与处方药费用在穷人和老年人之间共享相关的不良事件
R Tamblyn1, R Laprise, J A Hanley
1McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion, Room 4-12, 687 Pine Ave W, Montréal, Quebec, Canada H3A 1A1.
JAMA
|March 10, 2001
概括
引入处方药费用共享减少了老年人和福利受益者使用必需药物的数量. 这导致严重不良事件和急诊室访问的增加,突出了成本共享政策对健康的潜在影响.
科学领域:
- 卫生经济学和健康政策
- 药品的获取和使用.
- 公共卫生和流行病学.
背景情况:
- 药品成本上升和获取不平等需要对毒品政策进行改革.
- 处方费用共享对弱势群体 (老年人,低收入人群) 的健康影响尚不清楚.
- 成本分担政策旨在控制药物支出,但可能会影响药物坚持和健康结果.
研究的目的:
- 评估处方药成本共享对基本药物和不那么基本药物的使用的影响.
- 评估急诊室 (ED) 访问的变化和与政策后减少药物使用相关的严重不良事件.
- 在1996年政策变化之后,分析这些影响在北克老年人和福利受益者身上.
主要方法:
- 对北克政策实施前32个月和政策实施后17个月的中断时间序列分析.
- 包括93,950名老年人和55,333名福利受益人的随机样本.
- 政策前后的队列研究 (每项10个月) 专门评估不良事件.
主要成果:
- 在老年人中,基本药物使用减少了9.12%,在福利受益者中减少了14.42%,不太重要的药物使用分别下降了15.14%和22.39%.
- 与减少基本药物使用相关的严重不良事件在两组中都显著增加 (老年人:+6.8,福利:每10,000人/月+12.9).
- 与减少必需药物使用相关的急诊室访问也大幅增加 (老年人: +14.2,福利: 每10,000人/月+54.2).
结论:
- 增加处方药费用共享导致老年人和福利受益者减少使用必需药物.
- 这些减少与更高的严重不良事件发生率和急诊室访问有关.
- 研究结果表明,成本共享政策可能会对依赖基本药物的弱势群体产生不利的健康后果.
相关概念视频
01:02Prescription, Nonprescription and Orphan Drugs
Prescription drugs require a prescription from a medical practitioner and can only be obtained from a pharmacy. They have many applications, including treating pain, anxiety, and hypertension.
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
01:15Drug Dosing: Geriatric Patients
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
01:26Pharmaceutical Poisoning: Potential Scenarios
Pharmaceutical poisoning can occur through various channels, impacting an estimated 2 million hospitalized patients in the U.S. annually with serious adverse drug responses. These scenarios encompass both therapeutic uses, such as drug toxicity, where even standard dosages can lead to severe central nervous system depression, and non-therapeutic exposures, including accidental ingestion by children, and environmental and occupational exposures.Unintentional poisonings often involve exploratory...