Shah Baiju R, Booth Gillian L, Lipscombe Lorraine L, Feig Denice S, Bhattacharyya Onil K, Bierman Arlene S
University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Eval Clin Pract. 2014 Apr;20(2):176-83. doi: 10.1111/jep.12104. Epub 2013 Dec 4.
RATIONALE, AIMS AND OBJECTIVES: To determine whether demographic, community or health status disparities in cardioprotective medication utilization by diabetes patients exist under a universal drug insurance programme, and whether they narrow or widen during periods of increasing drug utilization.
We examined all prescriptions filled by all people with diabetes aged ≥65 years in Ontario, Canada in annual cohorts from 1996 (n = 175 345) to 2010 (n = 504 093). We ascertained whether any disparities in use of three classes of cardioprotective medication (statins, all antihypertensives and renin-angiotensin-aldosterone system inhibitors) existed, and whether disparities changed over time.
Utilization of all three cardioprotective medication classes increased substantially over time, particularly statins (rate ratio per year: 1.13, 95% confidence interval 1.11-1.15). We found no disparities associated with many of the demographic or community characteristics examined (including sex, income or rural residence). Use of statins was lower in those aged ≥80 compared with younger age groups, although this disparity narrowed during the study. Persistently lower use of antihypertensives by minorities and by recent immigrants may be due to lower quality of care, barriers to access, or other patient or provider factors, which highlights the need for ongoing monitoring for disparities even in populations with universal drug insurance. Differences in medication utilization based on health status characteristics such as previous cardiovascular disease were medically indicated.
Although a universal drug insurance programme was reasonably successful in ensuring few disparities in cardioprotective medication use by older patients with diabetes, disparities persisted for some subpopulations, so additional interventions continue to be needed to ensure equitable care.
原理、目的与目标：确定在全民药物保险计划下，糖尿病患者在使用心脏保护药物方面是否存在人口统计学、社区或健康状况差异，以及在药物使用增加期间这些差异是缩小还是扩大。
我们检查了1996年（n = 175345）至2010年（n = 504093）加拿大安大略省所有年龄≥65岁糖尿病患者每年队列中填写的所有处方。我们确定在使用三类心脏保护药物（他汀类药物、所有抗高血压药物和肾素 - 血管紧张素 - 醛固酮系统抑制剂）方面是否存在任何差异，以及差异是否随时间变化。
随着时间的推移，所有三类心脏保护药物的使用均大幅增加，尤其是他汀类药物（每年的率比：1.13，95%置信区间1.11 - 1.15）。我们发现与所检查的许多人口统计学或社区特征（包括性别、收入或农村居住情况）无关的差异。≥80岁人群使用他汀类药物的比例低于较年轻年龄组，尽管在研究期间这种差异有所缩小。少数族裔和新移民持续较低的抗高血压药物使用率可能是由于护理质量较低、获取障碍或其他患者或提供者因素，这凸显了即使在全民药物保险人群中也需要持续监测差异。基于健康状况特征（如既往心血管疾病）的药物使用差异在医学上是合理的。
尽管全民药物保险计划在确保老年糖尿病患者在使用心脏保护药物方面几乎没有差异方面相当成功，但某些亚人群中仍存在差异，因此仍需要额外的干预措施以确保公平护理。
