Prescription Drug Expenditures and Population Demographics

Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada V6T 1Z3.
Health Services Research (Impact Factor: 2.78). 05/2006; 41(2):411-28. DOI: 10.1111/j.1475-6773.2005.00495.x
Source: PubMed


To provide detailed demographic profiles of prescription drug utilization and expenditures in order to isolate the impact of demographic change from other factors that affect drug expenditure trends.
Demographic information and drug utilization data were extracted for virtually the entire British Columbia (BC) population of 1996 and 2002. All residents had public medical and hospital insurance; however their drug coverage resembled the mix of private and public insurance in the United States.
A series of research variables were constructed to illustrate profiles of drug expenditures and drug utilization across 96 age/sex strata.
Drug use and expenditure information was extracted from the BC PharmaNet, a computer network connecting all pharmacies in the province.
Per capita drug expenditures increased at an average annual rate of 10.8 percent between 1996 and 2002. Population aging explained 1.0 points of this annual rate of expenditure growth; the balance was attributable to rising age/sex-specific drug expenditures.
Relatively little of the observed increase in drug expenditures in BC could be attributed to demographic change. Most of the expenditure increase stemmed from the age/sex-specific quantity and type of drugs purchased. The sustainability of drug spending therefore depends not on outside forces but on decisions made by policy makers, prescribers, and patients.

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Available from: Steven George Morgan, Jul 22, 2014
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    • "Daily counts of pharmaceutical dispensations were received for each LHA from the BC PharmaNet database. Law requires that every prescription dispensed in the province be recorded in PharmaNet, regardless of the recipient or the payer [29]. We decided a priori to examine relationships between PM2.5 and counts for inhaled salbutamol sulfate, a selective beta-2-adrenoreceptor agonist that is commonly and specifically used to rapidly relieve exacerbations of asthma, COPD, and other obstructive lung diseases. "
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    ABSTRACT: Background Several studies have evaluated the association between forest fire smoke and acute exacerbations of respiratory diseases, but few have examined effects on pharmaceutical dispensations. We examine the associations between daily fine particulate matter (PM2.5) and pharmaceutical dispensations for salbutamol in forest fire-affected and non-fire-affected populations in British Columbia (BC), Canada. Methods We estimated PM2.5 exposure for populations in administrative health areas using measurements from central monitors. Remote sensing data on fires were used to classify the populations as fire-affected or non-fire-affected, and to identify extreme fire days. Daily counts of salbutamol dispensations between 2003 and 2010 were extracted from the BC PharmaNet database. We estimated rate ratios (RR) and 95% confidence intervals (CIs) for each population during all fire seasons and on extreme fire days, adjusted for temperature, humidity, and temporal trends. Overall effects for fire-affected and non-fire-affected populations were estimated via meta-regression. Results Fire season PM2.5 was positively associated with salbutamol dispensations in all fire-affected populations, with a meta-regression RR (95% CI) of 1.06 (1.04-1.07) for a 10 ug/m3 increase. Fire season PM2.5 was not significantly associated with salbutamol dispensations in non-fire-affected populations, with a meta-regression RR of 1.00 (0.98-1.01). On extreme fire days PM2.5 was positively associated with salbutamol dispensations in both population types, with a global meta-regression RR of 1.07 (1.04 - 1.09). Conclusions Salbutamol dispensations were clearly associated with fire-related PM2.5. Significant associations were observed in smaller populations (range: 8,000 to 170,000 persons, median: 26,000) than those reported previously, suggesting that salbutamol dispensations may be a valuable outcome for public health surveillance during fire events.
    Environmental Health 01/2013; 12(1):11. DOI:10.1186/1476-069X-12-11 · 3.37 Impact Factor
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    • "For example, increased utilization of angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and HMG-CoA reductase inhibitors (commonly referred to as statins) for cardiovascular disease (CVD) management will likely lead to increased costs to patients. Increasing costs associated with procurement of these critically-important medications may produce an economic barrier to access these medications by patients [11]. Increased utilization of CVD medications may also increase their cost short-term, while non-adherence, procurement and their repercussions will also likely lead to overall higher costs to the system. "
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    ABSTRACT: Background Only a small amount of research has focused on the relationship between socio-economic status (SES) and geographic access to prescription medications at community pharmacies in North America and Europe. To examine the relationship between a community’s socio-economic context and its residents’ geographic access to common medications in pharmacies, we hypothesized that differences are present in access to pharmacies across communities with different socio-economic environments, and in availability of commonly prescribed medications within pharmacies located in communities with different socio-economic status. Methods We visited 408 pharmacies located in 168 socio-economically diverse communities to assess the availability of commonly prescribed medications. We collected the following information at each pharmacy visited: hours of operation, pharmacy type, in-store medication availability, and the cash price of the 13 most commonly prescribed medications. We calculated descriptive statistics for the sample and fitted a series of hierarchical linear models to test our hypothesis that the in-stock availability of medications differs by the socio-economic conditions of the community. This was accomplished by modeling medication availability in pharmacies on the socio-economic factors operating at the community level in a socio-economically devise urban area. Results Pharmacies in poor communities had significantly higher odds of medications being out of stock, OR=1.24, 95% CI [1.02, 1.52]. There was also a significant difference in density of smaller, independent pharmacies with very limited stock and hours of operation, and larger, chain pharmacies in poor communities as compared to the middle and low-poverty communities. Conclusions The findings suggest that geographic access to a neighborhood pharmacy, the type of pharmacy, and availability of commonly prescribed medications varies significantly across communities. In extreme cases, entire communities could be deemed “medication deserts” because geographic access to pharmacies and the availability of the most prescribed medications within them were very poor. To our knowledge, this study is first to report on the relationship between SES and geographic access to medications using small area econometric analysis techniques. Our findings should be reasonably generalizable to other urban areas in North America and Europe and suggest that more research is required to better understand the relationship of socio-economic environments and access to medications to develop strategies to achieve equitable medication access.
    International Journal of Health Geographics 11/2012; 11(1):48. DOI:10.1186/1476-072X-11-48 · 2.62 Impact Factor
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    • "In Ontario, drug listings are categorized as open, limited use (LU) or not listed. An income-based co-payment applies to all ODBP prescriptions, but open-listed drug costs are covered by the government for all plan beneficiaries, while LU drug costs are covered only if the patient meets specific criteria (Laupacis et al. 2002; Laupacis 2005; Morgan 2006; Ontario Ministry of Health and Long-Term Care 2003b). Coverage for drugs that are not listed can be accessed only on a per-patient basis through ODBP approval of individual physician requests. "
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    ABSTRACT: Reimbursement policies, such as those used to manage the public drug program for senior citizens in Ontario, focus on providing access to cost-effective drug therapies. These policies may create a dilemma for physicians who want to prescribe a particular drug to a patient, but must factor reimbursement restrictions affecting patient-level access into the prescribing decision. Information was collected from 102 physicians about prescriptions given to osteoarthritis patients (n=2,147) aged 65 years or older. Patients' access to prescribed drugs was determined from their insurance coverage and the reimbursement criteria set out in the formulary of the public Ontario Drug Benefit Program (ODBP). Starting from the assumption that physicians would follow published consensus guidelines respecting gastroprotection when prescribing NSAIDs in these at-risk elderly patients, three groups of physicians were identified from the record of their actual prescriptions. Group A physicians (n=14) prescribed non-selective NSAIDs alone to >60% of their patients. Group B physicians (n=26) prescribed an NSAID + gastroprotective agent or a Cox-2 selective NSAID to >70% of their patients. Group C physicians (n=62) were those that fit into neither category. An open-ended question was included in the study questionnaire to elicit physicians' own interpretation of what impact drug coverage had on their prescribing behaviour. No significant differences were found across groups with respect to years or type of practice, or to patient characteristics (LR=3.00, p>.2). Group C physicians were most likely to change their treatment choice in favour of restricted (limited use) drugs when patients met the criteria for reimbursement or had private insurance and therefore did not have to bear the additional cost out-of-pocket (LR=58.5; p<.0001). Most elderly at-risk patients are prescribed NSAIDs according to the prevailing guidelines. We found, however, that 40% of physicians have prescribing behaviour that favours non-evidence-based (Group A) or evidence-based (Group B) prescribing in this clinical setting irrespective of drug coverage. The remaining 60% of physicians appeared to be more responsive in their prescribing behaviour to financial constraints on patients' access to drugs. They also self-identified as most likely to change treatment if drug coverage had been different. These results have important implications for equity and quality of patient care. They also confirm that physicians' knowledge, values and self-efficacy are key determinants of prescribing behaviour and require further study to better understand how medical education and third-party policies and programs that govern pharmaceutical care are integrated into physicans' decision-making.
    Healthcare policy = Politiques de sante 12/2007; 3(2):e128-44. DOI:10.12927/hcpol.2007.19366
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