加拿大处方药患者付费的后果：一项横断面调查。
The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey.
作者信息
Law Michael R, Cheng Lucy, Kolhatkar Ashra, Goldsmith Laurie J, Morgan Steven G, Holbrook Anne M, Dhalla Irfan A
机构信息
Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
出版信息
CMAJ Open. 2018 Feb 5;6(1):E63-E70. doi: 10.9778/cmajo.20180008.
BACKGROUND
Many Canadians face substantial out-of-pocket charges for prescription drugs. Prior work suggests that this causes some patients to not take their medications as prescribed; however, we have little understanding of whether charges for prescription medicines lead patients to forego basic needs or to use more health care services. Our study aimed to quantify the consequences of patient charges for medicines in Canada.
METHODS
As part of the 2016 Canadian Community Health Survey, we designed and fielded cross-sectional questions to 28 091 Canadians regarding prescription drug affordability, consequent use of health care services and trade-offs with other expenditures. We calculated weighted population estimates and proportions, and used logistic regression to determine which patient characteristics were associated with these behaviours.
RESULTS
Overall, 5.5% (95% confidence interval 5.1%-6.0%) of Canadians reported being unable to afford 1 or more drugs in the prior year, representing 8.2% of those with at least 1 prescription. Drugs for mental health conditions were the most commonly reported drug class for cost-related nonadherence. About 303 000 Canadians had additional doctor visits, about 93 000 sought care in the emergency department, and about 26 000 were admitted to hospital at the population level. Many Canadians forewent basic needs such as food (about 730 000 people), heat (about 238 000) and other health care expenses (about 239 000) because of drug costs. These outcomes were more common among females, younger adults, Aboriginal peoples, those with poorer health status, those lacking drug insurance and those with lower income.
INTERPRETATION
Out-of-pocket charges for medicines for Canadians are associated with foregoing prescription drugs and other necessities as well as use of additional health care services. Changes to protect vulnerable populations from drug costs might reduce these negative outcomes.
背景
许多加拿大人面临着高昂的处方药自付费用。先前的研究表明，这导致一些患者不按规定服药；然而，我们对处方药费用是否会导致患者放弃基本需求或使用更多医疗服务了解甚少。我们的研究旨在量化加拿大患者药物费用的后果。
方法
作为2016年加拿大社区健康调查的一部分，我们设计并向28091名加拿大人提出了横断面问题，内容涉及处方药的可负担性、随后的医疗服务使用情况以及与其他支出的权衡。我们计算了加权人口估计数和比例，并使用逻辑回归来确定哪些患者特征与这些行为相关。
结果
总体而言，5.5%（95%置信区间5.1%-6.0%）的加拿大人报告在前一年无法负担1种或更多药物，占至少有1张处方者的8.2%。精神疾病药物是最常被报告的因费用导致治疗依从性不佳的药物类别。在总体人群中，约30.3万加拿大人增加了看医生的次数，约9.3万人前往急诊科就诊，约2.6万人住院。许多加拿大人因药物费用而放弃了食物（约73万人）、取暖（约23.8万人）等基本需求以及其他医疗费用（约23.9万人）。这些结果在女性、年轻人、原住民、健康状况较差者、缺乏药物保险者和低收入者中更为常见。
解读
加拿大人的药物自付费用与放弃处方药和其他必需品以及使用更多医疗服务有关。保护弱势群体免受药物费用影响的政策变化可能会减少这些负面后果。
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