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Adherence to beta-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature162000
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Publication Type
Article
Date
Aug-2007
Author
Sebastian Schneeweiss
Amanda R Patrick
Malcolm Maclure
Colin R Dormuth
Robert J Glynn
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St (Ste 3030), Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - economics - therapeutic use
Aged
Aged, 80 and over
British Columbia
Case-Control Studies
Cohort Studies
Comorbidity
Cost Sharing
Deductibles and Coinsurance
Diabetes Complications
Female
Health Policy - trends
Humans
Male
Medical Record Linkage
Myocardial Infarction - drug therapy - economics
Patient Compliance - statistics & numerical data
Prescription Fees
Vascular Diseases
Abstract
To evaluate the effects of patient copayment and coinsurance policies on adherence to therapy with beta-adrenergic blocking agents (beta-blockers) and on the rate of initiation of beta-blocker therapy after acute myocardial infarction (MI) in a population-based natural experiment.
Three sequential cohorts included British Columbia residents age 66 years and older who initiated beta-blocker therapy during time intervals with full drug coverage (2001), a $10 or $25 copayment (2002), and 25% coinsurance (2003-2004). We used linked data on all prescription drug dispensings, physician services, and hospitalizations. Follow-up of each cohort was 9 months after the policy changes.
We measured the proportion of subjects in each cohort who were adherent to beta-blocker therapy over time, with adherence defined as having >80% of days covered. We also measured the proportion of patients initiating beta-blocker therapy after acute MI. Policy effects were evaluated using multivariable regression.
Adherence to beta-blocker therapy was marginally reduced as a consequence of the copayment policy (-1.3 percentage points, 95% confidence interval [CI] = -2.5 , -0.04) or the coinsurance policy (-0.8 percentage points, 95% CI = -2.0, 0.3). The proportion of patients initiating beta-blockers after hospitalization for acute MI remained steady at about 61% during the study period, similar to that observed in a control population of elderly Pennsylvania residents with full drug coverage.
Fixed patient copayment and coinsurance policies had little negative effect on adherence to relatively inexpensive beta-blocker therapy, or initiation of beta-blockers after acute MI.
Notes
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PubMed ID
17685825 View in PubMed
Less detail

A conceptual framework for the roles of legislation and education in reducing exposure to environmental tobacco smoke.

https://arctichealth.org/en/permalink/ahliterature225567
Source
Am J Health Promot. 1991 Nov-Dec;6(2):105-11
Publication Type
Article
Author
L L Pederson
J M Wanklin
S B Bull
M J Ashley
Author Affiliation
Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.
Source
Am J Health Promot. 1991 Nov-Dec;6(2):105-11
Language
English
Publication Type
Article
Keywords
Attitude to Health
Health education
Health Policy - legislation & jurisprudence
Health promotion
Humans
Legislation, Medical
Models, Theoretical
Ontario
Smoking
Social Control, Informal
Tobacco Smoke Pollution - legislation & jurisprudence
Abstract
More and more legislation regulating smoking in public places is being enacted. A conceptual model is proposed incorporating a large number of factors that may affect smokers' compliance with resulting restrictions. The model stems from findings in our own research and from a consideration of the literature. It includes individual variables such as personality characteristics and attitudes, as well as population variables such as social norms and political and economic factors. Education about the health effects of environmental tobacco smoke and attitudes toward legislative measures regulating smoking, in the context of a supportive environment, are postulated to directly affect personal compliance with regulations. Some directions for future research and implications for public policy are presented.
PubMed ID
10148684 View in PubMed
Less detail

Dimensions underlying legislator support for tobacco control policies.

https://arctichealth.org/en/permalink/ahliterature185177
Source
Tob Control. 2003 Jun;12(2):133-9
Publication Type
Article
Date
Jun-2003
Author
N A de Guia
J E Cohen
M J Ashley
R. Ferrence
J. Rehm
D T Studlar
D. Northrup
Author Affiliation
Ontario Tobacco Research Unit, Centre for Health Promotion, University of Toronto, Toronto, Ontario, Canada. ndeguia@cihi.ca
Source
Tob Control. 2003 Jun;12(2):133-9
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Canada
Cross-Sectional Studies
Health Policy - legislation & jurisprudence
Humans
Multivariate Analysis
Politics
Public Opinion
Smoking - legislation & jurisprudence - prevention & control
Tobacco Industry - legislation & jurisprudence
Abstract
To propose and test a new classification system for characterising legislator support for various tobacco control policies.
Cross sectional study.
Federal and provincial legislators in Canada serving as of October 1996 who participated in the Canadian Legislator Study (n = 553; response rate 54%).
A three factor model (Voters, Tobacco industry, Other interest groups) that assigns nine tobacco control policies according to legislators' hypothesised perceptions of which group is more directly affected by these policies.
Based on confirmatory factor analysis, the proposed model had an acceptable fit and showed construct validity. Multivariate analysis indicated that three of the predictors (believing that the government has a role in health promotion, being a non-smoker, and knowledge that there are more tobacco than alcohol caused deaths) were associated with all three factor scales. Several variables were associated with two of the three scales. Some were unique to each scale.
Based on our analyses, legislator support for tobacco control policies can be grouped according to our a priori factor model. The information gained from this work can help advocates understand how legislators think about different types of tobacco control policies. This could lead to the development of more effective advocacy strategies.
Notes
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PubMed ID
12773721 View in PubMed
Less detail

Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications.

https://arctichealth.org/en/permalink/ahliterature156082
Source
Clin Ther. 2008;30 Spec No:1038-50
Publication Type
Article
Date
2008
Author
Colin R Dormuth
Malcolm Maclure
Robert J Glynn
Peter Neumann
Alan M Brookhart
Sebastian Schneeweiss
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. colin.dormuth@ti.ubc.ca
Source
Clin Ther. 2008;30 Spec No:1038-50
Date
2008
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adrenergic beta-Agonists - economics - therapeutic use
Aged
Aged, 80 and over
Asthma - drug therapy
Canada
Cholinergic Antagonists - economics - therapeutic use
Cohort Studies
Deductibles and Coinsurance - economics
Drug Utilization
Emergency Service, Hospital - statistics & numerical data
Emphysema - drug therapy
Female
Glucocorticoids - economics - therapeutic use
Health Policy
Health Services - utilization
Humans
Insurance Claim Review
Lung Diseases - drug therapy
Male
Pulmonary Disease, Chronic Obstructive - drug therapy
State Health Plans - economics
Abstract
Rapid growth in prescription drug costs has compelled insurers to require increased patient cost-sharing.
The aim of this study was to compare the effects of 2 recent cost-sharing policies on emergency hospitalizations due to chronic obstructive pulmonary disease, asthma, or emphysema (CAE), and on physician visits.
We analyzed data from a large-scale natural experiment in British Columbia (BC), Canada. The cost-sharing policies were a fixed copayment policy (fixed copay policy) and an income-based deductible (IBD) policy with 25% coinsurance (IBD policy). Prescription, physician billing, and hospitalization records were obtained from the BC Ministry of Health. From the total population of BC residents > or = 65 years of age, we extracted data from all patients dispensed an inhaled corticosteroid, beta(2)-agonist, or anticholinergic from June 30, 1997, to April 30, 2004. Poisson regression was used to evaluate the impact of the policies in a cohort of patients receiving long-term inhaler treatment. An identically defined historical control group unaffected by the policy changes was used for comparison.
The study population included 37,320 users of long-term inhaled medications from the BC population of 576,000 persons > or = 65 years of age. During the IBD period but not the fixed copay period, emergency hospitalizations for CAE increased 41% (95% CI for adjusted rate ratio [RR], 1.24-1.60) in patients > or = 65 years of age. There was also a significant increase in physician visits of 3% (95% CI for adjusted RR, 1.01-1.05). No significant increases were observed during the fixed copay period. In a secondary analysis using a concurrent control group, we estimated a smaller but significant increase in emergency CAE hospitalizations of 29% (95% CI for adjusted RR, 1.09-1.52). This analysis also showed increases in physician visits (fixed copay period RR, 1.03 [95% CI for adjusted RR, 1.01-1.05]; IBD period RR, 1.07 [95% CI for adjusted RR, 1.05-1.08]).
The results suggest that the IBD policy was likely associated with an increased risk for emergency hospitalization and physician visits in these users of inhaled medications who were aged > or = 65 years.
Notes
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PubMed ID
18640478 View in PubMed
Less detail

How Canadian legislators view health promotion: does party affiliation matter?

https://arctichealth.org/en/permalink/ahliterature195322
Source
Can J Public Health. 2001 Jan-Feb;92(1):16-8
Publication Type
Article
Author
M J Ashley
J E Cohen
D A Northrup
R G Ferrence
Author Affiliation
Department of Public Health Sciences, University of Toronto, Toronto, ON M5S 1A8. maryjane.ashley@utoronto.ca
Source
Can J Public Health. 2001 Jan-Feb;92(1):16-8
Language
English
Publication Type
Article
Keywords
Attitude to Health
Canada
Data Collection
Health Policy
Health Promotion - legislation & jurisprudence
Humans
National Health Programs
Politics
PubMed ID
11257983 View in PubMed
Less detail

The impact of cost sharing on antidepressant use among older adults in British Columbia.

https://arctichealth.org/en/permalink/ahliterature157979
Source
Psychiatr Serv. 2008 Apr;59(4):377-83
Publication Type
Article
Date
Apr-2008
Author
Philip S Wang
Amanda R Patrick
Colin R Dormuth
Jerry Avorn
Malcolm Maclure
Claire F Canning
Sebastian Schneeweiss
Author Affiliation
National Institute of Mental Health, Bethesda, MD 20892-9629, USA. wangphi@mail.nih.gov
Source
Psychiatr Serv. 2008 Apr;59(4):377-83
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Adrenergic Uptake Inhibitors - therapeutic use
Aged
Antidepressive Agents - therapeutic use
British Columbia - epidemiology
Cost Sharing - statistics & numerical data
Depressive Disorder - drug therapy - epidemiology
Drug Therapy - trends - utilization
Female
Health Policy
Humans
Imipramine - therapeutic use
Male
Middle Aged
Prevalence
Abstract
Antidepressant therapies are underused among older adults and could be further curtailed by patient cost-sharing requirements. The authors studied the effects of two sequential cost-sharing policies in a large, stable population of all British Columbia seniors: change from full prescription coverage to 10-25 dollars copayments (copay) in January 2002 and replacement with income-based deductibles and 25% coinsurance in May 2003.
PharmaNet data were used to calculate monthly dispensing of antidepressants (in imipramine-equivalent milligrams) among all British Columbia residents age 65 and older beginning January 1997 through December 2005. Monthly rates of starting and stopping antidepressants were calculated. Population-level patterns over time were plotted, and the effects of implementing cost-sharing policies on antidepressant use, initiation, and stopping were examined in segmented linear regression models.
Implementation of the copay policy was not associated with significant changes in level of antidepressant dispensing or the rate of dispensing growth. Subsequent implementation of the income-based deductible policy also did not lead to a significant change in dispensing level but led to a significant (p=.02) decrease in the rate of growth of antidepressant dispensing. The copay policy was associated with a significant (p=.01) drop in the frequency of antidepressant initiation among persons with depression. Income-based deductibles reduced the rate of increase in antidepressant initiation over time. Implementation of the copay and income-based deductible policies did not have significant effects on stopping rates.
Introducing new forms of medication cost sharing appears to have the potential to reduce some use and initiation of antidepressant therapy by seniors. The clinical consequences of such reduced use need to be clarified.
Notes
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PubMed ID
18378836 View in PubMed
Less detail

Is nicotine dependence related to smokers' support for restrictions on smoking?

https://arctichealth.org/en/permalink/ahliterature193683
Source
Nicotine Tob Res. 2001 Aug;3(3):257-60
Publication Type
Article
Date
Aug-2001
Author
C. Lacchetti
J. Cohen
M J Ashley
R. Ferrence
S. Bull
M. de Groh
L. Pederson
Author Affiliation
Ontario Tobacco Research Unit, Centre for Health Promotion, University of Toronto, Canada.
Source
Nicotine Tob Res. 2001 Aug;3(3):257-60
Date
Aug-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude
Behavior, addictive - psychology
Cross-Sectional Studies
Environment
Female
Health Policy - legislation & jurisprudence
Health Promotion - legislation & jurisprudence
Humans
Male
Middle Aged
Ontario - epidemiology
Questionnaires
Severity of Illness Index
Smoking - epidemiology - prevention & control - psychology
Tobacco Use Disorder - diagnosis - epidemiology - psychology
Abstract
To examine the relationship between nicotine dependence and attitudes, predicted behaviours and support regarding restrictions on smoking.
Population-based, computer-assisted, telephone survey of adults in Ontario, Canada using a two-stage stratified sampling design; 1764 interviews were completed (65% response rate) yielding 424 (24%) cigarette smokers, of whom 354 (83%) smoked daily. The Heaviness of Smoking Index was used as a measure of nicotine dependence.
Attitudes toward smoking restrictions, predicted compliance with more restrictions, and support for total smoking bans.
Attitudes favorable to smoking restrictions tended to decrease with increased nicotine dependence, but the associations were not statistically significant after adjusting for demographic variables. Predicted compliance with more restrictions on smoking decreased with higher levels of dependence, as did support for a total ban on smoking in restaurants, workplaces, bingo halls, and hockey arenas. Support for smoking bans in food courts, family fast food restaurants, and bars and taverns did not vary significantly with level of nicotine dependence.
Level of nicotine dependence is associated with intended behaviors and support for smoking restrictions in some settings. These results have implications for tobacco control programs and policies.
PubMed ID
11506769 View in PubMed
Less detail

Knowledge about tobacco and attitudes toward tobacco control: how different are smokers and nonsmokers?

https://arctichealth.org/en/permalink/ahliterature196544
Source
Can J Public Health. 2000 Sep-Oct;91(5):376-80
Publication Type
Article
Author
M J Ashley
J. Cohen
S. Bull
R. Ferrence
B. Poland
L. Pederson
J. Gao
Author Affiliation
Department of Public Health Sciences, University of Toronto, ON. maryjane.ashley@utoronto.ca
Source
Can J Public Health. 2000 Sep-Oct;91(5):376-80
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Data Collection - statistics & numerical data
Drug and Narcotic Control
Female
Guideline Adherence
Health Knowledge, Attitudes, Practice
Health Policy
Humans
Male
Ontario
Smoking - prevention & control - psychology
Tobacco Industry - legislation & jurisprudence
Abstract
Using data from a 1996 random-digit-dialing computer-assisted telephone survey of Ontario adults, 424 smokers and 1,340 nonsmokers were compared regarding knowledge about the health effects of tobacco use, attitudes toward restrictions on smoking and other tobacco control measures, and predictions of compliance with more restrictions. The response rate was 65%. Smokers were less knowledgeable than nonsmokers. Smokers were also less likely to support bans on smoking in specific locations, but majorities of both groups supported some restriction in most settings. Smokers were more likely than nonsmokers to predict that most smokers would comply with more restrictions, and more than three quarters indicated that they, themselves, would comply. Sizable proportions of both groups, especially smokers, failed to appreciate the effectiveness of taxation in reducing smoking. Support for other control measures also differed by smoking status. Both knowledge and smoking status were independently associated with support for more restrictions and other tobacco control policy measures.
PubMed ID
11089293 View in PubMed
Less detail

Predictors of Canadian legislators' support for public health policy interventions.

https://arctichealth.org/en/permalink/ahliterature193742
Source
Can J Public Health. 2001 May-Jun;92(3):188-9
Publication Type
Article
Author
J E Cohen
N A de Guia
M J Ashley
R. Ferrence
D T Studlar
D A Northrup
Author Affiliation
Ontario Tobacco Research Unit, Centre for Health Promotion, University of Toronto. joanna_cohen@camh.net
Source
Can J Public Health. 2001 May-Jun;92(3):188-9
Language
English
Publication Type
Article
Keywords
Administrative Personnel
Attitude to Health
Canada
Data Collection
Health Policy - legislation & jurisprudence
Health Promotion - legislation & jurisprudence
Humans
Politics
Public Health - legislation & jurisprudence
PubMed ID
11496627 View in PubMed
Less detail

Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies.

https://arctichealth.org/en/permalink/ahliterature204806
Source
Tob Control. 1998;7(1):61-5
Publication Type
Article
Date
1998
Author
M J Ashley
R. Ferrence
Author Affiliation
Ontario Tobacco Research Unit, University of Toronto, Canada. maryjane.ashley@utoronto.ca
Source
Tob Control. 1998;7(1):61-5
Date
1998
Language
English
Publication Type
Article
Keywords
Adult
Canada
Child
Child Welfare
Child, Preschool
Health Policy
Health promotion
Humans
Public Policy
Tobacco Smoke Pollution - prevention & control
Abstract
It is now well established that children's exposure to environmental tobacco smoke (ETS) results in substantial public health and economic impacts. Children are more likely than adults to suffer health effects from ETS exposure, and the home is the most important site of such exposure. Although the responsibility and authority of the community and health professionals to protect children from harm are entrenched in North American society, social, economic, legal, and political factors contribute to a lower level of support for ETS control measures in homes compared with workplaces and public places. It is now clear that ETS control in home environments must be a priority on the public health agenda. Programme and policy options and strategies for ETS control in home environments are outlined. We conclude that the current research base is inadequate to fully support programme and policy development in this area and priorities for research are identified.
Notes
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Comment In: Tob Control. 1998 Spring;7(1):1-29706745
PubMed ID
9706756 View in PubMed
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