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Acute treatment of myocardial infarction in Canada 1999-2002.

https://arctichealth.org/en/permalink/ahliterature176049
Source
Can J Cardiol. 2005 Feb;21(2):145-52
Publication Type
Article
Date
Feb-2005
Author
Cynthia A Jackevicius
David Alter
Jafna Cox
Paul Daly
Shaun Goodman
Woganee Filate
Alice Newman
Jack V Tu
Author Affiliation
Pharmacy Department, University Health Network-Toronto General Hospital, Toronto, Ontario M5G 2C4. Cynthia.Jackevicius@uhn.on.ca
Source
Can J Cardiol. 2005 Feb;21(2):145-52
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Adult
Age Distribution
Aged
Angioplasty, Balloon
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Drug Utilization - statistics & numerical data
Emergency Service, Hospital
Female
Fibrinolytic Agents - contraindications - therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Myocardial Infarction - epidemiology - therapy
Myocardial Reperfusion - utilization
Patient Discharge
Physician's Practice Patterns - statistics & numerical data
Registries
Sex Distribution
Time Factors
Abstract
Therapy for management of acute myocardial infarction (AMI) varies according to patient, prescriber and geographical characteristics.
To describe the in-hospital use of reperfusion therapy for ST elevation MI (STEMI) and discharge use of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) and statins in patients presenting with either STEMI or non-STEMI in Canada from 1999 to 2002.
Four Canadian registries (FASTRAK II, Canadian Acute Coronary Syndromes, Enhanced Feedback for Effective Cardiac Treatment and Improving Cardiovascular Outcomes in Nova Scotia) were used to identify patients with AMI in Canada and to measure in-hospital reperfusion and medication use. Use rates were compared by age, sex, time period and geographical area, according to available data.
Use rates for reperfusion in STEMI patients ranged from 60% to 70%, primarily representing fibrinolytic therapy. A delay in presentation to hospital after symptom onset represented an impediment to timely therapy, which was particularly pronounced for women and elderly patients. Overall, less than 50% of patients met the door-to-needle target of less than 30 min. Medication use rates at discharge increased from 1999/2000 to 2000/2001 across the different data sources: acetylsalicylic acid, 83% to 88%; beta-blockers, 74% to 89%; ACEIs, 54% to 67%; statins, 41% to 53%; and calcium antagonists, 21% to 32%.
Canadian and provincial rates of use of evidence-based medications for the treatment of AMI have increased over time, although there remains room for improvement. A single, comprehensive data source would supply better insights into the management of AMI in Canada.
PubMed ID
15729413 View in PubMed
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Anticoagulation in atrial fibrillation. Is there a gap in care for ambulatory patients?

https://arctichealth.org/en/permalink/ahliterature177716
Source
Can Fam Physician. 2004 Sep;50:1244-50
Publication Type
Article
Date
Sep-2004
Author
Wayne Putnam
Kelly Nicol
David Anderson
Brenda Brownell
Meredith Chiasson
Frederick I Burge
Gordon Flowerdew
Jafna Cox
Author Affiliation
Dalhousie University, Department of Family Medicine, Dalhousie University, Halifax, NS. Wayne.Putnam@Dal.ca
Source
Can Fam Physician. 2004 Sep;50:1244-50
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anticoagulants - contraindications - therapeutic use
Atrial Fibrillation - complications - drug therapy
Drug Utilization
Family Practice
Female
Health Care Surveys
Humans
Male
Middle Aged
Nova Scotia
Patient compliance
Physician's Practice Patterns
Stroke - complications - prevention & control
Warfarin - contraindications - therapeutic use
Abstract
Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy.
Telephone survey of family physicians regarding specific patients in their practices.
Nova Scotia.
Ambulatory AF patients not taking warfarin who had risk factors that made anticoagulation appropriate.
Proportion of patients removed from the care gap; reasons given for not giving the remainder anticoagulants.
Half the patients thought to be in the care gap had previously unknown contraindications to anticoagulation, lacked a clear indication for anticoagulation, or were taking warfarin. Patients' refusal and anticipated problems with compliance and monitoring were among the reasons for not giving patients anticoagulants.
Adding data from primary care physicians significantly narrowed the care gap. Attention should focus on the remaining reasons for not giving eligible patients anticoagulants.
Notes
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PubMed ID
15508374 View in PubMed
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The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.

https://arctichealth.org/en/permalink/ahliterature179979
Source
CMAJ. 2004 May 25;170(11):1678-86
Publication Type
Article
Date
May-25-2004
Author
G Ross Baker
Peter G Norton
Virginia Flintoft
Régis Blais
Adalsteinn Brown
Jafna Cox
Ed Etchells
William A Ghali
Philip Hébert
Sumit R Majumdar
Maeve O'Beirne
Luz Palacios-Derflingher
Robert J Reid
Sam Sheps
Robyn Tamblyn
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, McMurrich Building Room 2031, 12 Queen's Park Crescent West, Toronto, Ontario M5S 1A8, Canada. ross.baker@utoronto.ca
Source
CMAJ. 2004 May 25;170(11):1678-86
Date
May-25-2004
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Health Facility Size
Hospital Mortality
Hospitals, Community - standards - statistics & numerical data - utilization
Hospitals, Teaching - standards - statistics & numerical data - utilization
Humans
Iatrogenic Disease - epidemiology - prevention & control
Incidence
Length of Stay - statistics & numerical data
Medical Audit - methods
Medical Errors - prevention & control - statistics & numerical data
Patient Admission - statistics & numerical data
Patient Advocacy
Safety Management - standards
Abstract
Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals.
We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability.
At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7- 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016).
The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.
Notes
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Comment In: CMAJ. 2004 Oct 12;171(8):833; author reply 83415477611
Comment In: CMAJ. 2004 Oct 12;171(8):833-4; author reply 83415477610
Comment In: CMAJ. 2004 Oct 12;171(8):832; author reply 83415477609
Comment In: CMAJ. 2004 Oct 12;171(8):829, 832; author reply 83415477606
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Comment In: CMAJ. 2004 Oct 12;171(8):834; author reply 83415477613
Comment In: CMAJ. 2010 Aug 10;182(11):121420696812
PubMed ID
15159366 View in PubMed
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Canadian Cardiovascular Society atrial fibrillation guidelines 2010: catheter ablation for atrial fibrillation/atrial flutter.

https://arctichealth.org/en/permalink/ahliterature136941
Source
Can J Cardiol. 2011 Jan-Feb;27(1):60-6
Publication Type
Conference/Meeting Material
Article
Author
Atul Verma
Laurent Macle
Jafna Cox
Allan C Skanes
Author Affiliation
Southlake Regional Health Centre, Newmarket, Ontario, Canada. atul.verma@utoronto.ca
Source
Can J Cardiol. 2011 Jan-Feb;27(1):60-6
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Ambulatory Surgical Procedures
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - etiology - surgery
Atrial Flutter - surgery
Canada
Catheter Ablation - adverse effects - methods
Heart Atria - surgery
Humans
Patient Selection
Postoperative Complications - etiology
Pulmonary Veins - surgery
Reoperation
Treatment Outcome
Abstract
Catheter ablation of atrial fibrillation (AF) offers a promising treatment for the maintenance of sinus rhythm in patients for whom a rhythm control strategy is desired. While the precise mechanisms of AF are incompletely understood, there is substantial evidence that in many cases (particularly for paroxysmal AF), ectopic activity most commonly located in and around the pulmonary veins of the left atrium plays a central role in triggering and/or maintaining arrhythmic episodes. Catheter ablation involves electrically disconnecting the pulmonary veins from the rest of the left atrium to prevent AF from being triggered. Further substrate modification may be required in patients with more persistent AF. Successful ablation of AF has never been shown to alter mortality or obviate the need for oral anticoagulation; thus, the primary indication for this procedure should be improvement of symptoms caused by AF. The success rate of catheter ablation for AF is superior to the efficacy of antiarrhythmic drugs, but success is still in the range of 75%-90% after 2 procedures. Ablation is also associated with a complication rate of 2%-3%. Thus, ablation should primarily be used as a second-line therapy after failure of antiarrhythmic drugs. In contrast to AF, catheter ablation of atrial flutter has a higher success rate with a smaller incidence of complications. Thus, catheter ablation for atrial flutter may be considered a first-line alternative to antiarrhythmic drugs.
PubMed ID
21329863 View in PubMed
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Canadian Network and Centre for Trials Internationally (CANNeCTIN): a national network for Canadian-led trials in cardiovascular diseases and diabetes mellitus.

https://arctichealth.org/en/permalink/ahliterature140738
Source
Can J Cardiol. 2010 Aug-Sep;26(7):353-8
Publication Type
Article
Author
John A Cairns
Salim Yusuf
Richard J Cook
Jafna Cox
Gilles R Dagenais
P J Devereaux
Finlay A McAlister
Tara McCready
Author Affiliation
University of British Columbia, Vancouver, British Columbia. jacairns@medd.med.ubc.ca
Source
Can J Cardiol. 2010 Aug-Sep;26(7):353-8
Language
English
Publication Type
Article
Keywords
Biomedical Research - organization & administration
Canada
Cardiovascular diseases
Clinical Trials as Topic
Diabetes mellitus
Health Services Research - organization & administration
Humans
International Cooperation
Multicenter Studies as Topic
Pilot Projects
Randomized Controlled Trials as Topic
Abstract
The Canadian Network and Centre for Trials INternationally (CANNeCTIN) was jointly funded by the Canadian Institutes of Health Research and the Canadian Foundation for Innovation in April 2008 to provide infrastructure for clinical studies of cardiovascular diseases and diabetes mellitus. Its functional components include a national coordinating centre at the Population Health Research Institute (PHRI) in Hamilton (Ontario), a collaborative Canadian network and an affiliated international network of hospitals and clinics. The rationales for CANNeCTIN include the global health burden of cardiovascular diseases and diabetes, the strengths of randomized controlled trials - particularly large, multicentre and international - and the track record of success of the PHRI. CANNeCTIN will provide investigators from across Canada with opportunities to become the principal investigators of national and international trials coordinated by the PHRI. CANNeCTIN will support priority pilot studies, and successful investigators will be encouraged and assisted to apply for peer review and industrial funding for full studies to be conducted within the network and coordinated by the PHRI. An extensive education program offers hands-on experience in organizing and leading large national/international clinical trials led by accomplished researchers, distance learning courses in clinical research methodology, biostatistics and study coordination, and 'cutting-edge' workshops. A knowledge translation program seeks opportunities arising from clinical trials and encourages research into this paradigm for understanding how best to close the gaps between knowledge and effective practice. The five-year goals are to enhance the capacity of Canadian investigators to lead major clinical studies, facilitate knowledge translation and exchange, and augment Canada's capacity to train the next generation of leaders in cardiovascular and diabetes clinical research.
Notes
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PubMed ID
20847960 View in PubMed
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Cardiac procedures after an acute myocardial infarction across nine Canadian provinces.

https://arctichealth.org/en/permalink/ahliterature180468
Source
Can J Cardiol. 2004 Apr;20(5):491-500
Publication Type
Article
Date
Apr-2004
Author
Louise Pilote
Patrick Merrett
Igor Karp
David Alter
Peter C Austin
Jafna Cox
Helen Johansen
William Ghali
Jack V Tu
Author Affiliation
McGill University Health Centre at the Montreal General Hospital, Montreal, Quebec, Canada. louise.pilote@mcgill.ca
Source
Can J Cardiol. 2004 Apr;20(5):491-500
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Angioplasty, Balloon, Coronary - utilization
Canada - epidemiology
Coronary Artery Bypass - utilization
Female
Health Services Needs and Demand - statistics & numerical data
Humans
Longitudinal Studies
Male
Medical Records
Middle Aged
Myocardial Infarction - epidemiology - etiology - therapy
Retrospective Studies
Sex Distribution
Waiting Lists
Abstract
Geographical variations in the use of invasive cardiac procedures have been documented. It remains unclear to what extent these variations exist across the Canadian provinces.
To describe variation in the use of invasive cardiac procedures and waiting times for these procedures across nine Canadian provinces.
Using longitudinal, de-identified patient data from the Canadian Institute for Health Information, records of patients who had suffered an acute myocardial infarction (AMI) in each of nine Canadian provinces between 1997/1998 and 1999/2000 were selected. Rates and median waiting times for percutaneous coronary intervention and coronary artery bypass graft surgery were calculated by age, sex and health region.
There was a large variation in the use of and waiting times for invasive cardiac procedures across the Canadian provinces studied. In general, cardiac procedure rates in Western provinces were higher than in Eastern provinces, most notably higher than in the Maritime provinces and Ontario. In addition to interprovincial variation, there was also significant regional variation in the rates of revascularization and waiting times. Rates of percutaneous coronary intervention increased over the study period, whereas rates of bypass surgery remained relatively stable.
Significant variation in the use of cardiac procedures after AMI exists across Canada and this April represent potential inequalities in the treatment of AMI across Canada.
PubMed ID
15100750 View in PubMed
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Cardiovascular outcomes after a change in prescription policy for clopidogrel.

https://arctichealth.org/en/permalink/ahliterature154590
Source
N Engl J Med. 2008 Oct 23;359(17):1802-10
Publication Type
Article
Date
Oct-23-2008
Author
Cynthia A Jackevicius
Jack V Tu
Virginie Demers
Magda Melo
Jafna Cox
Stephane Rinfret
Dimitri Kalavrouziotis
Helen Johansen
Hassan Behlouli
Alice Newman
Louise Pilote
Author Affiliation
Western University of Health Sciences, College of Pharmacy, 309 E. Second St., Pomona, CA 91766, USA. cjackevicius@westernu.edu
Source
N Engl J Med. 2008 Oct 23;359(17):1802-10
Date
Oct-23-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary
Aspirin - therapeutic use
Coronary Artery Bypass
Drug Therapy, Combination
Female
Health Policy
Hemorrhage - epidemiology
Humans
Insurance Benefits
Insurance, Health, Reimbursement
Insurance, Pharmaceutical Services
Male
Myocardial Infarction - drug therapy - mortality - therapy
National Health Programs
Ontario
Physician's Practice Patterns - trends
Platelet Aggregation Inhibitors - therapeutic use
Recurrence
Stents
Ticlopidine - analogs & derivatives - therapeutic use
Abstract
Drug-reimbursement policies may have an adverse effect on patient outcomes if they interfere with timely access to efficacious medications for acute medical conditions. Clopidogrel in combination with aspirin is the recommended standard of care for patients receiving coronary stents to prevent thrombosis. We examined the population-level effect of a change by a Canadian provincial government in a pharmacy-benefits program from a prior-authorization policy to a less restrictive, limited-use policy on access to clopidogrel among patients undergoing percutaneous coronary intervention (PCI) with stenting after acute myocardial infarction.
We conducted a population-based, retrospective, time-series analysis from April 1, 2000, to March 31, 2005, of all patients 65 years of age or older with acute myocardial infarction who underwent PCI with stenting in Ontario, Canada. The primary outcome was the composite rate of death, recurrent acute myocardial infarction, PCI, and coronary-artery bypass grafting at 1 year, with adjustment for sex and age. The secondary outcome was major bleeding.
The rate of clopidogrel use within 30 days after hospital discharge following myocardial infarction increased from 35% in the prior-authorization period to 88% in the limited-use period. The median time to the first dispensing of a clopidogrel prescription decreased from 9 days in the first period to 0 days in the second period. The 1-year composite cardiovascular outcome significantly decreased from 15% in the prior-authorization group to 11% in the limited-use group (P=0.02). Rates of bleeding in the two groups did not change.
The removal of a prior-authorization program led to improvement in timely access to clopidogrel for coronary stenting and improved cardiovascular outcomes.
PubMed ID
18946065 View in PubMed
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CCORT/CCS quality indicators for acute myocardial infarction care.

https://arctichealth.org/en/permalink/ahliterature186778
Source
Can J Cardiol. 2003 Jan;19(1):38-45
Publication Type
Article
Date
Jan-2003
Author
Chau T T Tran
Douglas S Lee
Virginia F Flintoft
Lyall Higginson
F Curry Grant
Jack V Tu
Jafna Cox
Doug Holder
Cynthia Jackevicius
Louise Pilote
Paul Tanser
Christopher Thompson
Edward Tsoi
Wayne Warnica
Andreas Wielgosz
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario.
Source
Can J Cardiol. 2003 Jan;19(1):38-45
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Ambulatory Care
Benchmarking
Canada
Cardiovascular Agents - standards - therapeutic use
Guideline Adherence
Humans
International Classification of Diseases
Length of Stay
Myocardial Infarction - diagnosis - therapy
Outcome and Process Assessment (Health Care)
Quality Indicators, Health Care - standards
Abstract
Although quality indicators for the care of acute myocardial infarction (AMI) patients have been described for other countries, there are none specifically designed for the Canadian health care system. The authors' goal was to develop a set of Canadian quality indicators for AMI care.
A literature review identified existing quality indicators for AMI care. A list of potential indicators was assessed by a nine-member panel of clinicians from a variety of disciplines using a modified-Delphi panel process. After an initial round of rating the potential indicators, a series of indicators was identified for a second round of discussion at a national meeting. Further refinement of indicators occurred following a teleconference and review by external reviewers.
To identify an AMI cohort, case definition criteria were developed, using a hospital discharge diagnosis for AMI of International Classification of Diseases-Ninth revision (ICD-9) code 410.x. Thirty-seven indicators for AMI care were established. Pharmacological process of care indicators included administration of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors, thrombolytics and statins. Mortality and readmissions for AMI, unstable angina and congestive heart failure were recommended as outcome indicators. Nonpharmacological indicators included median length of stay in the emergency department, and median waiting times for cardiac catheterization, percutaneous coronary intervention and/or coronary artery bypass graft surgery.
A set of Canadian quality indicators for the care of AMI patients has been established. It is anticipated that these indicators will be useful to clinicians and researchers who want to measure and improve the quality of AMI patient care in Canada.
PubMed ID
12571693 View in PubMed
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Comparison of machine learning techniques with classical statistical models in predicting health outcomes.

https://arctichealth.org/en/permalink/ahliterature178470
Source
Stud Health Technol Inform. 2004;107(Pt 1):736-40
Publication Type
Article
Date
2004
Author
Xiaowei Song
Arnold Mitnitski
Jafna Cox
Kenneth Rockwood
Author Affiliation
Geriatric Medicine Research Unit, QE II Health Sciences Centre, Canada.
Source
Stud Health Technol Inform. 2004;107(Pt 1):736-40
Date
2004
Language
English
Publication Type
Article
Keywords
Aged
Area Under Curve
Artificial Intelligence
Canada
Dementia - mortality
Female
Health status
Humans
Male
Models, Statistical
Myocardial Infarction - mortality - therapy
Neural Networks (Computer)
Prognosis
ROC Curve
Treatment Outcome
Abstract
Several machine learning techniques (multilayer and single layer perceptron, logistic regression, least square linear separation and support vector machines) are applied to calculate the risk of death from two biomedical data sets, one from patient care records, and another from a population survey. Each dataset contained multiple sources of information: history of related symptoms and other illnesses, physical examination findings, laboratory tests, medications (patient records dataset), health attitudes, and disabilities in activities of daily living (survey dataset). Each technique showed very good mortality prediction in the acute patients data sample (AUC up to 0.89) and fair prediction accuracy for six year mortality (AUC from 0.70 to 0.76) in individuals from epidemiological database surveys. The results suggest that the nature of data is of primary importance rather than the learning technique. However, the consistently superior performance of the artificial neural network (multi-layer perceptron) indicates that nonlinear relationships (which cannot be discerned by linear separation techniques) can provide additional improvement in correctly predicting health outcomes.
PubMed ID
15360910 View in PubMed
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Comparison of provincial prescription drug plans and the impact on patients' annual drug expenditures.

https://arctichealth.org/en/permalink/ahliterature158858
Source
CMAJ. 2008 Feb 12;178(4):405-9
Publication Type
Article
Date
Feb-12-2008
Author
Virginie Demers
Magda Melo
Cynthia Jackevicius
Jafna Cox
Dimitri Kalavrouziotis
Stéphane Rinfret
Karin H Humphries
Helen Johansen
Jack V Tu
Louise Pilote
Author Affiliation
Division of General Internal Medicine, McGill University Health Centre, Montréal, Que.
Source
CMAJ. 2008 Feb 12;178(4):405-9
Date
Feb-12-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cost Sharing - economics - trends
Drug Prescriptions - economics - statistics & numerical data
Drug Utilization - economics - trends
Health Expenditures - trends
Humans
Insurance, Pharmaceutical Services - statistics & numerical data - utilization
Middle Aged
Regional Medical Programs
Reimbursement Mechanisms
Retrospective Studies
Abstract
Reimbursement for outpatient prescription drugs is not mandated by the Canada Health Act or any other federal legislation. Provincial governments independently establish reimbursement plans. We sought to describe variations in publicly funded provincial drug plans across Canada and to examine the impact of this variation on patients' annual expenditures.
We collected information, accurate to December 2006, about publicly funded prescription drug plans from all 10 Canadian provinces. Using clinical scenarios, we calculated the impact of provincial cost-sharing strategies on individual annual drug expenditures for 3 categories of patients with different levels of income and 2 levels of annual prescription burden ($260 and $1000).
We found that eligibility criteria and cost-sharing details of the publicly funded prescription drug plans differed markedly across Canada, as did the personal financial burden due to prescription drug costs. Seniors pay 35% or less of their prescription costs in 2 provinces, but elsewhere they may pay as much as 100%. With few exceptions, nonseniors pay more than 35% of their prescription costs in every province. Most social assistance recipients pay 35% or less of their prescription costs in 5 provinces and pay no costs in the other 5. In an example of a patient with congestive heart failure, his out-of-pocket costs for a prescription burden of $1283 varied between $74 and $1332 across the provinces.
Considerable interprovincial variation in publicly funded prescription drug plans results in substantial variation in annual expenditures by Canadians with identical prescription burdens. A revised pharmaceutical strategy might reduce these major inequities.
Notes
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