费用分担对老年急性心肌梗死患者基本药物处方、医疗服务利用及预后的影响。
The effects of cost-sharing on essential drug prescriptions, utilization of medical care and outcomes after acute myocardial infarction in elderly patients.
作者信息
Pilote Louise, Beck Christine, Richard Hugues, Eisenberg Mark J
机构信息
Division of Internal Medicine, Montreal General Hospital Research Institute, Que.
出版信息
CMAJ. 2002 Aug 6;167(3):246-52.
BACKGROUND
After a change in Quebec's policy on drug coverage in August 1996, elderly patients' copayments for prescription drugs increased. We assessed the impact of this drug policy reform on prescribing patterns for essential cardiac medications, utilization of medical care and related health outcomes after acute myocardial infarction.
METHODS
Patients at least 65 years of age who experienced acute myocardial infarction between 1994 and 1998 were identified through the Quebec discharge summary database. Drug claims databases were analyzed to determine rates of prescription of essential cardiac medications for cohorts of patients admitted before and after the policy reform. The impact on readmissions for cardiac-related complications, outpatient visits to physicians and emergency departments, and mortality rate was also assessed.
RESULTS
The proportion of patients who received prescriptions for beta-blockers, angiotensin-converting enzyme inhibitors and lipid-lowering drugs increased over time and, more specifically, did not appear to decline with the change in the drug policy. In addition, the policy reform did not appear to affect persistence of drug therapy (the proportion of time for which patients were covered by prescriptions over the year after discharge). There was no within-class shift from more to less expensive drugs. Use of cardiac procedures increased over time, but this increase was unrelated to the date of the policy reform. Finally, rates of readmission for complications, visits to individual physicians and to emergency departments, and mortality rate were unchanged. The findings did not vary with sex or socioeconomic status.
INTERPRETATION
Prescriptions for essential cardiac medications and care related to acute myocardial infarction in elderly patients did not change with increases in out-of-pocket copayment, regardless of sex or socioeconomic status.
背景
1996年8月魁北克省药品覆盖政策发生变化后，老年患者的处方药自付费用增加。我们评估了这项药品政策改革对基本心脏药物处方模式、医疗服务利用情况以及急性心肌梗死后相关健康结局的影响。
方法
通过魁北克出院摘要数据库识别出1994年至1998年间发生急性心肌梗死的65岁及以上患者。分析药品报销数据库，以确定政策改革前后入院患者队列中基本心脏药物的处方率。还评估了对心脏相关并发症再入院率、门诊就诊率、急诊就诊率和死亡率的影响。
结果
接受β受体阻滞剂、血管紧张素转换酶抑制剂和降脂药物处方的患者比例随时间增加，更具体地说，似乎并未因药品政策的变化而下降。此外，政策改革似乎并未影响药物治疗的持续性（出院后一年内患者有处方覆盖的时间比例）。没有出现从昂贵药物向便宜药物的同类转换。心脏手术的使用随时间增加，但这种增加与政策改革日期无关。最后，并发症再入院率、个体医生和急诊科就诊率以及死亡率均未改变。研究结果在性别或社会经济地位方面没有差异。
解读
无论性别或社会经济地位如何，老年患者基本心脏药物的处方以及与急性心肌梗死相关的医疗服务并未因自付费用增加而改变。
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