Résumé :
|
[BDSP. Notice produite par INIST U59dR0xu. Diffusion soumise à autorisation]. Context Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. Objectives To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation. Design and Setting Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events. Participants A random sample of 93950 elderly persons and 55333 adult welfare medication recipients. Main Outcome Measures Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction. Results After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [Cl], 8.7% - 9.6%) in elderly persons and by 14. (...)
|