Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons
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 impac...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2001-01, Vol.285 (4), p.421-429 |
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| creator | Tamblyn, Robyn Laprise, Rejean Hanley, James A Abrahamowicz, Michael Scott, Susan Mayo, Nancy Hurley, Jerry Grad, Roland Latimer, Eric Perreault, Robert McLeod, Peter Huang, Allen Larochelle, Pierre Mallet, Louise |
| description | 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 postpolicy
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 10 000 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 10 000 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 ess |
| doi_str_mv | 10.1001/jama.285.4.421 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_76951549</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>1108322</ama_id><sourcerecordid>76951549</sourcerecordid><originalsourceid>FETCH-LOGICAL-a397t-b6c4a89abc00a764fb5ef0fd36bd896dc8c537cfbd4785bbad3239e5b4def2603</originalsourceid><addsrcrecordid>eNqF0c1r2zAYB2AxVtYs3XWHHYZYYTen-rSko8mytVBooC29DIy-3DrYVirZgfz3VWk2Si_Vi6TLw4_3lQD4itECI4TPNrrXCyL5gi0YwR_ADHMqC8qV_AhmCClZCCbZMfic0gblhan4BI4xJixXOQN_K7fzMXm42vlhTLBKKdhWj97Bu3Z8gOvok43tdmzDAH_F6R4uQxqL6wcd2-EeVn3I5zqECPXg4KpzPnZ7uM6RYUgn4KjRXfJfDvcc3P5e3SzPi8urPxfL6rLQVImxMKVlWiptLEJalKwx3DeocbQ0TqrSWWk5FbYxjgnJjdGOEqo8N8z5hpSIzsHPl9xtDI-TT2Pdt8n6rtODD1OqRak45ky9C7GkgtK85-DHG7gJUxzyEDXBmGFVSpnR9wOaTO9dvY1tr-O-_ve6GZwegE5Wd03Ug23TfycFwuS5-28vKn_lqwwkKSH0Cb6ZkRg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211419688</pqid></control><display><type>article</type><title>Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Tamblyn, Robyn ; Laprise, Rejean ; Hanley, James A ; Abrahamowicz, Michael ; Scott, Susan ; Mayo, Nancy ; Hurley, Jerry ; Grad, Roland ; Latimer, Eric ; Perreault, Robert ; McLeod, Peter ; Huang, Allen ; Larochelle, Pierre ; Mallet, Louise</creator><creatorcontrib>Tamblyn, Robyn ; Laprise, Rejean ; Hanley, James A ; Abrahamowicz, Michael ; Scott, Susan ; Mayo, Nancy ; Hurley, Jerry ; Grad, Roland ; Latimer, Eric ; Perreault, Robert ; McLeod, Peter ; Huang, Allen ; Larochelle, Pierre ; Mallet, Louise</creatorcontrib><description>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 postpolicy
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 10 000 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 10 000 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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.285.4.421</identifier><identifier>PMID: 11242426</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cost sharing ; Cost Sharing - legislation & jurisprudence ; Drug Prescriptions - economics ; elderly ; Emergency Service, Hospital - statistics & numerical data ; Female ; General aspects ; Health care expenditures ; Health Policy ; Health Services Accessibility - economics ; Health systems. Social services ; Humans ; Insurance, Pharmaceutical Services - economics ; Insurance, Pharmaceutical Services - legislation & jurisprudence ; Logistic Models ; Low income groups ; Male ; Medical research ; Medical sciences ; Middle Aged ; Older people ; Patient Compliance ; Poisson Distribution ; Poverty ; Prescription drugs ; Proportional Hazards Models ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quebec ; Self Administration - economics ; Self Administration - statistics & numerical data ; Social Welfare ; Socioeconomic Factors ; Welfare</subject><ispartof>JAMA : the journal of the American Medical Association, 2001-01, Vol.285 (4), p.421-429</ispartof><rights>2001 INIST-CNRS</rights><rights>Copyright American Medical Association Jan 24/Jan 31, 2001</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a397t-b6c4a89abc00a764fb5ef0fd36bd896dc8c537cfbd4785bbad3239e5b4def2603</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.285.4.421$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.285.4.421$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,315,781,785,3341,27929,27930,76494,76497</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=870120$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11242426$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tamblyn, Robyn</creatorcontrib><creatorcontrib>Laprise, Rejean</creatorcontrib><creatorcontrib>Hanley, James A</creatorcontrib><creatorcontrib>Abrahamowicz, Michael</creatorcontrib><creatorcontrib>Scott, Susan</creatorcontrib><creatorcontrib>Mayo, Nancy</creatorcontrib><creatorcontrib>Hurley, Jerry</creatorcontrib><creatorcontrib>Grad, Roland</creatorcontrib><creatorcontrib>Latimer, Eric</creatorcontrib><creatorcontrib>Perreault, Robert</creatorcontrib><creatorcontrib>McLeod, Peter</creatorcontrib><creatorcontrib>Huang, Allen</creatorcontrib><creatorcontrib>Larochelle, Pierre</creatorcontrib><creatorcontrib>Mallet, Louise</creatorcontrib><title>Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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 postpolicy
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 10 000 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 10 000 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cost sharing</subject><subject>Cost Sharing - legislation & jurisprudence</subject><subject>Drug Prescriptions - economics</subject><subject>elderly</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>General aspects</subject><subject>Health care expenditures</subject><subject>Health Policy</subject><subject>Health Services Accessibility - economics</subject><subject>Health systems. Social services</subject><subject>Humans</subject><subject>Insurance, Pharmaceutical Services - economics</subject><subject>Insurance, Pharmaceutical Services - legislation & jurisprudence</subject><subject>Logistic Models</subject><subject>Low income groups</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Older people</subject><subject>Patient Compliance</subject><subject>Poisson Distribution</subject><subject>Poverty</subject><subject>Prescription drugs</subject><subject>Proportional Hazards Models</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quebec</subject><subject>Self Administration - economics</subject><subject>Self Administration - statistics & numerical data</subject><subject>Social Welfare</subject><subject>Socioeconomic Factors</subject><subject>Welfare</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c1r2zAYB2AxVtYs3XWHHYZYYTen-rSko8mytVBooC29DIy-3DrYVirZgfz3VWk2Si_Vi6TLw4_3lQD4itECI4TPNrrXCyL5gi0YwR_ADHMqC8qV_AhmCClZCCbZMfic0gblhan4BI4xJixXOQN_K7fzMXm42vlhTLBKKdhWj97Bu3Z8gOvok43tdmzDAH_F6R4uQxqL6wcd2-EeVn3I5zqECPXg4KpzPnZ7uM6RYUgn4KjRXfJfDvcc3P5e3SzPi8urPxfL6rLQVImxMKVlWiptLEJalKwx3DeocbQ0TqrSWWk5FbYxjgnJjdGOEqo8N8z5hpSIzsHPl9xtDI-TT2Pdt8n6rtODD1OqRak45ky9C7GkgtK85-DHG7gJUxzyEDXBmGFVSpnR9wOaTO9dvY1tr-O-_ve6GZwegE5Wd03Ug23TfycFwuS5-28vKn_lqwwkKSH0Cb6ZkRg</recordid><startdate>20010124</startdate><enddate>20010124</enddate><creator>Tamblyn, Robyn</creator><creator>Laprise, Rejean</creator><creator>Hanley, James A</creator><creator>Abrahamowicz, Michael</creator><creator>Scott, Susan</creator><creator>Mayo, Nancy</creator><creator>Hurley, Jerry</creator><creator>Grad, Roland</creator><creator>Latimer, Eric</creator><creator>Perreault, Robert</creator><creator>McLeod, Peter</creator><creator>Huang, Allen</creator><creator>Larochelle, Pierre</creator><creator>Mallet, Louise</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7U1</scope><scope>7U2</scope><scope>7X8</scope></search><sort><creationdate>20010124</creationdate><title>Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons</title><author>Tamblyn, Robyn ; Laprise, Rejean ; Hanley, James A ; Abrahamowicz, Michael ; Scott, Susan ; Mayo, Nancy ; Hurley, Jerry ; Grad, Roland ; Latimer, Eric ; Perreault, Robert ; McLeod, Peter ; Huang, Allen ; Larochelle, Pierre ; Mallet, Louise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a397t-b6c4a89abc00a764fb5ef0fd36bd896dc8c537cfbd4785bbad3239e5b4def2603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cost sharing</topic><topic>Cost Sharing - legislation & jurisprudence</topic><topic>Drug Prescriptions - economics</topic><topic>elderly</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>General aspects</topic><topic>Health care expenditures</topic><topic>Health Policy</topic><topic>Health Services Accessibility - economics</topic><topic>Health systems. Social services</topic><topic>Humans</topic><topic>Insurance, Pharmaceutical Services - economics</topic><topic>Insurance, Pharmaceutical Services - legislation & jurisprudence</topic><topic>Logistic Models</topic><topic>Low income groups</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Older people</topic><topic>Patient Compliance</topic><topic>Poisson Distribution</topic><topic>Poverty</topic><topic>Prescription drugs</topic><topic>Proportional Hazards Models</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Quebec</topic><topic>Self Administration - economics</topic><topic>Self Administration - statistics & numerical data</topic><topic>Social Welfare</topic><topic>Socioeconomic Factors</topic><topic>Welfare</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tamblyn, Robyn</creatorcontrib><creatorcontrib>Laprise, Rejean</creatorcontrib><creatorcontrib>Hanley, James A</creatorcontrib><creatorcontrib>Abrahamowicz, Michael</creatorcontrib><creatorcontrib>Scott, Susan</creatorcontrib><creatorcontrib>Mayo, Nancy</creatorcontrib><creatorcontrib>Hurley, Jerry</creatorcontrib><creatorcontrib>Grad, Roland</creatorcontrib><creatorcontrib>Latimer, Eric</creatorcontrib><creatorcontrib>Perreault, Robert</creatorcontrib><creatorcontrib>McLeod, Peter</creatorcontrib><creatorcontrib>Huang, Allen</creatorcontrib><creatorcontrib>Larochelle, Pierre</creatorcontrib><creatorcontrib>Mallet, Louise</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tamblyn, Robyn</au><au>Laprise, Rejean</au><au>Hanley, James A</au><au>Abrahamowicz, Michael</au><au>Scott, Susan</au><au>Mayo, Nancy</au><au>Hurley, Jerry</au><au>Grad, Roland</au><au>Latimer, Eric</au><au>Perreault, Robert</au><au>McLeod, Peter</au><au>Huang, Allen</au><au>Larochelle, Pierre</au><au>Mallet, Louise</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2001-01-24</date><risdate>2001</risdate><volume>285</volume><issue>4</issue><spage>421</spage><epage>429</epage><pages>421-429</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>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 postpolicy
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 10 000 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 10 000 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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>11242426</pmid><doi>10.1001/jama.285.4.421</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2001-01, Vol.285 (4), p.421-429 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_76951549 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Adult Aged Biological and medical sciences Cost sharing Cost Sharing - legislation & jurisprudence Drug Prescriptions - economics elderly Emergency Service, Hospital - statistics & numerical data Female General aspects Health care expenditures Health Policy Health Services Accessibility - economics Health systems. Social services Humans Insurance, Pharmaceutical Services - economics Insurance, Pharmaceutical Services - legislation & jurisprudence Logistic Models Low income groups Male Medical research Medical sciences Middle Aged Older people Patient Compliance Poisson Distribution Poverty Prescription drugs Proportional Hazards Models Public health. Hygiene Public health. Hygiene-occupational medicine Quebec Self Administration - economics Self Administration - statistics & numerical data Social Welfare Socioeconomic Factors Welfare |
| title | Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-12T05%3A17%3A05IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Adverse%20Events%20Associated%20With%20Prescription%20Drug%20Cost-Sharing%20Among%20Poor%20and%20Elderly%20Persons&rft.jtitle=JAMA%20:%20the%20journal%20of%20the%20American%20Medical%20Association&rft.au=Tamblyn,%20Robyn&rft.date=2001-01-24&rft.volume=285&rft.issue=4&rft.spage=421&rft.epage=429&rft.pages=421-429&rft.issn=0098-7484&rft.eissn=1538-3598&rft.coden=JAMAAP&rft_id=info:doi/10.1001/jama.285.4.421&rft_dat=%3Cproquest_pubme%3E76951549%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=211419688&rft_id=info:pmid/11242426&rft_ama_id=1108322&rfr_iscdi=true |