Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2010 Dec 29;5(12):e15883. doi: 10.1371/journal.pone.0015883.
Increasing attention is being paid to variations in the use of prescription drugs because their role in health care has grown to the point where their use can be considered a proxy for health system performance. Studies have shown that prescription drug use varies across regions in the US, UK, and Canada by more than would be predicted based on age and health status alone. In this paper, we explore the determinants of variations in the use of prescription drugs, drawing on health services theories of access to care.
We conducted a cross-sectional analysis using population-based administrative health care data for British Columbia (BC), Canada. We used logistic and hierarchical regressions to analyze the effects of individual- and area-level determinants of use of prescriptions overall and rates of purchase of prescriptions from five therapeutic categories representing a range of indications: antihypertensives, statins, acid reducing drugs, opioid drugs, and antidepressants. To indicate the relative scale of regional variations and the importance of individual- and area-level variables in explaining them, we computed standardized rates of utilization for 49 local health areas in BC.
We found that characteristics of individuals and the areas in which they live affect likelihood of prescription drug purchase. Individual-level factors influenced prescription drug purchases in ways generally consistent with behavioral models of health services use. Contextual variables exerted influences that differed by type of drug studied. Population health, education levels, and ethnic composition of local areas were associated with significant differences in the likelihood of purchasing medications. Relatively modest regional variations remained after both individual-level and area-level determinants were taken into account.
The results of this study suggest that individual- and area-level factors should be considered when studying variations in the use of prescription drugs. Some sources of such variations, including individual- and area-level socioeconomic status, warrant further investigation and possible intervention to address inequities.
由于处方药在医疗保健中的作用不断增强，人们越来越关注其使用情况的差异，甚至可以将其作为评估医疗体系绩效的一个指标。研究表明，在美国、英国和加拿大，处方药的使用情况因地域而异，其差异程度超出了仅根据年龄和健康状况所预测的范围。在本文中，我们借鉴卫生服务获取理论，探讨了处方药使用差异的决定因素。
我们使用加拿大不列颠哥伦比亚省（BC）的基于人群的行政医疗保健数据进行了横断面分析。我们使用逻辑回归和分层回归分析了总体处方使用和五类治疗性药物（包括降压药、他汀类药物、胃酸抑制剂、阿片类药物和抗抑郁药）的购买率的个体和区域水平决定因素的影响。为了表示区域差异的相对规模以及个体和区域变量在解释这些差异方面的重要性，我们计算了不列颠哥伦比亚省 49 个地方卫生区域的标准化利用率。
我们发现个人特征和他们居住的地区会影响处方药购买的可能性。个体水平的因素以与卫生服务使用行为模型一致的方式影响处方药的使用。背景变量的影响因所研究的药物类型而异。地方区域的人口健康状况、教育水平和种族构成与购买药物的可能性存在显著差异。在考虑了个体和区域水平的决定因素后，相对较小的区域差异仍然存在。
本研究结果表明，在研究处方药使用情况的差异时，应考虑个体和区域因素。一些差异的来源，包括个体和区域的社会经济地位，值得进一步调查和可能的干预，以解决不平等问题。
