information on public funding programs for TPO-RAs in Canada from health care providers, pharmacists, and provincial ministries of health. RESULTS Head-to-head trials involving TPO-RAs, rituximab, splenectomy, and fostamatinib are lacking. There is substantial evidence of effect for TPO-RAs in improving platelet count levels, health-related quality of life, bleeding, and fatigue from placebo-controlled trials and observational studies; however, access to TPO-RAs through provincial funding programs in Canada is variable. Splenectomy failure is a prerequisite for the funding of TPO-RAs in Ontario, Manitoba, and Saskatchewan, but not in Alberta or Quebec. Other provinces either do not have access to public funding or funding is provided on a case-by-case basis. DISCUSSION TPO-RAs are effective second-line therapies for the treatment of ITP; however, access is variable across Canada, which results in health disparities and poor uptake of international treatment guidelines.
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Affiliation(s)
- Joanne Britto
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne Holbrook
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Ontario, Canada
| | - Haowei Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Cserti-Gazdewich
- Department of Medicine/Division of Hematology, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Oksana Prokopchuk-Gauk
- Department of Pathology and Lab Medicine, University of Saskatchewan, Saskatchewan Health Authority, Canada
| | - Cyrus Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Karima Khamisa
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul R Yenson
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Sholzberg
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold J Olney
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Sudeep Shivakumar
- Division of Hematology, Nova Scotia Health Authority, Halifax, NS, Canada
| | - David Jones
- Department of Hematology, Eastern Health, Memorial University, Newfoundland & Labrador, Canada
| | - Hayley Merkeley
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Costello
- Department of Hematology, Eastern Health, Memorial University, Newfoundland & Labrador, Canada
| | - Erin Jamula
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
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Johnson KM, Cheng L, Yin Y, Carter R, Chow S, Brigham E, Law MR. Impact of income-based public drug coverage deductibles on adherence to asthma medications. Ann Allergy Asthma Immunol 2024; 132:223-228.e8. [PMID: 37871771 DOI: 10.1016/j.anai.2023.10.017] [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: 06/09/2023] [Revised: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Cost-related nonadherence to medications can be a barrier to asthma management. OBJECTIVE To quantify the impact of public drug plan deductibles on adherence to asthma medications. METHODS We used a quasi-experimental regression discontinuity analysis to determine whether thresholds in deductibles for public drug coverage, determined on the basis of annual household income, decreased medication use among lower-income children and adults with asthma in British Columbia from 2013 to 2018. Using dispensed medication records, we evaluated deductible thresholds at annual household incomes of $15,000 (a deductible increase from 0% to 2% of annual household income), and $30,000 (a deductible increase from 2% to 3% annual household income). We evaluated medication costs, use, the ratio of inhaled corticosteroids-containing controller medications to total medications, excessive use of short-acting β-agonists, and the proportion of days covered by controller therapies. All costs are reported in 2020 Canadian dollars. RESULTS Overall, 88,935 individuals contributed 443,847 person-years of follow-up (57% of female sex, mean age 31 years). Public drug subsidy decreased by -$41.74 (95% CI, -$28.34 to -$55.13) at the $15,000-deductible threshold, a 28% reduction, and patient costs increased by $48.45 (95% CI, $35.37-$61.53). The $30,000 deductible threshold did not affect public drug costs (P = .31), but patient costs increased by $27.65 (95% CI, $15.22-$40.09), which is an 11% increase. Asthma-related medication use, inhaled corticosteroids-to-total medication ratio, excessive use of short-acting β-agonists, and proportion of days covered by controller therapies were not impacted by deductible thresholds. CONCLUSION Income-based deductibles reduced public drug costs with no effect on asthma-related medication use, adherence to controller therapies, or excessive reliever therapy use in lower-income individuals with asthma.
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Affiliation(s)
- Kate M Johnson
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, The 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
| | - Yiwei Yin
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Carter
- Patient Partner, Community Partner Committee, Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Santa Chow
- Patient Partner, Community Partner Committee, Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Emily Brigham
- Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R 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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Cressman S, Ghanbarian S, Edwards L, Peterson S, Bunka M, Hoens AM, Riches L, Austin J, Vijh R, McGrail K, Bryan S. Costs of major depression covered / not covered in British Columbia, Canada. BMC Health Serv Res 2023; 23:1446. [PMID: 38124043 PMCID: PMC10734183 DOI: 10.1186/s12913-023-10474-y] [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: 04/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the world's leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness. METHODS We performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions. RESULTS There were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53-104 unless MDD was refractory to treatment ($125/week between week 12-52 and $101/week over weeks 53-104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached - 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII - 0.07 to 0.6). CONCLUSIONS MDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.
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Affiliation(s)
- Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda Riches
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Patient Partner, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
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Gorfinkel I. Cost-of-living challenges highlight urgency for clinicians to prescribe affordable medications. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:599-600. [PMID: 37704251 PMCID: PMC10498914 DOI: 10.46747/cfp.6909599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Iris Gorfinkel
- General practitioner and Principal Investigator and Founder of PrimeHealth Clinical Research in Toronto, Ont
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Gorfinkel I. Les défis du coût de la vie soulignent l’urgence pour les médecins de prescrire des médicaments abordables. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:606-608. [PMID: 37704238 PMCID: PMC10498903 DOI: 10.46747/cfp.6909606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Iris Gorfinkel
- Praticienne générale, chercheuse principale et fondatrice de PrimeHealth Clinical Research à Toronto (Ontario)
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McClean AR, Cheng L, Bansback N, Clement F, Tadrous M, Harrison M, Law MR. Uptake and Spending on Biosimilar Infliximab and Etanercept After New Start and Switching Policies in Canada: An Interrupted Time Series Analysis. Arthritis Care Res (Hoboken) 2023; 75:2011-2021. [PMID: 36752358 DOI: 10.1002/acr.25099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 01/09/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Uptake of biosimilars has been suboptimal in North America. This study was undertaken to quantify the impact of various policy interventions (namely, new start and switching policies) on uptake and spending on biosimilar infliximab and etanercept in British Columbia (BC), Canada. METHODS We used administrative claims data to identify BC residents ≥18 years of age with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and/or plaque psoriasis who qualified for public drug coverage from January 2013 to November 2020. Using interrupted time series analysis, we studied the change in proportion spent on and prescriptions dispensed of biosimilar infliximab and etanercept out of the total amount per agent after new start and biosimilar switching policies were implemented. RESULTS Our study included 208,984 individuals living with rheumatoid arthritis, ankylosing spondylitis, plaque psoriasis, and/or psoriatic arthritis, corresponding to 5,884 patients taking infliximab and etanercept. After the new start policy, we detected a small gradual increase in the proportion of dispensed biosimilar etanercept prescriptions of 0.65% per month (95% confidence interval [95% CI] 0.44, 0.85). The trend related to the proportion of total spending on biosimilar etanercept also increased (0.51% [95% CI 0.28, 0.73]). After the switching policy, there was a sustained increase in the proportion of dispensed biosimilar etanercept and infliximab prescriptions of 76.98% (95% CI 75.56, 78.41) and 58.43% (95% CI 52.11, 64.75), respectively. Similarly, there was a persistent increase in monthly spending on biosimilar etanercept and infliximab of 78.22% (95% CI 76.65, 79.79) and 71.23% (95% CI 66.82, 75.65), respectively. CONCLUSION We found that mandatory switching policies were much more effective than new starting policies for increasing the use of biosimilar medications.
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Affiliation(s)
- Alison R McClean
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mina Tadrous
- University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | - Mark Harrison
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- University of British Columbia, Vancouver, British Columbia, 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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Pico-Espinosa OJ, Hull M, MacPherson P, Grace D, Lachowsky N, Gaspar M, Mohammed S, Truong R, Tan DHS. Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey. CMAJ Open 2023; 11:E560-E568. [PMID: 37369522 PMCID: PMC10310342 DOI: 10.9778/cmajo.20220113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV is underutilized. We aimed to identify barriers to use of PrEP and strategies that may facilitate its uptake. METHODS Gay, bisexual and other men who have sex with men, aged 19 years or older and living in Ontario and British Columbia, Canada, completed a cross-sectional survey in 2019-2020. Participants who met Canadian PrEP guideline criteria and were not already using PrEP identified relevant barriers and which strategies would make them more likely to start PrEP. We described the barriers and strategies separately for Ontario and BC. RESULTS Of 1527 survey responses, 260 respondents who never used PrEP and met criteria for PrEP were included. In Ontario, the most common barriers were affordability (43%) and concern about adverse effects (42%). In BC, the most common reasons were concern about adverse effects (41%) and not feeling at high enough risk (36%). In Ontario, preferred strategies were short waiting time (63%), the health care provider informing about their HIV risk being higher than perceived (62%), and a written step-by-step guide (60%). In BC, strategies were short waiting time (68%), people speaking publicly about PrEP (68%), and the health care provider counselling about their HIV risk being higher than perceived (64%), adverse effects of PrEP (65%) and how well PrEP works (62%). INTERPRETATION Concern about adverse effects and not self-identifying as having high risk for HIV were common barriers, and shorter waiting times may increase PrEP uptake. In Ontario, the findings suggested lack of affordability, whereas in BC, strategies involving health care providers were valued.
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Affiliation(s)
- Oscar Javier Pico-Espinosa
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Hull
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Paul MacPherson
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Daniel Grace
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Nathan Lachowsky
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Gaspar
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Saira Mohammed
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Robinson Truong
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Darrell H S Tan
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
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Akuffo-Addo E, Udounwa T, Chan J, Cauchi L. Exploring Biologic Treatment Hesitancy Among Black and Indigenous Populations in Canada: a Review. J Racial Ethn Health Disparities 2023; 10:942-951. [PMID: 35476223 PMCID: PMC9045033 DOI: 10.1007/s40615-022-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Biologics are becoming an increasingly important part of patient care across Canada. Recent studies from the USA show that Black patients are less likely than White patients to receive biologic treatment for several medical conditions. The relative lack of race-based data in Canada makes it difficult to replicate such studies in Canada. As a result, there is a paucity of literature that explores the association between biologic usage and race in Canada. Our review aims to explore the factors that might be driving racial treatment disparity in Canada that likely parallels the inequalities found in the USA. We provide a summary of the available literature on the factors that contribute to biologic treatment hesitancy among Black and Indigenous populations in Canada. We highlight several solutions that have been proposed in the literature to address biologic treatment hesitancy. Our review found that biologic treatment decision at the individual level can be very complex as patient's decisions are influenced by social inputs from family and trusted community members, biologic-related factors (negative injection experience, fear of needles, formulation, and unfamiliarity), cultural tenets (beliefs, values, perception of illness), and historical and systemic factors (past research injustices, socioeconomic status, patient-physician relationship, clinical trial representation). Some proposed solutions to address biologic treatment hesitancy among Black and Indigenous populations include increasing the number of Black and Indigenous researchers involved in and leading clinical trials, formally training physicians and healthcare workers to deliver culturally competent care, and eliminating financial barriers to accessing medications. Further research is needed to characterize and address race-based new treatment inequalities and hesitancy in Canada.
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Affiliation(s)
- Edgar Akuffo-Addo
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.
| | - Theodora Udounwa
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Chan
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Laura Cauchi
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada
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12
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Furzer J, Isabelle M, Miloucheva B, Laporte A. Public drug insurance, moral hazard and children's use of mental health medication: Latent mental health risk-specific responses to lower out-of-pocket treatment costs. HEALTH ECONOMICS 2023; 32:518-538. [PMID: 36408897 DOI: 10.1002/hec.4631] [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: 09/09/2021] [Revised: 09/09/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Studies have shown that reducing out-of-pocket costs can lead to higher medication initiation rates in childhood. Whether the cost of such initiatives is inflated by moral hazard issues remains a question of concern. This paper looks to the implementation of a public drug insurance program in Québec, Canada, to investigate potential low-benefit consumption in children. Using a nationally representative longitudinal sample, we harness machine learning techniques to predict a child's risk of developing a mental health disorder. Using difference-in-differences analyses, we then assess the impact of the drug program on children's mental health medication uptake across the distribution of predicted mental health risk. Beyond showing that eliminating out-of-pocket costs led to a 3 percentage point increase in mental health drug uptake, we show that demand responses are concentrated in the top two deciles of risk for developing mental health disorders. These higher-risk children increase take-up of mental health drugs by 7-8 percentage points. We find even stronger effects for stimulants (8-11 percentage point increases among the highest risk children). Our results suggest that reductions in out-of-pocket costs could achieve better uptake of mental health medications, without inducing substantial low-benefit care among lower-risk children.
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Affiliation(s)
- Jill Furzer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maripier Isabelle
- Department of Economics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche CERVO, Quebec City, Quebec, Canada
- CIRANO, Montreal, Quebec, Canada
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
| | - Boriana Miloucheva
- Center for Health and Wellbeing, Princeton University, Princeton, New Jersey, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
- Department of Economics, University of Toronto, Toronto, Ontario, Canada
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13
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Quality of Coronary Care: Reducing Practice Variability. Can J Cardiol 2023; 39:524-526. [PMID: 36681382 DOI: 10.1016/j.cjca.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
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14
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Hazlewood GS, Pardo JP, Barnabe C, Schieir O, Barber CEH, Proulx L, Richards DP, Tugwell P, Bansback N, Akhavan P, Bombardier C, Bykerk V, Jamal S, Khraishi M, Taylor-Gjevre R, Thorne JC, Agarwal A, Pope JE. Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs. J Rheumatol 2022; 49:1092-1099. [PMID: 35840155 DOI: 10.3899/jrheum.220209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To provide the initial installment of a living guideline that will provide up-to-date guidance on the pharmacological management of patients with rheumatoid arthritis (RA) in Canada. METHODS The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel composed of rheumatologists, researchers, methodologists, and patients. In this first installment of our living guideline, the panel developed a recommendation for the tapering of biologic and targeted synthetic disease-modifying antirheumatic drug (b/ts DMARD) therapy in patients in sustained remission using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach, including a health equity framework developed for the Canadian RA population. The recommendation was adapted from a living guideline of the Australia & New Zealand Musculoskeletal Clinical Trials Network. RESULTS In people with RA who are in sustained low disease activity or remission for at least 6 months, we suggest offering stepwise reduction in the dose of b/tsDMARD without discontinuation, in the context of a shared decision, provided patients are able to rapidly access rheumatology care and reestablish their medications if needed. In patients where rapid access to care or reestablishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation. CONCLUSION This living guideline will provide contemporary RA management recommendations for Canadian practice. New recommendations will be added over time and updated, with the latest recommendation, evidence summaries, and Evidence to Decision summaries available through the CRA website (www.rheum.ca).
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada;
| | - Jordi Pardo Pardo
- J. Pardo Pardo, Ldo, Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Barnabe
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Orit Schieir
- O. Schieir, PhD, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Claire E H Barber
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Bansback
- N. Bansback, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- P. Akhavan, MD, MSc, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Claire Bombardier
- C. Bombardier, MD, Professor, Division of Rheumatology, Mount Sinai Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Bykerk
- V. Bykerk, MD, Professor, Hospital for Special Surgery, New York, New York, USA
| | - Shahin Jamal
- S. Jamal, MD, MSc, Clinical Associate Professor, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Majed Khraishi
- M. Khraishi, MD, Clinical Professor, Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Regina Taylor-Gjevre
- R. Taylor-Gjevre, MD, MSc, Professor, Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J Carter Thorne
- J.C. Thorne, MD, Assistant Professor, The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Arnav Agarwal
- A. Agarwal, MD, Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Janet E Pope
- J.E. Pope, MD, MPH, Professor, Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
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15
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Ally MZ, Woods H, Adekoya I, Bali A, Persaud N. Acceptability of a short list of essential medicines to patients and prescribers: Multimethod study. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e204-e214. [PMID: 35831082 PMCID: PMC9842143 DOI: 10.46747/cfp.6807e204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the acceptability of providing free access to only a short list of medicines used in the Carefully seLected and Easily Accessible at No charge Medications (CLEAN Meds) trial. DESIGN A multimethod explanatory sequential design including interviews with trial participants and focus groups with prescribers. SETTING Ontario. PARTICIPANTS Participants in the intervention arm of the CLEAN Meds trial and primary care providers who prescribed medicines to those in the intervention arm of the trial. MAIN OUTCOME MEASURES The number of trial participants in each prescription category (ie, prescribed no off-list medicine, prescribed 1 off-list medicine, or prescribed 2 or more off-list medicines) and the acceptability of the list to both participants and prescribers. RESULTS There were 395 participants in the intervention group of the CLEAN Meds trial, but 16 participants withdrew consent or were not prescribed any medicines during the first 12 months of the trial, resulting in a total of 379 participants in the quantitative component of this study. Of the 2648 total prescriptions, 2349 (89%) were for medications that were on or had an equivalent covered by the list. Random sampling was used to select 5 participants to interview from each prescription category. A total of 19 prescribers participated in the focus groups. Themes from participant interviews included the following: having access to medicines on the list was a relief, participants trusted health care professionals to switch medicines and to decide which medicines should be on a publicly funded list, and a short list of essential medicines should be publicly funded. Major themes from the prescribers' focus groups related to the process of developing the list, support for the list, and publicly funding a short list of essential medicines in Canada. CONCLUSION The consensus among trial participants and prescribers is that the short list of medicines used in the trial is comprehensive and provides access to medicines commonly prescribed.
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Affiliation(s)
- Muhamad Z. Ally
- Former research student at MAP Centre for Urban Health Solutions at St Michael's Hospital as part of Unity Health Toronto in Ontario
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16
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Marani H, Allin S. Collecting Information on Caregivers’ Financial Well-Being: A Document Review of Federal Surveys in Canada. J Appl Gerontol 2022; 41:2033-2044. [PMID: 35599593 PMCID: PMC9434210 DOI: 10.1177/07334648221099279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Population-based surveys conducted by governments inform strategies concerning emergent
areas of policy interest. One such area is unpaid caregiving in the context of an aging
population. In the Canadian and global contexts, research suggests a need for public
financial support to mitigate financial risks of caregiving. In this document analysis, we
reviewed 17 federal surveys since 2005 to understand how caregiving-related information is
captured. We found that caregiving-related questions were largely derived from two
surveys, the General Social Survey and the Canadian Community Health Survey. However, gaps
exist concerning questions related to estimates of private care expenditure, and the
impacts of older adult caregiving across domains of financial risk (income, productivity,
and healthcare utilization). Addressing these gaps, either through revising existing
surveys or a new national survey on unpaid caregiving, may improve meaningful assessments
about risks and impacts of caregiving, which may better inform public strategies that
offset these risks.
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Affiliation(s)
- Husayn Marani
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON, Canada
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17
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Lexchin J. After More Than 50 Years, Pharmacare (and Dental Care) are Coming to Canada. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:341-346. [PMID: 35535406 PMCID: PMC9203667 DOI: 10.1177/00207314221100654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In March 2022, the New Democratic Party (NDP), Canada's social democratic party, and the centrist Liberal government signed a supply and confidence agreement. In return for the NDP agreeing to vote with the government on all crucial issues until June 2025, the Liberals pledged to bring in both pharmacare and dental care programs. Pharmacare, universal public insurance coverage for prescription drugs, had been promised for more than 50 years but never implemented, while public dental care was an almost completely neglected issue. This article explains the long genesis of pharmacare, the need for public dental care, and the political circumstances that led to the agreement. However, at this point, details about both plans are largely absent. As a result, how well those plans will serve the needs of Canadians is yet to be determined.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, 7991York University, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Giruparajah M, Everett K, Shah BR, Austin PC, Fuchs S, Shulman R. Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis. CMAJ Open 2022; 10:E519-E526. [PMID: 35700995 PMCID: PMC9343121 DOI: 10.9778/cmajo.20210214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We evaluated the impact of publicly funded pharmacare (Ontario Health Insurance Plan [OHIP]+), which was introduced in Ontario on Jan. 1, 2018, for youth less than 25 years of age, on temporal trends in hemoglobin A1c (HbA1c, a measure of glycemic management) and the differential effect on the change in temporal trends in HbA1c according to socioeconomic status (SES). METHODS We conducted a trend analysis using administrative data sets. We included youth aged 21 years, 9 months or younger, residing in Ontario on Jan. 1, 2016, with diabetes diagnosed before age 15 years and before Jan. 1, 2015. We used claims for insulin to measure pharmacare use. We evaluated the change in HbA1c (%) per 90 days before (Jan. 1, 2016, to Dec. 31, 2017) the introduction of and during (Apr. 1, 2018, to Mar. 31, 2019) OHIP+ coverage, and the difference in the change in HbA1c according to SES, using segmented regression analysis. RESULTS Of 9641 patients, 7041 (73.0%) made an insulin claim. We found a negligible difference in the temporal change in HbA1c during compared with before OHIP+ coverage that was not statistically significant (β estimate -0.0002, 95% confidence interval [CI] -0.0004 to 0.0000). The size of the effect was slightly greater in those individuals with the lowest SES than in those with the highest SES (β estimate -0.0008, 95% CI -0.0015 to -0.0001). INTERPRETATION We found that the effect of OHIP+ on the change in HbA1c was slightly greater for youth in the lowest SES than for those in the highest SES. Our findings suggest that publicly funded pharmacare may be an effective policy tool to combat worsening socioeconomic disparities in diabetes care and outcomes.
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Affiliation(s)
- Mohana Giruparajah
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Karl Everett
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Baiju R Shah
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Peter C Austin
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Shai Fuchs
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Rayzel Shulman
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.
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Tran SHN, Weaver RG, Manns BJ, Saunders-Smith T, Campbell T, Ivers N, Hemmelgarn BR, Tonelli M, Pannu R, Campbell DJT. Factors Affecting the Reception of Self-Management Health Education: A Cross-Sectional Survey Assessing Perspectives of Lower-Income Seniors with Cardiovascular Conditions. Patient Prefer Adherence 2022; 16:971-981. [PMID: 35422615 PMCID: PMC9005130 DOI: 10.2147/ppa.s351459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Self-management education and support (SMES) programs can prevent adverse chronic disease outcomes, but factors modifying their reception remain relatively unexplored. We examined how perceptions of an SMES program were influenced by the mode of delivery, and co-receipt of a paired financial benefit. METHODS AND PATIENTS Using a cross-sectional survey, we evaluated the perceived helpfulness of a SMES program among 446 low-income seniors at high risk for cardiovascular events in Alberta, Canada. Secondary outcomes included frequency of use, changes in perspectives on health, satisfaction with the program, and comprehensibility of the material. Participants received surveys after engaging with the program for at least 6 months. We used modified Poisson regression to calculate relative risks. Open-ended questions were analyzed inductively. RESULTS The majority of participants reported that the SMES program was helpful (>80%). Those who also received the financial benefit (elimination of medication copayments) were more likely to report that the SMES program was helpful (RR 1.24, 95% CI 1.11-1.39). Those who received the program electronically were more likely to use the program weekly (RR 1.51, 1.25-1.84). Both those who received the intervention electronically (RR 1.18, 1.06-1.33), and those who also received copayment elimination (RR 1.17, 1.05-1.31) were more likely to state that the program helped change their perspectives on health. CONCLUSION When designing SMES programs, providing the option for electronic delivery appears to promote greater use for seniors. The inclusion of online-delivery and co-receipt of tangible benefits when designing an SMES program for seniors results in favorable reception and could facilitate sustained adherence to health behavior recommendations. Participants also specifically expressed that what they enjoyed most was that the SMES program was informative, helpful, engaging, and supportive.
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Affiliation(s)
- Sophia H N Tran
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert G Weaver
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON, Canada
| | | | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Raj Pannu
- Emergence Creative, New York, NY, USA
| | - David J T Campbell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Correspondence: David JT Campbell, Tel +1 403-210-9511, Email
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20
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Prevalence and determinants of frailty in older adult patients with chronic coronary syndrome: a cross-sectional study. BMC Geriatr 2021; 21:519. [PMID: 34592947 PMCID: PMC8482732 DOI: 10.1186/s12877-021-02426-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Frailty is an expression of vulnerability and decline of physical, mental, and social activities, more commonly found in older adults. It is also closely related to the occurrence and poor prognosis of coronary artery disease (CAD). Little investigation has been conducted on the prevalence and determinants of frailty in older adult patients with chronic coronary syndrome (CCS). METHODS A cross-sectional study was conducted, simple random sampling was used in this study. 218 older adults (age ≥ 60 years) with CCS with an inpatient admission number ending in 6 were randomly selected who hospitalized in Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, between January and December 2018. For measurement and assessment, we used the 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), demographic characteristics, Barthel Index(BI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutrition Assessment Shor-Form (MNA-SF), Morse Fall Scale (MFS), Caprini risk assessment, polypharmacy, and Numerical Rating Scale (NRS). Multivariate logistic regression analysis was used to confirme determinants. RESULTS The FRAIL scale showed 30.3% of the subjects suffered from frailty. Determinants were aging (OR1.12; 95% CI 1.04 ~ 1.62), out-of-pocket (OR18.93; 95% CI 1.11 ~ 324.07), hearing dysfunction (OR9.43; 95% CI 1.61 ~ 55.21), MNA-SF score (OR0.71; CI 0.57 ~ 0.89), GDS-15 score (OR1.35; 95% CI 1.11 ~ 1.64), and Caprini score (OR1.34; 95% CI 1.06 ~ 1.70). CONCLUSIONS The FRAIL scale confirmed that the prevalence of frailty in patients with CCS was slightly lower than CAD. Aging, malnutrition, hearing dysfunction, depression, and VTE risk were significantly associated with frail for older adult patients with CCS. A comprehensive assessment of high-risk patients can help identify determinants for frailty progression. In the context of CCS, efforts to identify frailty are needed, as are interventions to limit or reverse frailty status in older CCS patients.
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21
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Marani H, Allin S, Marchildon GP. Development of a web-based survey on the financial risks of unpaid caregiving: approach and lessons learned from a Canadian perspective. Home Health Care Serv Q 2021; 40:276-301. [PMID: 34581238 DOI: 10.1080/01621424.2021.1976344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is known about the financial risks of unpaid caregiving. This is, in part, due to challenges in identifying people who are caregivers and limitations in capturing all aspects of spending related to caregiving in existing approaches to public data collection. To fill these gaps, we developed a composite survey informed by validated instruments that assesses the types and magnitude of out-of-pocket expenditures caregivers incur in the provision of homebased care for someone living with a long-term health condition, and their impact across various domains of financial risk. This paper discusses the development of this survey currently in circulation in a Canadian province, and reflects on considerations in the engagement of unpaid caregivers in participatory research. Given its replicability and adaptability, this survey may inform future research in other developed or high-income settings and guide policy attention toward understanding how to protect unpaid caregivers from the financial risks of caring.
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Affiliation(s)
- Husayn Marani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,North American Observatory on Health Systems and Policies, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,North American Observatory on Health Systems and Policies, University of Toronto, Toronto, Ontario, Canada
| | - Gregory P Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,North American Observatory on Health Systems and Policies, University of Toronto, Toronto, Ontario, Canada
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22
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Antonipillai V, Guindon GE, Sweetman A, Baumann A, Wahoush O, Schwartz L. Associations of health services utilization by prescription drug coverage and immigration category in Ontario, Canada. Health Policy 2021; 125:1311-1321. [PMID: 34226053 DOI: 10.1016/j.healthpol.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022]
Abstract
Canada is the only high-income country with a universal healthcare system that does not provide prescription drug coverage for all its residents. This study examines whether Canadians' prescription drug coverage status is associated with their health services use and how this association differs by gender across non-migrants and three categories of migrants: economic immigrants, family-class immigrants, and refugees. Very few studies have examined differences across these migrant groups, and there is a need to do so as they experience varying health disparities. This study contributes to the prescription drug coverage, migration and health literature by employing an intersectional lens to analyze a sample of Ontario working-aged residents (n=39,792) generated from linking the Canadian Community Health Survey (2005, 2008, 2013, 2014) and Longitudinal Immigrant Database. Predicted probabilities and average marginal effects from multivariable logistic regression models were generated, and interaction effects between prescription drug coverage and immigrant status were examined. The study reveals important differences in the use of health services across prescription drug coverage groups by immigration status. As the general debate about universal pharmacare in Canada is ongoing, this study reveals that drug insurance is positively associated with health services use of most migrants and non-migrants, however, some immigrant women may still experience barriers to access general practitioner services. If pharmacare is introduced, ongoing evaluation is needed to ensure that its implementation produces equitable outcomes for all.
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Affiliation(s)
| | - G Emmanuel Guindon
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Arthur Sweetman
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada; Economics, McMaster University, Hamilton, Canada
| | - Andrea Baumann
- Global Health, McMaster University, Hamilton, Canada; School of Nursing, McMaster University, Hamilton, Canada
| | - Olive Wahoush
- Global Health, McMaster University, Hamilton, Canada; School of Nursing, McMaster University, Hamilton, Canada
| | - Lisa Schwartz
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
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Men F, Fischer B, Urquia ML, Tarasuk V. Food insecurity, chronic pain, and use of prescription opioids. SSM Popul Health 2021; 14:100768. [PMID: 33763516 PMCID: PMC7974024 DOI: 10.1016/j.ssmph.2021.100768] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic pain has been on the rise in recent decades in Canada. Accordingly, the use of prescription opioids (PO) in Canada increased drastically between 2005 and 2014, only starting to decrease in 2015. Both pain and PO use have serious public health repercussions, disproporionately affecting select socially disadvantaged populations. Food insecurity is a strong risk factor for mental disorders and suicidal outcomes, yet its relationship to chronic pain and PO use is largely unknown. Using two recent cycles from the population representative Canadian Community Health Survey (CCHS), we examined the association of household food insecurity status with chronic pain and PO use among Canadians 12 years and older, adjusting for health and sociodemographic characteristics. Compared to food-secure individuals, marginally, moderately, and severely food-insecure individuals had 1.31 (95% confidence interval [CI] 1.15-1.48), 1.89 (95% CI 1.71-2.08), and 3.29 (95% CI 2.90-3.74) times higher odds of experiencing chronic pain and 1.55 (95% CI 1.30-1.85), 1.77 (95% CI 1.54-2.04), and 2.65 (95% CI 2.27-3.09) times higher odds of using PO in the past year, respectively. The graded association with food insecurity severity was also found in severe pain experience and pain-induced activity limitations among chronic pain patients and, less consistently, in intensive, excess, and alternative use of PO and its acquisition through means other than medical prescription among past-year PO users. Food insecurity was a much more powerful predictor of chronic pain and PO use than other well-established social determinants of health like income and education. Policies reducing food insecurity may lower incidence of chronic pain and help contain the opioid crisis.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Consumer Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Marcelo L. Urquia
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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The impact of a co-payment increase on the consumption of type 2 antidiabetics - A nationwide interrupted time series analysis. Health Policy 2021; 125:1166-1172. [PMID: 34078544 DOI: 10.1016/j.healthpol.2021.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/21/2020] [Accepted: 05/15/2021] [Indexed: 11/21/2022]
Abstract
International literature suggests that co-payment increases are associated with decreased medicine use, although the effects depend on context. We examined the impact of a co-payment increase on the consumption of type 2 antidiabetics in Finland, a country with a comprehensive health and social security system including ceiling mechanisms aiming to protect patients from high co-payment expenditures. We used administrative register data on all reimbursed purchases of antidiabetics during 2014-2018. An interrupted time series design with segmented regression was used to examine the mean monthly purchase per person, measured as Defined Daily Doses (DDDs), before and after the co-payment increase. At baseline, the mean monthly purchase per person of type 2 antidiabetics was 105 DDDs (95% CI 103.8; 106.0;p<0.001) and there was a decreasing trend of 0.2 DDDs per month (95% CI -0.23;-0.13;p<0.001). A statistically significant decrease of 5.6 DDDs (95% CI -7.3;-3.8;p<0.001) was detected after the reform; however, no significant change in the trend was observed. No significant increase was detected in the mean monthly per person purchase of insulins. The results suggest that a co-payment increase decreases consumption of necessary medicines despite the presence of a medicine co-payment ceiling mechanism. Whether the decrease was associated with negative health effects remains to be further investigated.
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Rättö H, Aaltonen K. The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study. PLoS One 2021; 16:e0250305. [PMID: 33951077 PMCID: PMC8099050 DOI: 10.1371/journal.pone.0250305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/04/2021] [Indexed: 11/29/2022] Open
Abstract
Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients' pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences estimation, we analyze whether the reform increased the use of social assistance, a last-resort financial aid. We found that after the reform the share of social assistance recipients increased more among type 2 diabetes patients than among a patient group not affected by the co-payment increase, suggesting the reform increased the use of social assistance among those subject to it. The results indicate that increases in patients' pharmaceutical expenses can lead to serious financial difficulties even in countries with a comprehensive social security system.
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Affiliation(s)
- Hanna Rättö
- Research Unit, The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Katri Aaltonen
- Research Unit, The Social Insurance Institution of Finland (Kela), Helsinki, Finland
- Department of Social Research, University of Turku, Turku, Finland
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Persaud N, Bedard M, Boozary A, Glazier RH, Gomes T, Hwang SW, Juni P, Law MR, Mamdani M, Manns B, Martin D, Morgan SG, Oh P, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Laupacis A. Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial. PLoS Med 2021; 18:e1003590. [PMID: 34019540 PMCID: PMC8139488 DOI: 10.1371/journal.pmed.1003590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. METHODS AND FINDINGS We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI -0.25 to 0.79, p = 0.302), systolic blood pressure (-3.9; 95% CI -9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI -0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. CONCLUSIONS In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years. TRIAL REGISTRATION ClinicalTrials.gov NCT02744963.
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Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Boozary
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Richard H Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Juni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training at St Michael's Hospital and Vector Institute, Toronto, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Oh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, University of St Andrews, Scotland
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Holbrook AM, Wang M, Lee M, Chen Z, Garcia M, Nguyen L, Ford A, Manji S, Law MR. Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact. Syst Rev 2021; 10:11. [PMID: 33407875 PMCID: PMC7788798 DOI: 10.1186/s13643-020-01558-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear. OBJECTIVES Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. METHODS We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. RESULTS Twenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year. CONCLUSION CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.
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Affiliation(s)
- Anne M Holbrook
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Mei Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Munil Lee
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Zhiyuan Chen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Garcia
- Bachelor of Health Studies Program, University of Waterloo, Waterloo, ON, Canada
| | - Laura Nguyen
- Bachelor of Health Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Angela Ford
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Selina Manji
- Global Health Program, McMaster University, Hamilton, ON, Canada
| | - Michael R Law
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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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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Gorfinkel I, Brown A, Lexchin JR. Engaging physicians to prescribe more cost-effectively: Blueprint for change. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:723-725. [PMID: 33077447 PMCID: PMC7571639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Iris Gorfinkel
- General practitioner and Principal Investigator and Founder of PrimeHealth Clinical Research in Toronto, Ont.
| | - Ahuva Brown
- Clinical Research Fellow at the Hospital For Sick Children in Toronto
| | - Joel R Lexchin
- Fellow of the Canadian Academy of Health Sciences, Professor Emeritus in the School of Health Policy and Management at York University in Toronto, and an emergency physician in the University Health Network
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31
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Men F, Tarasuk V. Severe food insecurity associated with mortality among lower-income Canadian adults approaching eligibility for public pensions: a population cohort study. BMC Public Health 2020; 20:1484. [PMID: 32998712 PMCID: PMC7528377 DOI: 10.1186/s12889-020-09547-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension. METHODS We linked respondents of the Canadian Community Health Survey 2005-15 to the death records from the Canadian Vital Statistics Database 2005-17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52-64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately. RESULTS Marginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample. CONCLUSIONS Severely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, Room 5366, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, Room 5366, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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32
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Gorfinkel I, Brown A, Lexchin JR. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e251-e254. [PMID: 33077464 PMCID: PMC7571646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Iris Gorfinkel
- Omnipraticienne, chercheure principale et fondatrice de PrimeHealth Clinical Research à Toronto (Ontario).
| | - Ahuva Brown
- Boursière de recherche clinique au Hospital For Sick Children à Toronto
| | - Joel R Lexchin
- Membre de l'Académie canadienne des sciences de la santé, professeur émérite à l'École des politiques et de la gestion de la santé de l'Université York à Toronto et urgentologue à l'University Health Network
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33
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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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Daw JR, Law MR. Compared With Other Countries, Women In The US Are More Likely Than Men To Forgo Medicines Because Of Cost. Health Aff (Millwood) 2020; 39:1334-1342. [DOI: 10.1377/hlthaff.2019.01554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jamie R. Daw
- Jamie R. Daw is an assistant professor in health policy and management at the Columbia Mailman School of Public Health, in New York, New York
| | - Michael R. Law
- Michael R. Law is the Canada Research Chair in Access to Medicines and director of the Centre for Health Services and Policy Research, School of Population and Public Health, at the University of British Columbia, in Vancouver, British Columbia, Canada
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What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan. Health Policy 2020; 124:977-983. [PMID: 32553741 DOI: 10.1016/j.healthpol.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/06/2020] [Accepted: 05/05/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The role of cost-sharing for medicines is under active policy discussion, including in proposals for value-based insurance design. To inform this debate, we estimated the impact of completely removing cost-sharing on medication use and expenditure using a quasi-experimental approach. METHODS Fair PharmaCare, British Columbia's income-based public drug plan, includes a household out-of-pocket limit. Therefore, when one household member starts a long-term high-cost drug surpassing this maximum, cost-sharing is completely removed for other family members. We used an interrupted time series design to estimate monthly prescriptions and expenditures of other household members, 24 months before and after cost-sharing removal. RESULTS We studied 2191 household members newly free of cost-sharing requirements, most of whom had lower incomes. R emoving cost-sharing increased the level of drug expenditure and prescription numbers by 16 and 19%, respectively (i.e. $2659.43 (95%$1507.27-$3811.59, p < 0.001); 50.0 (95%CI 25.1-74.9, p < 0.001)) relative to prior expenditures and utilization without changing pre-existing trends. Much of this change was driven by 533 individuals initiating medication for the first time after cost-sharing removal. This initiation substantially increased average expenditure, especially for antiviral agents. CONCLUSIONS Completely removing cost-sharing, independent of health status, significantly increased medication use and expenditure particularly due to medicine initiation by new users. While costs may be preventing use, the appropriateness of additional use, especially among new users, is unclear.
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Kaal KJ, Bansback N, Hudson M, Anis A, Koehn C, Harrison M. Patient-provider communication about medication cost in rheumatoid arthritis. Clin Rheumatol 2020; 40:93-100. [PMID: 32506315 DOI: 10.1007/s10067-020-05188-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine the perceived importance and frequency with which out-of-pocket medication costs are discussed between rheumatologists and patients with rheumatoid arthritis (RA) in Canada. METHODS A cross-sectional online survey was distributed to patients with RA and rheumatologists; both were asked to rate their perceived importance of discussing medication costs, and how often these discussions occurred. Predictors of (1) patients discussing costs with their rheumatologist and (2) the perceived importance of discussing medication cost for patients were explored. RESULTS Seventy-eight patients and 64 rheumatologists completed the survey; 68% patients and 75% of physicians rated the perceived importance of discussing medication costs as "quite" or "very important"; 22% of patients reported never talking about medication cost, but no physicians reported never discussing costs with patients. The only predictor of talking about cost among patients (at 10% level) was whether they perceived it as highly important (p = 0.058). Higher perceived importance of discussing out-of-pocket costs was associated with a more positive attitude to shared decision-making (p = 0.044). CONCLUSION Discussions about cost do not always happen, even with diseases with potentially high medication costs like RA. Cost was more likely to be discussed by patients who perceived it as "very important," suggesting the onus might be on patients to initiate these conversations. Without any significant predictors regarding what may make physicians more likely to think it was important to discuss medication costs, there is a need to reinforce recommendations that all physicians seek to discuss costs with all of their patients when suggesting medications. Key Points • There is a need for patients and physicians to discuss costs in the treatment decision-making process. Our findings suggest this does not always happen. • Among patients, medication cost was more likely to be discussed by those who perceived it as "very important" and higher perceived importance of discussing out-of-pocket costs was associated with a more positive attitude to shared decision-making. • Our results did not reveal any significant predictors regarding what may make physicians more likely to think it was important to discuss medication costs, suggesting that there is a need to reinforce recommendations that all physicians seek to discuss medication costs with all of their patients when suggesting medications.
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Affiliation(s)
- K Julia Kaal
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Aslam Anis
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Cheryl Koehn
- Arthritis Consumer Experts/JointHealth, Vancouver, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. .,St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Arthritis Research Canada, Richmond, Canada.
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McLaughlin T, Jong G', Gilpin A, Hepburn CM. Pharmacare in Canada: The paediatric perspective. Paediatr Child Health 2020; 25:113-124. [PMID: 32189975 DOI: 10.1093/pch/pxz176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
Canada's drug insurance system is one of the most expensive in the world, yet millions of Canadians still struggle to access necessary medications. As a result, provincial, territorial, and federal governments are considering public pharmacare policy proposals to ensure that all Canadians can access the medications they need. Pharmacare policies offer an opportunity to prioritize children and youth, whose unique drug needs have long been neglected. Prescription drug use is common in this population, with approximately half of Canadian children and youth requiring at least one prescription in any given year. Drug use remains concentrated, however, among those with complex, chronic, and serious diseases. Children and youth rely heavily on compounded and off-label prescription drugs, which impacts safety, efficacy, palatability, and cost. Reimbursement decision-making bodies do not appropriately value the unique benefits of paediatric drugs, including child-friendly formulations, improved quality of life for children and families, and cost-savings outside the healthcare system. Regardless of the pharmacare model ultimately implemented, ensuring universal, comprehensive, and portable prescription drug coverage for all children and youth is essential. To accomplish this, paediatric drug experts should develop a national, evidence-informed formulary of paediatric drugs. Health Canada should also improve processes to make commercial paediatric drugs and child-friendly formulations more available and accessible. The federal government must also support paediatric drug research and development to this end.
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Affiliation(s)
| | | | - Andrea Gilpin
- Goodman Family Pediatric Formulations Centre, CHU Sainte-Justine, Montreal, Quebec
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McLaughlin T, Jong G‘, Gilpin A, Hepburn CM. L’assurance médicaments au Canada : le point de vue de la pédiatrie. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxz177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Résumé
Le système d’assurance médicaments du Canada est l’un des plus coûteux au monde, mais des millions de Canadiens peinent pourtant à accéder aux médicaments dont ils ont besoin. C’est pourquoi les gouvernements fédéral, provinciaux et territoriaux envisagent des propositions de polices d’assurance médicaments publiques pour tous les Canadiens. Les polices d’assurance médicaments permettent de prioriser les enfants et les adolescents, dont les besoins pharmacologiques particuliers ont longtemps été négligés. La prise de médicaments sur ordonnance est courante au sein de cette population, puisqu’environ la moitié des enfants et des adolescents canadiens ont besoin d’au moins une ordonnance au cours d’une année donnée. La prise de médicaments demeure toutefois concentrée au sein des populations atteintes de maladies complexes, chroniques ou graves. Les enfants et les adolescents recourent largement aux préparations magistrales et aux médicaments dans un emploi non conforme à l’étiquette, ce qui a une incidence sur l’innocuité, l’efficacité, la palatabilité et les coûts. Les organes décisionnels en matière de remboursement n’accordent pas toute l’importance qu’ils devraient aux avantages uniques des médicaments pédiatriques, ce qui inclut les formulations adaptées à la pédiatrie, une meilleure qualité de vie pour les enfants et les familles et les économies à l’extérieur du système de santé. Quel que soit le modèle d’assurance médicaments finalement adopté, il est essentiel d’offrir une couverture d’assurance médicaments sur ordonnance complète, universelle et transférable pour tous les enfants et les adolescents. C’est pourquoi les experts des médicaments pédiatriques doivent créer un formulaire national de médicaments pédiatriques fondé sur des données probantes. Santé Canada doit également améliorer les processus pour que les formulations et médicaments commerciaux adaptés à la pédiatrie deviennent plus disponibles et accessibles. À cette fin, le gouvernement fédéral doit également soutenir la recherche-développement des médicaments pédiatriques.
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Affiliation(s)
| | | | - Andrea Gilpin
- Le Centre de formulations pédiatriques de la famille Rosalind et Morris Goodman du CHU Sainte-Justine, Montréal (Québec)
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Mohamed FA, Chaufan C. A Critical Discourse Analysis of Intellectual Property Rights Within NAFTA 1.0: Implications for NAFTA 2.0 and for Democratic (Health) Governance in Canada. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:278-291. [PMID: 32019396 DOI: 10.1177/0020731420902600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 1993, the Canadian federal government ratified the North American Free Trade Agreement (NAFTA). Prior to ratification, compulsory licensing was eliminated from Canada's Patent Act and intellectual property rights (IPRs) were strengthened. Compulsory licensing allows competitors to produce drugs under patent without the consent of the patent holder, challenging drug monopolies and lowering prices, whereas IPRs lengthen patent protections, shielding patent holders from competition and increasing prices. We perform a critical discourse analysis of key provisions in Chapter 17 of NAFTA in light of industry claims that pharmaceutical innovation requires important investments in research and development, justifying high drug prices. We note that since NAFTA, spending in research and development in Canada has decreased and drug prices have increased, becoming a major barrier to equitable access to critically necessary medications. We argue that by modifying the law, the federal government has wronged the Canadian people by discursively appropriating the language of protecting the public good while in practice legitimizing and consolidating private drug development and production, legalizing exorbitant profits, and excluding well-tested publicly financed alternatives. While NAFTA has now been superseded by the Canada-United States-Mexico Agreement, our analysis offers important lessons moving forward.
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Prescription medication cost, insurance coverage, and cost-related nonadherence among people with spinal cord injury in Canada. Spinal Cord 2020; 58:587-595. [DOI: 10.1038/s41393-019-0406-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/08/2022]
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Grignon M, Longo C, Marchildon G, Officer S. The 2018 decision to establish an Advisory Council on adding pharmaceuticals to universal health coverage in Canada. Health Policy 2020; 124:7-11. [DOI: 10.1016/j.healthpol.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/29/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Canada does not have universal public coverage for prescription drugs, which leaves an important role for private insurance plans. However, we do not have recent data on the characteristics of Canadians who report holding such coverage, particularly differences based on household income. We performed a study to examine the relation between household income and private drug insurance coverage in Canada. METHODS We used data from the 2015-2016 cycle of the Canadian Community Health Survey to investigate the relation between household income and holding private drug insurance. We constructed modified multivariate Poisson regression models with robust error variances, including several potential confounders. RESULTS Overall, 59.4% of respondents reported having private drug insurance. We found a strong dose-response relation between household income level and private drug insurance coverage: 19.8% of those with a household income less than $20 000 reported private coverage, compared to 76.2% of those with a household income of $80 000 or more. INTERPRETATION Higher-income households are much more likely to hold private drug insurance coverage in Canada. This likely contributes to differential access to medicines and health outcomes by different income groups.
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Affiliation(s)
- Talshyn Bolatova
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC
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Manja V, Monteiro S, You J, Guyatt G, Lakshminrusimha S, Jack SM. Incorporating content related to value and cost-considerations in clinical decision-making: enhancements to medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:751-766. [PMID: 31144075 DOI: 10.1007/s10459-019-09896-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
Although incorporating cost-considerations during healthcare decision-making is increasingly important to American patients and physicians, content related to these constructs is not routinely included in medical education. As a result, physicians are ill-equipped to consider costs. This study sought input from practicing physicians on perceived deficiencies in current teaching and recommendations for necessary content to include in medical teaching. We conducted a qualitative descriptive study using semi-structured interviews utilizing a purposeful maximum variation sample of cardiologists and neonatologists practicing in diverse settings. We analyzed interviews using conventional content analysis. 18 cardiologists and 17 neonatologists participated in this study. Respondents perceived that current teaching does not impart sufficient knowledge of value and cost considerations to achieve patient-centered, high-value decision-making. They identified the following priority areas for education related to healthcare costs: the business of medicine and information about out-of-pocket patient costs, training in health research interpretation skills to critically appraise evidence, and communication skills to engage patients as partners in shared decision-making. Participants recommended a variety of teaching methods, including didactic sessions on core topics, role modeling and case studies. American physicians perceive learning needs related to the incorporation of costs into clinical decision-making that can inform curriculum development initiatives in this field. Physicians perceive knowledge of these topics and skills to be crucial to achieving patient-centered high-value care. Concomitant health system reforms supporting the needs of the patient at its center are essential to enable physicians to focus on a patient-centered approach to healthcare delivery.
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Affiliation(s)
- Veena Manja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, University of California Davis, 2335 Stockton Blvd., Sacramento, CA, 95817, USA.
- Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, 95655, USA.
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - John You
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Susan M Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Managing Medication Cost Burden: A Qualitative Study Exploring Experiences of People with Disabilities in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173066. [PMID: 31450782 PMCID: PMC6747197 DOI: 10.3390/ijerph16173066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
Despite the abundant literature on the burden of rising costs of prescription medications, there is limited research to explore how these costs affect people and the decisions they are forced to make within the context of disability. In this qualitative study we explored strategies adopted, factors influencing, and the impact of some of these strategies to manage the burden of medication cost among persons with disabilities. We interviewed 12 adults with spinal cord injuries living in Canada, using a general inductive approach to analyze the data. We found that before cutting back on medications due to costs, participants generally tried and sought help from the government, employers, and/or their prescribers to improve their drug coverage. The key factors that participants considered while making decisions on the strategies included the cost and perceived importance of medications, their financial status, other competing needs, and their relationship with the prescribers. While some of their efforts were successful, many participants were still not able to obtain their medications as prescribed. In those cases, patients resorted to rationing strategies such as cutting back on medications, other essential needs, or selling assets. These strategies had serious implications on their health, healthcare utilization, and quality of life.
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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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Cost-related nonadherence to medicines in people with multiple chronic conditions. Res Social Adm Pharm 2019; 16:415-421. [PMID: 31253501 DOI: 10.1016/j.sapharm.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/30/2019] [Accepted: 06/18/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multimorbidity is common and frequently associated with medicine nonadherence. Although cost is a common reason for nonadherence, very little research has quantified cost-related nonadherence (CRNA) to medicines specifically in people with multimorbidity, the prevalence of CRNA for different conditions nor the impact of cost when prioritising treatment between conditions. OBJECTIVE To determine the extent of CRNA in people with multimorbidity and the patient characteristics associated with these behaviours. DESIGN AND SETTING People reporting two or more chronic conditions responding to a rapid response module regarding prescription drug affordability fielded between January 1 and June 30 2016 in the Canadian Community Health Survey, a cross-sectional household survey. METHODS Ordinal logistic regression, adjusted for key sociodemographic, clinical and treatment related variables, of weighted population estimates of self-reported CRNA within one group of conditions, across multiple groups of conditions, or no CRNA. RESULTS 10.2% of 8420 Canadians with multimorbidity reported CRNA. The majority (61%) reported CRNA within one group of conditions, especially respiratory (16%) and mental health disorders (17%). CRNA was more common in younger adults, people without employer or association drug insurance plans, poorer health status, more chronic conditions, and increased out-of-pocket prescription costs. Having no prescription insurance was associated with a higher probability of CRNA across multiple groups of conditions. CONCLUSIONS People with multimorbidity primarily forego medicines because of cost within one group of conditions. However, those without drug insurance extended these behaviours to multiple condition groups. Further work is needed to determine how people prioritise the conditions and treatments that are foregone because of cost, and how to best incorporate this information into treatment plans.
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Moody E, Martin-Misener R, Warner G, Macdonald M, Weeks LE, Shaw L, McKibbon S. Out-of-pocket expenses related to aging in place for frail older people: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:2326-2333. [PMID: 30864982 DOI: 10.11124/jbisrir-2017-003921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to describe the available evidence reporting out-of-pocket expenses for aging-in-place for frail older people and their caregivers. INTRODUCTION There has been an increased focus on supporting frail older people to live in the community, rather than in costly long-term residential care. The out-of-pocket expenses associated with supporting older people with frailty to remain in their homes and communities contribute to caregiver burden and can influence decisions about where to live. INCLUSION CRITERIA This scoping review will consider literature on community-dwelling older people 60 years and older who have been identified as frail. Research and policy papers that report the out-of-pocket expenses incurred by older people with frailty or by their family or friend caregivers to support aging well at home will be included. Studies in English will be considered with no date restriction. METHODS The search strategy aims to find both published and unpublished literature (e.g. policy papers, theses and dissertations). Search databases include CINAHL, PubMed, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index, as well as databases of unpublished sources. The language will be limited to English or French. Title and abstract screening, as well as full-text screening, will be completed by two reviewers. Data will be charted to describe the body of literature focusing on elements such as type of literature, methods used, setting and out-of-pocket expenses. Data will be presented graphically when possible, and accompanied by a narrative that describes the characteristics of the body of literature.
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Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence
| | - Lynn Shaw
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Shelley McKibbon
- Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence.,WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada
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Chan FKI, McGrail K, Majumdar SR, Law MR. Changes in employer-sponsored private health insurance among retirees in Ontario: a cross-sectional study. CMAJ Open 2019; 7:E15-E22. [PMID: 30665895 PMCID: PMC6342701 DOI: 10.9778/cmajo.20180067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Employer-sponsored health insurance, particularly for retirees with limited incomes, plays a major funding role in Canadian health care, including prescription drugs and dental services. We aimed to investigate the changes in retiree health insurance availability over time. METHODS We performed a secondary analysis of data from the 2005 and 2013-2014 cycles of the Canadian Community Health Survey using multivariate logistic regression to study changes in retiree coverage availability over time in Ontario. We estimated the adjusted odds ratios of having employer coverage for likely retirees (people over age 65 yr who reported not working and those over age 75 yr), adjusting for a number of potential confounders. Sensitivity analysis was also performed for coverage of different treatments separately. RESULTS The response rate was 76% for the 2005 cycle and 66% for 2013-2014 for the entire survey. The characteristics of respondents in the 2 survey cycles were similar, except respondents in 2013-2014 were wealthier. In our adjusted model, respondents in 2013-2014 had lower odds of reporting retiree coverage than respondents in 2005 (adjusted odds ratio 0.87; 95% confidence interval 0.77-0.99). This represents an absolute reduction in the probability of receiving retiree coverage of up to 3.4%. INTERPRETATION Our analysis suggests that the rate of retiree health insurance has declined for Canadians with similar characteristics over the past decade. As we know insurance coverage has a strong association with use of treatments such as prescription drugs and dental care, this decline may result in decreased access to treatment and is an issue that warrants further investigation.
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Affiliation(s)
- Fiona K I Chan
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta
| | - Sumit R Majumdar
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta
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Law MR, Cheng L, Worthington H, Majumdar SR, McGrail KM, Chan F, Laba TL, Mamdani M. Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study. CMAJ Open 2019; 7:E167-E173. [PMID: 30926600 PMCID: PMC6440883 DOI: 10.9778/cmajo.20180198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several Canadian public drug plans have income-based deductibles, but we have limited data on their impact, particularly for vulnerable populations. Therefore, we studied the impact of deductibles in British Columbia's Fair PharmaCare program on drug use among lower-income adults. METHODS We used a quasi-experimental regression discontinuity design to study the impact of BC rules that impose no deductible before receiving public coverage on households with incomes less than $15 000, a deductible of 2% of household income on those with incomes between $15 000 and $30 000, and a deductible of 3% of household income on those with incomes above $30 000. We studied the impact of these thresholds on public and total drug expenditures between 2003 and 2015 using 24 million person-years of data. RESULTS Both thresholds decreased the proportion of beneficiaries receiving benefits, by 0.33 (95% confidence interval [CI] -0.34 to -0.30) and 0.05 (95% CI -0.064 to -0.032) respectively. There were also substantial reductions in the extent of public drug plan expenditures ($59.94 [95% CI -74.74 to -45.14] and $26.12 [95% CI -39.78 to -12.46], respectively). The change at the $15 000 threshold reduced patient drug expenditures by $26.00 (95% CI -45.48 to -6.51), or 7.2%. In contrast, we found no statistically significant change in total expenditures when households moved from a deductible of 2% to 3% at the $30 000 threshold. INTERPRETATION Income-based deductibles considerably affected the extent of public subsidy for prescription drugs. For lower-income households making around $15 000, the deductible led to a reduction of 7.2% in overall drug use and costs. Although deductibles are a useful tool to limit public expenditures, policy-makers should be cautious in their use among vulnerable populations.
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Affiliation(s)
- Michael R Law
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont.
| | - Lucy Cheng
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
| | - Heather Worthington
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
| | - Sumit R Majumdar
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
| | - Fiona Chan
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
| | - Tracey-Lea Laba
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
| | - Muhammad Mamdani
- Centre for Health Services and Policy Research (Law, Cheng, Worthington, McGrail, Chan, Laba), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.; Menzies Centre for Health Policy (Laba), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Clinical Epidemiology and Evaluation (Laba), University of British Columbia, Vancouver, BC; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital, Toronto, Ont
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Brandt J, Shearer B, Morgan SG. Prescription drug coverage in Canada: a review of the economic, policy and political considerations for universal pharmacare. J Pharm Policy Pract 2018; 11:28. [PMID: 30443371 PMCID: PMC6220568 DOI: 10.1186/s40545-018-0154-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians. METHODS A narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic. MAIN FINDINGS Regarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, 'first-dollar' coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic 'last-dollar' coverage model, more similar to the current "patchwork" state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, 'first-dollar' coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix. CONCLUSION Canada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests.
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Affiliation(s)
- Jaden Brandt
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Brenna Shearer
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- Pharmacists Manitoba, Winnipeg, MB Canada
| | - Steven G. Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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