Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Can J Psychiatry. 2023 Nov;68(11):826-837. doi: 10.1177/07067437231166836. Epub 2023 Apr 5.
Stimulants are first-line pharmacotherapy for individuals with attention-deficit hyperactivity disorder. However, disparities in drug coverage may contribute to inequitable treatment access. In January 2018, the government of Ontario, Canada, implemented a publicly-funded program (OHIP+) providing universal access to medications at no cost to children and youth between the ages of 0 and 24. In April 2019, the program was amended to cover only children and youth without private insurance. We studied whether these policy changes were associated with changes in prescription stimulant dispensing to Ontario children and youth.
We conducted a population-based observational natural experiment study of stimulant dispensing to children and youth in Ontario between January 2013 and March 2020. We used interventional autoregressive integrated moving average models to estimate the association between OHIP+ and its subsequent modification with stimulant dispensing trends.
The implementation of OHIP+ was associated with a significant immediate increase in the monthly rate of stimulant dispensing of 53.6 individuals per 100,000 population (95% confidence interval [CI], 36.8 to 70.5 per 100,000) and a 14.2% (95% CI, 12.8% to 15.6%) relative percent increase in stimulant dispensing rates between December 2017 and March 2019 (1198.6 vs. 1368.7 per 100,000 population). The April 2019 OHIP+ program amendment was associated with an increase in monthly stimulant dispensing trends of 10.2 individuals per 100,000 population (95% CI, 5.0 to 15.5), with rates increasing 7.5% (95% CI, 6.2% to 8.7%) between March 2019 and March 2020 (1368.7 vs. 1470.8 per 100,000 population). These associations were most pronounced among males, children and youth living in the highest income neighbourhoods and individuals aged 20 to 24.
A publicly-funded pharmacare program was associated with more children and youth being dispensed stimulants.
兴奋剂是治疗注意力缺陷多动障碍患者的一线药物疗法。然而，药物覆盖范围的差异可能导致治疗机会不平等。2018 年 1 月，加拿大安大略省政府实施了一项公共资助计划（OHIP+），为 0 至 24 岁的儿童和青少年提供免费的药物治疗。2019 年 4 月，该计划修订为仅涵盖没有私人保险的儿童和青少年。我们研究了这些政策变化是否与安大略省儿童和青少年处方兴奋剂的发放变化有关。
我们对安大略省儿童和青少年 2013 年 1 月至 2020 年 3 月期间的兴奋剂发放情况进行了基于人群的观察性自然实验研究。我们使用干预自回归综合移动平均模型来估计 OHIP+及其随后对兴奋剂发放趋势的修改与兴奋剂发放趋势之间的关联。
OHIP+的实施与每月兴奋剂发放率显著增加有关，每 10 万人中有 53.6 人（95%置信区间[CI]，36.8 至 70.5/10 万），2017 年 12 月至 2019 年 3 月期间，兴奋剂发放率相对百分比增加 14.2%（95%CI，12.8%至 15.6%）（每 10 万人 1198.6 至 1368.7）。2019 年 4 月 OHIP+计划修正案与每月兴奋剂发放趋势增加 10.2 人/10 万有关（95%CI，5.0 至 15.5），2019 年 3 月至 2020 年 3 月期间，发放率增加 7.5%（95%CI，6.2%至 8.7%）（每 10 万人 1368.7 至 1470.8）。这些关联在男性、居住在收入最高社区的儿童和青少年以及 20 至 24 岁的个体中最为明显。
一项公共资助的药物保险计划与更多的儿童和青少年获得兴奋剂治疗有关。
