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Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence.

https://arctichealth.org/en/permalink/ahliterature165702
Source
Psychiatr Serv. 2007 Jan;58(1):79-84
Publication Type
Article
Date
Jan-2007
Author
Colette B Raymond
Steven G Morgan
Patricia A Caetano
Author Affiliation
Department of Pharmaceutical Services, Health Sciences Centre Hospital, Winnipeg, Manitoba, Canada. craymond@exchange.hsc.mb.ca
Source
Psychiatr Serv. 2007 Jan;58(1):79-84
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antidepressive Agents - therapeutic use
British Columbia - epidemiology
Child
Depressive Disorder, Major - drug therapy - epidemiology
Drug Prescriptions - statistics & numerical data
Drug Therapy - utilization
Female
Humans
Incidence
Male
Middle Aged
Prevalence
Abstract
Expenditures on antidepressants in Canada are rapidly increasing; yet few studies have analyzed the characteristics of antidepressant users. This study investigated the prevalence and incidence of antidepressant use in British Columbia over eight years.
Antidepressant utilization and demographic data were assessed for the population of British Columbia from 1996 to 2004. Prescription claims were identified within the PharmaNet database for serotonin reuptake inhibitors (SSRI), tricyclics, monoamine oxidase inhibitors, bupropion (categorized separately for smoking cessation), and "novel" antidepressants, such as venlafaxine. Incident utilization (dispensed "first" antidepressant after two years without an antidepressant claim) and prevalent utilization were analyzed. All cohort members were required to have continuous registration with British Columbia medical services for at least two years before the first antidepressant claim.
Prevalence of antidepressant use doubled, from 34 to 72 users per 1,000 population, between 1996 and 2004. The prevalence of particular classes of antidepressants also changed over time. Prevalence of novel antidepressants and SSRIs increased, although incidence of SSRIs decreased. Prevalent and incident use of bupropion for smoking cessation peaked in 1999 but then declined. Quarterly incident antidepressant use increased in 1998 and 1999 (6.5 and 11.3 users per 1,000) but decreased through 2004 (4.2 users per 1,000). Those aged 20 to 44 years and those aged 45 to 64 years showed the greatest peak in incident antidepressant use. A socioeconomic gradient in prescribing was observed.
Prevalent antidepressant use has increased dramatically since 1996. By contrast, incident use increased from 1998 to 1999 but then decreased through 2004. Many complex factors likely contribute to antidepressant prescribing patterns.
PubMed ID
17215416 View in PubMed
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Booming prescription drug expenditure: a population-based analysis of age dynamics.

https://arctichealth.org/en/permalink/ahliterature172853
Source
Med Care. 2005 Oct;43(10):996-1008
Publication Type
Article
Date
Oct-2005
Author
Steven G Morgan
Author Affiliation
Centre for Health Services and Policy Research, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada. morgan@chspr.ubc.ca
Source
Med Care. 2005 Oct;43(10):996-1008
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Age Factors
Aged
Aged, 80 and over
British Columbia
Child
Child, Preschool
Databases, Factual
Drug Costs - statistics & numerical data - trends
Drug Utilization - economics - statistics & numerical data - trends
Financing, Personal - statistics & numerical data - trends
Health Expenditures - statistics & numerical data - trends
Humans
Infant
Infant, Newborn
Middle Aged
Population Dynamics
Prescription Fees - statistics & numerical data - trends
Abstract
Prescription drug expenditures in North America have nearly doubled in the past 5 years, creating intense pressure for all public and private benefits managers and policymakers.
The objective of this study was to describe age-specific drug expenditure trends from 1996 to 2002 for the Canadian province of British Columbia.
This study shows changes in expenditures per capita quantified for 5 age categories: residents aged 0 to 19, 20 to 44, 45 to 64, 65 to 84, and 85 and older. The cost impacts of 7 determinants of prescription drug expenditures are quantified.
This study describes population-based, patient-specific pharmaceutical data showing the type, quantity, and cost of every prescription drug purchased by virtually all residents of British Columbia.
Population-wide expenditures per capita grew at a rate of 11.6% per annum. Growth was primarily driven by the selection of more costly drugs per course of treatment and increases in the number concomitant treatments received per patient. Population aging did not have a major impact on expenditures. However, expenditure per capita grew most rapid among residents aged 45 to 64, the cohort that expended most over the period. The aging of this demographic cohort may threaten the financial viability of age-based drug benefit programs.
PubMed ID
16166869 View in PubMed
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"Breakthrough" drugs and growth in expenditure on prescription drugs in Canada.

https://arctichealth.org/en/permalink/ahliterature173034
Source
BMJ. 2005 Oct 8;331(7520):815-6
Publication Type
Article
Date
Oct-8-2005
Author
Steven G Morgan
Kenneth L Bassett
James M Wright
Robert G Evans
Morris L Barer
Patricia A Caetano
Charlyn D Black
Author Affiliation
Centre for Health Services and Policy Research, University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3. morgan@chspr.ubc.ca
Source
BMJ. 2005 Oct 8;331(7520):815-6
Date
Oct-8-2005
Language
English
Publication Type
Article
Keywords
British Columbia
Drug Prescriptions - economics
Health Expenditures - trends
Humans
Notes
Cites: Aust Health Rev. 2004 Nov 8;28(2):171-8115527397
PubMed ID
16141448 View in PubMed
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Canadian policy makers' views on pharmaceutical reimbursement contracts involving confidential discounts from drug manufacturers.

https://arctichealth.org/en/permalink/ahliterature102770
Source
Health Policy. 2013 Oct;112(3):248-54
Publication Type
Article
Date
Oct-2013
Author
Steven G Morgan
Paige A Thomson
Jamie R Daw
Melissa K Friesen
Source
Health Policy. 2013 Oct;112(3):248-54
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Administrative Personnel
Canada
Contracts
Drug Industry - economics
Drug and Narcotic Control - economics
Formularies as Topic
Humans
Interviews as Topic
Negotiating
Policy Making
Prescription Drugs - economics
Reimbursement Mechanisms - economics
Abstract
Pharmaceutical policy makers are increasingly negotiating reimbursement contracts that include confidential price terms that may be affected by drug utilization volumes, patterns, or outcomes. Though such contracts may offer a variety of benefits, including the ability to tie payment to the actual performance of a product, they may also create potential policy challenges. Through telephone interviews about this type of contract, we studied the views of officials in nine of ten Canadian provinces. Use of reimbursement contracts involving confidential discounts is new in Canada and ideas about power and equity emerged as cross-cutting themes in our interviews. Though confidential rebates can lower prices and thereby increase coverage of new medicines, several policy makers felt they had little power in the decision to negotiate rebates. Study participants explained that the recent rise in the use of rebates had been driven by manufacturers' pricing tactics and precedent set by other jurisdictions. Several policy makers expressed concerns that confidential rebates could result in inter-jurisdictional inequities in drug pricing and coverage. Policy makers also noted un-insured and under-insured patients must pay inflated "list prices" even if rebates are negotiated by drug plans. The establishment of policies for disciplined negotiations, inter-jurisdictional cooperation, and provision of drug coverage for all citizens are potential solutions to the challenges created by this new pharmaceutical pricing paradigm.
PubMed ID
23809914 View in PubMed
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Canadians confront health care reform.

https://arctichealth.org/en/permalink/ahliterature179975
Source
Health Aff (Millwood). 2004 May-Jun;23(3):186-93
Publication Type
Article
Author
Julia Abelson
Matthew Mendelsohn
John N Lavis
Steven G Morgan
Pierre-Gerlier Forest
Marilyn Swinton
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario. abelsonj@mcmaster.ca
Source
Health Aff (Millwood). 2004 May-Jun;23(3):186-93
Language
English
Publication Type
Article
Keywords
Canada
Data Collection
Delivery of Health Care - organization & administration - standards
Health Care Reform
Health Services Accessibility
Humans
National Health Programs
Public Opinion
Abstract
In 2002 Canadians were less anxious about the state of their health care system than they were a few years earlier, when perceptions peaked that the system needed major reform. They expressed strong support in 2002 for maintaining the status quo on health care financing (that is, no user fees and no two-tier care) within the traditional domains of physician and hospital care. But they appeared more receptive to two-tier care and for-profit delivery for the newer and rapidly expanding domains of home care and high-tech care.
PubMed ID
15160816 View in PubMed
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The effect of cost on adherence to prescription medications in Canada.

https://arctichealth.org/en/permalink/ahliterature127937
Source
CMAJ. 2012 Feb 21;184(3):297-302
Publication Type
Article
Date
Feb-21-2012
Author
Michael R Law
Lucy Cheng
Irfan A Dhalla
Deborah Heard
Steven G Morgan
Author Affiliation
The Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC. mlaw@chspr.ubc.ca
Source
CMAJ. 2012 Feb 21;184(3):297-302
Date
Feb-21-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Canada - epidemiology
Child
Drug Costs - statistics & numerical data
Female
Health status
Health Surveys
Humans
Income
Insurance, Pharmaceutical Services - statistics & numerical data
Logistic Models
Male
Medication Adherence - statistics & numerical data
Middle Aged
Odds Ratio
Prescription Drugs - economics
Prevalence
Sex Factors
Young Adult
Abstract
Many patients do not adhere to treatment because they cannot afford their prescription medications, putting them at increased risk of adverse health outcomes. We determined the prevalence of cost-related nonadherence and investigated its associated characteristics, including whether a person has drug insurance.
Using data from the 2007 Canada Community Health Survey, we analyzed the responses of 5732 people who answered questions about cost-related nonadherence to treatment. We determined the national prevalence of cost-related nonadherence and used logistic regression to evaluate the association between cost-related nonadherence and a series of demographic and socioeconomic variables, including province of residence, age, sex, household income, health status and having drug insurance.
Cost-related nonadherence was reported by 9.6% (95% confidence interval [CI] 8.5%-10.6%) of Canadians who had received a prescription in the past year. In our adjusted model, we found that people in poor health (odds ratio [OR] 2.64, 95% CI 1.77-3.94), those with lower income (OR 3.29, 95% CI 2.03-5.33), those without drug insurance (OR 4.52, 95% CI 3.29-6.20) and those who live in British Columbia (OR 2.56, 95% CI 1.49-4.42) were more likely to report cost-related nonadherence. Predicted rates of cost-related nonadherence ranged from 3.6% (95% CI 2.4-4.5) among people with insurance and high household incomes to 35.6% (95% CI 26.1%-44.9%) among people with no insurance and low household incomes.
About 1 in 10 Canadians who receive a prescription report cost-related nonadherence. The variability in insurance coverage for prescription medications appears to be a key reason behind this phenomenon.
Notes
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Comment In: CMAJ. 2012 Jul 10;184(10):117522778162
PubMed ID
22249979 View in PubMed
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Effects of prescription adaptation by pharmacists.

https://arctichealth.org/en/permalink/ahliterature139248
Source
BMC Health Serv Res. 2010;10:313
Publication Type
Article
Date
2010
Author
Michael R Law
Steven G Morgan
Sumit R Majumdar
Larry D Lynd
Carlo A Marra
Author Affiliation
Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. mlaw@chspr.ubc.ca
Source
BMC Health Serv Res. 2010;10:313
Date
2010
Language
English
Publication Type
Article
Keywords
British Columbia
Cohort Studies
Community Pharmacy Services - legislation & jurisprudence - standards
Drug Prescriptions - statistics & numerical data
Drug Utilization - legislation & jurisprudence - statistics & numerical data
Female
Health Care Reform
Humans
Male
Pharmacists - legislation & jurisprudence - trends
Policy Making
Professional Autonomy
Professional Role
Risk assessment
Abstract
Granting dispensing pharmacists the authority to prescribe has significant implications for pharmaceutical and health human resources policy, and quality of care. Despite the growing number of jurisdictions that have given pharmacists such privileges, there are few rigorous evaluations of these policy changes. This study will examine a January 2009 policy change in British Columbia (BC), Canada that allowed pharmacists to independently adapt and renew prescriptions. We hypothesize this policy increased drug utilization and drug costs, increased patient adherence to medication, and reduced total healthcare resource use.
We will study a population-based cohort of approximately 4 million BC residents from 2004 through 2010. We will use data from BC PharmaNet on all of the prescriptions obtained by this cohort during the study period, and link it to administrative billings from physicians and hospital discharges. Using interrupted time series analysis, we will study longitudinal changes in drug utilization and costs, medication adherence, and short-term health care use. Further, using hierarchical modelling, we will examine the factors at the regional, pharmacy, patient, and prescription levels that are associated with prescription adaptations and renewals.
In a recent survey of Canadian policymakers, many respondents ranked the issue of prescribing privileges as one of their most pressing policy questions. No matter the results of our study, they will be important for policymakers, as our data will make policy decisions surrounding pharmacist prescribing more evidence-based.
Notes
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PubMed ID
21083922 View in PubMed
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The essential and potentially inappropriate use of antipsychotics across income groups: an analysis of linked administrative data.

https://arctichealth.org/en/permalink/ahliterature122044
Source
Can J Psychiatry. 2012 Aug;57(8):488-95
Publication Type
Article
Date
Aug-2012
Author
Joseph H Puyat
Michael R Law
Sabrina T Wong
Jason M Sutherland
Steven G Morgan
Author Affiliation
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia. jpuyat@interchange.ubc.ca
Source
Can J Psychiatry. 2012 Aug;57(8):488-95
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antipsychotic Agents - adverse effects - therapeutic use
Bipolar Disorder - diagnosis - drug therapy - psychology
British Columbia
Cohort Studies
Data Collection
Dementia - diagnosis - drug therapy - psychology
Drug Therapy, Combination
Drug Utilization - statistics & numerical data
Female
Healthcare Disparities
Humans
Inappropriate Prescribing
Income
Male
Middle Aged
Poverty
Schizophrenia - diagnosis - drug therapy
Schizophrenic Psychology
Young Adult
Abstract
To examine the essential and potentially inappropriate use of antipsychotics across income groups.
Linked health, pharmaceutical use, and income data from British Columbia were analyzed to examine antipsychotic use in 2 study cohorts. In the first cohort, the essential use of antipsychotics was assessed among adults who had a recorded diagnosis of schizophrenia in a 2-year period, 2004-2005. In the second cohort, potentially inappropriate use of antipsychotics was examined in people with no recorded diagnosis of schizophrenia or bipolar disorders in 2004-2005. The second cohort was also composed exclusively of seniors with a dementia-related diagnosis who are either in long-term care or living in the community. Income-related differences in antipsychotic use in these 2 cohorts were assessed using logistic regression, controlling for health and sociodemographic characteristics known to influence medicine use.
Among adults, the prevalence of essential antipsychotic use was high (85%), with higher odds of use evident among those in the middle-income group. Among seniors, the prevalence of potentially inappropriate antipsychotic treatment is 23%, with prevalence higher in long-term care (56%) than in the community (13%). No income-related differences were found in long-term care; however, in the community, higher odds of use were found in low-income seniors.
People from low-income households have slightly lower levels of essential antipsychotic use and are more likely to receive potentially inappropriate antipsychotic treatment.
Notes
Comment In: Evid Based Ment Health. 2013 May;16(2):5623416525
PubMed ID
22854031 View in PubMed
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Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada.

https://arctichealth.org/en/permalink/ahliterature281833
Source
CMAJ. 2017 Feb 27;189(8):E295-E302
Publication Type
Article
Date
Feb-27-2017
Author
Steven G Morgan
Winny Li
Brandon Yau
Nav Persaud
Source
CMAJ. 2017 Feb 27;189(8):E295-E302
Date
Feb-27-2017
Language
English
Publication Type
Article
Keywords
Canada
Cost Savings - economics
Drug Costs
Drugs, Essential - economics
Drugs, Generic - economics
Health Care Costs
Health Expenditures
Humans
Insurance, Pharmaceutical Services - economics
National Health Programs - economics
New Zealand
Prescription Drugs - economics
Sweden
United States
Universal Coverage - economics
Abstract
Canada's universal health care system does not include universal coverage of prescription drugs. We sought to estimate the effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada.
We used administrative and market research data to estimate the 2015 shares of the volume and cost of prescriptions filled in the community setting that were for 117 drugs on a model list of essential medicines for Canada. We compared prices of these essential medicines in Canada with prices in the United States, Sweden and New Zealand. We estimated the cost of adding universal public drug coverage of these essential medicines based on anticipated effects on medication use and pricing.
The 117 essential medicines on the model list accounted for 44% of all prescriptions and 30% of total prescription drug expenditures in 2015. Average prices of generic essential medicines were 47% lower in the US, 60% lower in Sweden and 84% lower in New Zealand; brand-name drugs were priced 43% lower in the US. Estimated savings from universal public coverage of these essential medicines was $4.27 billion per year (range $2.72 billion to $5.83 billion; 28% reduction) for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year (range $373 million to $1.98 billion; 11% reduction).
Our analysis showed that adding universal public coverage of essential medicines to the existing public drug plans in Canada could address most of Canadians' pharmaceutical needs and save billions of dollars annually. Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned.
Notes
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Erratum In: CMAJ. 2017 Apr 3;189(13):E51128385901
PubMed ID
28246223 View in PubMed
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Ethnic disparities in antipsychotic drug use in British Columbia: a cross-sectional retrospective study.

https://arctichealth.org/en/permalink/ahliterature131693
Source
Psychiatr Serv. 2011 Sep;62(9):1026-31
Publication Type
Article
Date
Sep-2011
Author
Joseph H Puyat
Gillian E Hanley
Colleen M Cunningham
Michael R Law
Sabrina T Wong
Jason M Sutherland
Steven G Morgan
Author Affiliation
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
Source
Psychiatr Serv. 2011 Sep;62(9):1026-31
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antipsychotic Agents - therapeutic use
British Columbia
Cross-Sectional Studies
Female
Healthcare Disparities
Humans
Male
Middle Aged
Psychotic Disorders - ethnology
Regression Analysis
Retrospective Studies
Abstract
This study examined ethnic disparities in antipsychotic therapy in a population with significant Asian representation.
Using a cross-sectional retrospective study design, self-reported ethnicity data pooled from three cycles of the Canadian Community Health Survey were linked to 2005 administrative data on physician, hospital, and pharmaceutical use in British Columbia, Canada. Logistic regression was used to model the association between ethnicity and the likelihood of filling one or more prescriptions for any antipsychotic, with controls for sex, age, residence, immigrant status, income, health status, and diagnoses of schizophrenia, bipolar disorder, depression, and dementia.
Of the 27,658 individuals in the sample, 2.2% filled at least one antipsychotic prescription. The proportion varied across ethnic groups: Chinese, 1.0%; other Asians, 1.2%; whites, 2.3%; nonwhite non-Asians, 2.8%; and mixed ethnicity, 4.3%. After adjustment for patient characteristics and diagnoses of schizophrenia and bipolar disorder, the likelihood of filling a prescription was found to be lower among Chinese (odds ratio [OR] = .47, 95% confidence interval [CI] = .24-.90) and higher among persons of mixed ethnicity (OR = 3.19, CI = 1.49-6.83). Further adjustment for depression and dementia diagnoses did not significantly change the ORs for the Chinese (OR = .49, CI = .25-.98) and the mixed ethnic groups (OR = 2.97, CI = 1.30-6.80).
Consistent with the existing literature on ethnic disparities in antipsychotic therapy, the study found evidence of persistent disparities in a population that has a significant number of Asians. Further studies should be done to identify possible causes of these disparities and to identify potential interventions that may reduce or eliminate them.
PubMed ID
21885580 View in PubMed
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20 records – page 1 of 2.