Sanyal Chiranjeev, Ingram Ethel Langille, Sketris Ingrid S, Peltekian Kevork M, Kirkland Susan
, MSc, is with the College of Pharmacy and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
Can J Hosp Pharm. 2011 Mar;64(2):131-40. doi: 10.4212/cjhp.v64i2.997.
The prevalence of infection with hepatitis C virus (HCV) is increasing worldwide. Antiviral therapy, prescription and nonprescription medications, and nondrug therapies to treat HCV infection and to manage associated adverse effects are costly.
To determine whether individuals infected with HCV attending a hepatology clinic were negatively affected by the costs of prescription medications, and if so, to determine coping strategies they adopted.
Patients infected with HCV attending Hepatology Services, a clinic within the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, were interviewed as part of an exploratory study (April 2 to July 8, 2008). The interview was based on a validated survey adapted for Nova Scotia. Information collected included demographic characteristics; types of prescription, nonprescription, and complementary medications used by patients; and strategies patients adopted to pay their medication costs.
Fifty patients (age 33-64 years) participated in the interviewer-administered survey, including 35 (70%) men and 19 people (38%) with household income less than $30 000. Frequently used medications were antidepressants (19 patients [38%]), antihypertensive agents (12 [24%]), anxiolytics (10 [20%]), and nonsteroidal anti-inflammatory drugs (10 [20%]). More than half (29 [58%]) were concerned about having sufficient money to pay for their medications. Coping strategies adopted in response to costs of prescription medications were either self-initiated or undertaken in consultation with physicians and/or other health care professionals. Sixteen (32%) of the respondents expressed the belief that physicians usually do not consider patients' concerns about affordability when prescribing medications. Seven (14%) indicated they would seek help from a pharmacist to buy low-cost substitutes for their medications.
This study highlighted a range of coping strategies adopted by patients infected with HCV in response to medication costs. It underscores that cost may limit access to essential medications within this patient population, even in a publicly funded health care system. Some of the coping strategies adopted might reduce patients' persistence and adherence with medication therapy, which could lead to adverse health outcomes. Hospital and community pharmacists need to be aware of the challenges faced by patients in terms of paying for medications and should consider possible proactive responses to address potentially detrimental coping strategies.
丙型肝炎病毒（HCV）感染在全球范围内的患病率正在上升。用于治疗HCV感染及管理相关不良反应的抗病毒疗法、处方药和非处方药以及非药物疗法成本高昂。
确定在肝病诊所就诊的HCV感染者是否受到处方药费用的负面影响，若受到影响，则确定他们采取的应对策略。
作为一项探索性研究（2008年4月2日至7月8日）的一部分，对在新斯科舍省哈利法克斯伊丽莎白二世健康科学中心内的一家诊所——肝病服务中心就诊的HCV感染者进行了访谈。访谈基于一项经过验证的针对新斯科舍省的调查。收集的信息包括人口统计学特征；患者使用的处方药、非处方药和补充药物的类型；以及患者支付药物费用所采取的策略。
50名患者（年龄33 - 64岁）参与了由访谈者实施的调查，其中包括35名男性（70%）和19名家庭收入低于30000美元的人（38%）。常用药物有抗抑郁药（19名患者[38%]）、抗高血压药（12名[24%]）、抗焦虑药（10名[20%]）和非甾体抗炎药（10名[20%]）。超过一半（29名[58%]）的患者担心没有足够的钱支付药物费用。针对处方药费用采取的应对策略要么是自行采取的，要么是在与医生和/或其他医疗保健专业人员协商后采取的。16名（32%）受访者表示认为医生在开处方时通常不考虑患者对药物可承受性的担忧。7名（14%）表示他们会向药剂师寻求帮助，以购买低成本的替代药物。
本研究突出了HCV感染者针对药物费用所采取的一系列应对策略。它强调即使在公共资助的医疗保健系统中，费用也可能限制这一患者群体获得基本药物的机会。所采取的一些应对策略可能会降低患者坚持药物治疗的程度，这可能导致不良健康后果。医院和社区药剂师需要意识到患者在支付药物费用方面面临的挑战，并应考虑可能的积极应对措施，以应对潜在的有害应对策略。
