Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.
CMAJ Open. 2022 Jun 14;10(2):E519-E526. doi: 10.9778/cmajo.20210214. Print 2022 Apr-Jun.
We evaluated the impact of publicly funded pharmacare (Ontario Health Insurance Plan [OHIP]+), which was introduced in Ontario on Jan. 1, 2018, for youth less than 25 years of age, on temporal trends in hemoglobin A (HbA, a measure of glycemic management) and the differential effect on the change in temporal trends in HbA according to socioeconomic status (SES).
We conducted a trend analysis using administrative data sets. We included youth aged 21 years, 9 months or younger, residing in Ontario on Jan. 1, 2016, with diabetes diagnosed before age 15 years and before Jan. 1, 2015. We used claims for insulin to measure pharmacare use. We evaluated the change in HbA (%) per 90 days before (Jan. 1, 2016, to Dec. 31, 2017) the introduction of and during (Apr. 1, 2018, to Mar. 31, 2019) OHIP+ coverage, and the difference in the change in HbA according to SES, using segmented regression analysis.
Of 9641 patients, 7041 (73.0%) made an insulin claim. We found a negligible difference in the temporal change in HbA during compared with before OHIP+ coverage that was not statistically significant (β estimate -0.0002, 95% confidence interval [CI] -0.0004 to 0.0000). The size of the effect was slightly greater in those individuals with the lowest SES than in those with the highest SES (β estimate -0.0008, 95% CI -0.0015 to -0.0001).
We found that the effect of OHIP+ on the change in HbA was slightly greater for youth in the lowest SES than for those in the highest SES. Our findings suggest that publicly funded pharmacare may be an effective policy tool to combat worsening socioeconomic disparities in diabetes care and outcomes.
我们评估了 2018 年 1 月 1 日在安大略省推出的公共资助药物保险（安大略省医疗保险计划[OHIP]+）对 25 岁以下青年的血红蛋白 A（HbA，衡量血糖管理的指标）的时间趋势的影响，以及根据社会经济地位（SES）对 HbA 时间趋势变化的差异影响。
我们使用管理数据集进行趋势分析。我们纳入了 2016 年 1 月 1 日年龄在 21 岁 9 个月或以下、在安大略省居住、在 15 岁之前和 2015 年 1 月 1 日之前被诊断患有糖尿病的青年。我们使用胰岛素的报销来衡量药物保险的使用情况。我们使用分段回归分析评估了在 OHIP+覆盖之前（2016 年 1 月 1 日至 2017 年 12 月 31 日）和期间（2018 年 4 月 1 日至 2019 年 3 月 31 日）HbA 的变化，以及根据 SES 差异的 HbA 变化。
在 9641 名患者中，有 7041 名（73.0%）患者提出了胰岛素报销申请。我们发现，在 OHIP+覆盖期间与覆盖之前相比，HbA 的时间变化几乎没有差异，且无统计学意义（β估计值-0.0002，95%置信区间[CI]-0.0004 至 0.0000）。SES 最低的个体比 SES 最高的个体的效应稍大（β估计值-0.0008，95%CI-0.0015 至-0.0001）。
我们发现，OHIP+对 SES 最低的青年 HbA 变化的影响略大于 SES 最高的青年。我们的研究结果表明，公共资助药物保险可能是一项有效的政策工具，可用于消除糖尿病护理和结果方面日益恶化的社会经济差异。
