Adverse events associated with prescription drug cost-sharing among poor and elderly persons
Adverse events associated with prescription drug cost-sharing among poor and elderly persons
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DOI：
10.1001/jama.285.4.421
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发表时间：
2001-01-24
影响因子：
120.7
通讯作者：
Mallet, L
中科院分区：
文献类型：
--
作者：
Tamblyn, R;Laprise, R;Mallet, L
背景药物费用的上涨和获得药物的不平等引发了美国和加拿大对药物政策改革的呼吁。通过处方药费用分担来控制老年人和穷人的药物支出是一个有争议的问题，因为对这些亚组的健康影响知之甚少。目的确定（1）引入处方药费用分担对老年人和福利接受者使用基本药物和非基本药物的影响以及（2）急诊科（艾德）的比率访问和严重不良事件与减少药物使用的政策实施前后。设计和设置中断的时间序列分析的数据，从32个月前和17个月后，介绍了处方共同保险和免赔额的费用分摊政策在魁北克于1996年，分别进行为期10个月的政策前控制和政策后队列研究，以评估药物改革对不良事件的影响。参与者：随机抽样93950名老年人和55333名成年福利药物接受者。主要结果指标：每月平均每日使用基本药物和次基本药物的数量，艾德就诊次数，和严重不良事件结果实施费用分担后，基本药物的使用下降了9.12%（95%置信区间[CI]，8.7%-9.6%），14.42%（95% CI，13.3%~ 15.6%）;非必需药物的使用分别减少15.14%（95% CI，14.4%~ 15.9%）和22.39%（95% CI，20.9%~ 23.9%）。率与减少基本药物使用相关的严重不良事件（每10000人月）从老年人政策前对照队列的5.8例增加到政策后队列的12.6例（净增加6.8 [95%CI，5.6-8.0]），福利领取者从14.7增加到27.6（净增加12.9 [95%CI，10.2-15.5]）。与基本药物使用减少有关的急诊就诊率也增加了14.2（95% CI，8.5-19.9）/10000人月（政策前对照组，32.9;政策后组，47.1）和54.2（95%CI，33.5-74.8）在福利接受者（政策前控制队列，69.6;政策后队列，123.8）。这些增加主要是由于减少使用基本药物的受援者比例增加。减少基本药物的使用与不良事件或艾德visits. Conclusions的风险增加无关，在我们的研究中，增加老年人和福利受助人的处方药的费用分摊其次是减少基本药物的使用和更高的严重不良事件和艾德访问率与这些减少。
Context Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups.Objectives To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation.Design and Setting Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996, Separate 10-month prepolicy control and post-policy cohort studies were conducted to estimate the impact of the drug reform on adverse events.Participants A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients.Main Outcome Measures Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction.Results After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits.Conclusions In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.