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Tahvanainen H, Voipio-Pulkki LM, Hämeen-Anttila K, Närhi U, Mäntyranta T, Holmström AR, Airaksinen M. Drawing up the public national Rational Pharmacotherapy Action Plan as part of social and health services reform in Finland: a bottom-up approach involving stakeholders. BMC Health Serv Res 2024; 24:631. [PMID: 38750498 PMCID: PMC11097518 DOI: 10.1186/s12913-024-11068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Ensuring equal access to medicines and their appropriate and safe use at reasonable costs are core functions of health systems. Despite that, few descriptions of national medicines policies' development processes and implementation strategies have been published. This study aimed to describe the government program-based development of the Rational Pharmacotherapy Action Plan in Finland as a part of the undergoing major health and social service system reform, also covering the implementation of rational pharmacotherapy in the reformed system and processes. METHODS The data of this qualitative study consisted of public reports and Steering Group meeting memos related to the development of the national Rational Pharmacotherapy Action Plan that the Ministry of Social Affairs and Health coordinated. Qualitative content analysis applying systems theory and the conceptual framework of integrated services as theoretical frameworks was used as an analysis method. RESULTS The national Rational Pharmacotherapy Action Plan covering 2018-2022 was created in a bottom-up development process involving a wide range of stakeholders. Rational pharmacotherapy was redefined by adding equality as the fifth pillar to complement the previously defined pillars of being effective, safe, high-quality, and cost-effective. The Action Plan formed a normative framework for long-term development, with a vision and principles focusing on people-centeredness, better coordination and management of the medication use processes, the continuity of treatment paths and the flow of patient and medicines information through partnerships, and evidence-informed policies and practices. CONCLUSION Through intensive stakeholder participation, the bottom-up approach created a national vision and principles of rational pharmacotherapy along with strong commitment to implementing the goals and measures. The concern lies in ensuring the continuity of the Action Plan implementation and achieving a balanced long-term development aligned with the integrated and reformed national social and health services system. The development of the pharmaceutical system has several national and EU-level dependencies requiring political long-term commitment. While the Action Plan differs from the national medicines policy, it forms a good basis for long-term development covering important parts of medicine policy at the micro, meso, and macro levels of the service system.
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Affiliation(s)
- Heidi Tahvanainen
- Drug Research Doctoral Programme, University of Helsinki, P.O. Box 56, 00014, Helsinki, Finland.
- Ministry of Social Affairs and Health, Meritullinkatu 8, 00170, Helsinki, Finland.
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Helsinki, Finland.
| | | | - Katri Hämeen-Anttila
- School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
- National Medicines Agency, Fimea, Mannerheimintie 166, 00300, Helsinki, Finland
| | - Ulla Närhi
- Ministry of Social Affairs and Health, Meritullinkatu 8, 00170, Helsinki, Finland
- Health Emergency Preparedness and Response Authority (HERA), European Commission, Rue de La Loi 15, 1049, Brussels, Belgium
| | - Taina Mäntyranta
- Ministry of Social Affairs and Health, Meritullinkatu 8, 00170, Helsinki, Finland
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Helsinki, Finland
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Nurminen F, Rättö H, Arvio M, Teittinen A, Vesala HT, Saastamoinen L. Medicine use in people with intellectual disabilities: a Finnish nationwide register study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1291-1305. [PMID: 36372946 DOI: 10.1111/jir.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/09/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls. METHODS People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. RESULTS The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. CONCLUSIONS Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher.
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Affiliation(s)
- F Nurminen
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - H Rättö
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - M Arvio
- Päijät-Häme Joint Municipal Authority, Neurology, Lahti, Finland
- PEDEGO, Oulu University Hospital, Oulu, Finland
- Department of General Practice, Turku University, Turku, Finland
- Turku University Central Hospital, Turku, Finland
| | - A Teittinen
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - H T Vesala
- Finnish Association on Intellectual and Developmental Disabilities (FAIDD), Espoo, Finland
| | - L Saastamoinen
- Research Unit, The Social Insurance Institution, Helsinki, Finland
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Park D, Lee H, Kim DS. High-Cost Users of Prescription Drugs: National Health Insurance Data from South Korea. J Gen Intern Med 2022; 37:2390-2397. [PMID: 34704207 PMCID: PMC9360271 DOI: 10.1007/s11606-021-07165-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
IMPORTANCE In OECD countries, pharmaceutical spending reached around 800 billion USD in 2013, accounting for about 20% of total spending in the retail sector. Pharmaceutical expenditures are steadily increasing in South Korea, necessitating strategies to promote efficiency. OBJECTIVE This study investigated factors associated with high-cost users (HCUs), who account for the majority of outpatient prescriptions in the total South Korean population. The top 20 frequently prescribed therapeutic subgroups were also investigated. DESIGN This is an observational study performed using health insurance claims data in 2019. PARTICIPANTS In total, 44,744,632 people (including 6,806,339 aged 65 years or older) who were prescribed outpatient medications were included. MAIN MEASURES HCUs were defined as those for whom prescription drug costs were in the top 5%. Multivariate logistic regression analysis was performed using factors including age, insurance type, number of prescription drugs, outpatient visit days, prescription treatment days, and chronic diseases. RESULTS HCUs accounted for 3.6 million (5% of the total population) and 1.4 million (21.1% of those 65 years or older). Furthermore, 4.1% of HCUs in the total population had few comorbidities. Male sex, older age, insurance (Medical Aid), comorbidities, chronic diseases, number of prescription drugs, outpatient visit days, and prescription days were all associated with an increased probability of being an HCU. The highest spending was found for B01 (antithrombotic agents) with 0.4 billion USD, followed by C10 (lipid-modifying agents) and A10 (drugs used in diabetes). The proportion of spending for HCUs among the general population was highest in L01 (antineoplastic agents), at 98.2%, and L04 (immunosuppressants), at 87.8%, whereas among the elderly, the highest proportions were found for B01 (antithrombotic agents), at 44.5%, and N06 (antidepressants), at 44.3%. CONCLUSION Age and multiple chronic conditions were strongly associated with HCUs, and it seems necessary to reduce drug prescriptions in patients without complex comorbidities. Several measures should target those without multiple chronic conditions who are nonetheless HCUs.
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Affiliation(s)
- Dahye Park
- Department of Research, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - HyeYeong Lee
- Department of Research, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Dong-Sook Kim
- Department of Research, Health Insurance Review & Assessment Service, Wonju, South Korea
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Tahvanainen H, Kuitunen S, Holmström AR, Airaksinen M. Integrating medication risk management interventions into regular automated dose dispensing service of older home care clients - a systems approach. BMC Geriatr 2021; 21:663. [PMID: 34814848 PMCID: PMC8609790 DOI: 10.1186/s12877-021-02607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Automated dose dispensing (ADD) services have been implemented in many health care systems internationally. However, the ADD service itself is a logistic process that requires integration with medication risk management interventions to ensure safe and appropriate medication use. National policies and regulations guiding ADD in Finland have recommended medication reconciliation, review, and follow-up for suitable risk management interventions. This implementation study aimed to develop a medication management process integrating these recommended risk management interventions into a regular ADD service for older home care clients. METHODS This study applied an action research method and was carried out in a home care setting, part of primary care in the City of Lahti, Finland. The systems-approach to risk management was applied as a theoretical framework. RESULTS The outcome of the systems-based development process was a comprehensive medication management procedure. The medication risk management interventions of medication reconciliation, review and follow-up were integrated into the medication management process while implementing the ADD service. The tasks and responsibilities of each health care professional involved in the care team became more explicitly defined, and available resources were utilized more effectively. In particular, the hospital pharmacists became members of the care team where collaboration between physicians, pharmacists, and nurses shifted from parallel working towards close collaboration. More efforts are needed to integrate community pharmacists into the care team. CONCLUSION The transition to the ADD service allows implementation of the effective medication risk management interventions within regular home care practice. These systemic defenses should be considered when national ADD guidelines are implemented locally. The same applies to situations in which public home care organizations responsible for services e.g., municipalities, purchase ADD services from private service providers.
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Affiliation(s)
- Heidi Tahvanainen
- Doctoral Programme in Drug Research, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Sini Kuitunen
- Doctoral Programme in Drug Research, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
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Kalamägi J, Lavikainen P, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. Predictors of high hospital care and medication costs and cost trajectories in community-dwellers with Alzheimer's disease. Ann Med 2019; 51:294-305. [PMID: 31322423 PMCID: PMC7877886 DOI: 10.1080/07853890.2019.1642507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objectives: We studied the determinants of high healthcare costs (highest decile of hospital care and medication costs) and cost trajectories among all community-dwellers with clinically verified Alzheimer's disease (AD), diagnosed during 2005-2011 in Finland (N = 70,531). Methods: The analyses were done separately for hospital care costs, medication costs and total healthcare costs that were calculated for each 6-month period from 5 years before to 3 years after AD diagnosis. Results: Total healthcare costs were driven mainly by hospital care costs. The definition of "high-cost person" was time-dependent as 63% belonged to the highest 10% at some timepoint during the study period and six distinct cost trajectories were identified. Strokes, cardiovascular diseases, fractures and mental and behavioural disorders were most strongly associated with high hospital care costs. Conclusions: Although persons with AD are often collectively considered as expensive patient group, there is large temporal and inter-individual variation in belonging to the highest decile of hospitalization and/or medication costs. It would be important to assess whether hospitalization rate could be decreased by, e.g., comprehensive outpatient care with more efficient management of comorbidities. In addition, other interventions that could decrease hospitalization rate in persons with dementia should be studied further in this context. Key messages Persons with AD had large individual fluctuation in hospital care costs and medication costs over time. Hospital care costs were considerably larger than medication costs, with fractures, cardiovascular diseases and mental and behavioural disorders being the key predictors. Antidementia medication was associated with lower hospital care costs.
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Affiliation(s)
- Joosep Kalamägi
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland , Kuopio , Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland , Kuopio , Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland , Kuopio , Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland , Kuopio , Finland
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Hyttinen V, Jyrkkä J, Saastamoinen LK, Vartiainen AK, Valtonen H. Patient- and health care-related factors associated with initiation of potentially inappropriate medication in community-dwelling older persons. Basic Clin Pharmacol Toxicol 2018; 124:74-83. [PMID: 30003664 DOI: 10.1111/bcpt.13096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
Abstract
Potentially inappropriate medications (PIMs) in older persons are defined as medications of which the potential harms outweigh their benefits. The purpose of this study was to determine how initiation of PIMs accumulate in community-dwelling persons aged 65-74 and ≥75 years, and which patient- and health care-related factors are associated with PIM initiation over time. Data of this study were gathered from population-based registers by a 10% random sample of persons (n = 28 497) aged ≥65 years with no prior PIMs within a 2-year period preceding the index date (1 January 2002), and the study individuals were followed until 2013. The Finnish Prescription Register was linked using a personal identity code to register on inpatient care and causes of deaths and socio-economic data. In this study, 10 698 (37.5%) persons initiated PIMs during the study period. Female gender was associated with PIM initiation in 65-74-year-olds, but not in ≥75-year-olds. In 65-74-year-olds, the risk of PIM initiation increased with the higher income, whereas in ≥75-year-olds, the association between PIM initiation and the high income was not significant. The prescribing physician explained 9%-16% of the variation in the probability of PIM initiation. In conclusion, there were age-related differences in the factors associated with PIM initiation in relation to gender and socio-economic status. Overall, patient-related factors explained a large proportion of variation of PIM initiation, but there were also differences in PIM prescribing among physicians. However, physician-related variance of PIM initiations decreased during the 12-year follow-up.
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Affiliation(s)
- Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | | | - Anna-Kaisa Vartiainen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Hannu Valtonen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Longden T, Wong CY, Haywood P, Hall J, van Gool K. The prevalence of persistence and related health status: An analysis of persistently high healthcare costs in the short term and medium term. Soc Sci Med 2018; 211:147-156. [PMID: 29936332 DOI: 10.1016/j.socscimed.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 11/17/2022]
Abstract
Understanding whether high healthcare costs for individuals persist over time is critical for the development of policies that aim to reduce the prevalence of high cost patients. And while high healthcare costs will occur in any given year based on the prevalence of certain morbidities and acute conditions, a large random component of the distribution means that it is rarely the same people driving the bulk of healthcare expenditures. Using administrative data for over 250,000 Australian residents for the years between 2006 and 2011, we analyse the persistence of high annual healthcare costs. We examine the prevalence of high cost persistence in this sample, and then, we use endogenous switching models to identify the morbidity groups that are related with high cost persistence. These models also measure cases of cost amplification that are associated with a history of high cost healthcare. This analysis uses data from multiple categories of healthcare, specifically medical services, pharmaceuticals and admitted patient care. While there is a relatively low number of patients with persistent high cost (approximately 3% of the sample), this group accounted for 19% of aggregate expenditure. Pharmaceuticals were the most persistently high cost category of healthcare with 5% of the sample accounting for 32% of aggregate pharmaceutical expenditure. The morbidities associated with notable cost amplifications are morbidities that are hard to prevent or involve escalations of adverse health states that are difficult to avert. This casts doubt on whether broad policies can reduce the prevalence of individuals with persistently high healthcare costs.
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Affiliation(s)
- Thomas Longden
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia.
| | - Chun Yee Wong
- International University of Japan, Minami Uonuma-shi, Niigata-ken, Japan
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia
| | - Jane Hall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia
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Hirsch O, Schulz M, Erhart M, Donner-Banzhoff N. Factors associated with prescribing costs: analysis of a nationwide administrative database. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:5. [PMID: 29449789 PMCID: PMC5806480 DOI: 10.1186/s12962-018-0091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
Objective All health care systems in the world struggle with rising costs for drugs. We sought to explore factors impacting on prescribing costs in a nationwide database of ambulatory care in Germany. Factors identified by this research can be used for adjustment in future profiling efforts. Methods We analysed nationwide prescription data of physicians having contractual relationships with statutory health insurance funds in 2014. Predictor and outcome variables were aggregated at the practice level. We performed analyses separately for primary care and specialties of cardiology, gastroenterology, neurology and psychiatry, pulmology as well as oncology and haematology. Bivariate robust regressions and Spearman rank correlations were computed in order to find meaningful predictors for our outcome variable prescription costs per patient. Results Median age of patients and proportion of DDD issued were substantial predictors for prescription costs per patient in Primary Care, Cardiology, and Pulmology with explained variances between 41 and 61%. In Neurology and Psychiatry only proportion of patients with polypharmacy ≥ 2 quarters was a significant predictor for prescription costs per patient, explaining 20% of the variance. For gastroenterologists, oncologists and haematologists no stable models could be established. Conclusions Any analysis of prescribing behaviour must take the degree into account to which an individual physician or practice is responsible for prescribing patients' medication. Proportion of prescriptions/DDDs is an essential confounder for future studies of drug prescribing.
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Affiliation(s)
- O Hirsch
- 1Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
| | - M Schulz
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Herbert-Lewin-Platz 3, 10623 Berlin, Germany
| | - M Erhart
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Herbert-Lewin-Platz 3, 10623 Berlin, Germany
| | - N Donner-Banzhoff
- 1Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
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Miao Y, Qian D, Sandeep S, Ye T, Niu Y, Hu D, Zhang L. Exploring the characteristics of the high-cost population from the family perspective: a cross-sectional study in Jiangsu Province, China. BMJ Open 2017; 7:e017185. [PMID: 29127225 PMCID: PMC5695451 DOI: 10.1136/bmjopen-2017-017185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Across a range of healthcare settings, 5% of the population accounts for half of healthcare spending: these patients are identified as a 'high-cost population'. Characterising high-cost users is essential for predicting potential high-cost patients and the development of appropriate interventions to improve the management and financing of these patients. OBJECTIVE This cross-sectional study aimed to explore the characteristics of this high-cost population from a family perspective in China and provide suggestions for social health insurance policy development. METHODS This study used data from the Fifth Health Service Investigation of Jiangsu Province (2013), and 12 600 families were enrolled for analysis. Households whose medical expenditures were among the top 5% were identified to be high-cost families. A t-test, a Χ2 test, and a binary logistic regression were used. RESULTS High-cost families (n=631, 5%) accounted for 44.9% of the total medical expenditure of sampled families. High-cost families had 3.2 members and 1.2 chronic disease patients per household, which is significantly more than the 2.9 members and 0.7 people in the remaining families, respectively (p<0.05). Bi-weekly emergency department visits and annual hospitalisations preceding the household investigation of high-cost families were 1.19 and 0.98 per household, which is significantly more than the 0.68 and 0.17 of the remaining families, respectively (p<0.05). A binary logistic regression indicated that the number of family members (OR 1.152), the number of chronic disease patients (OR 1.508), bi-weekly emergency department visits (OR 1.218), and annual hospitalisations (OR 4.577) were associated with high costs. CONCLUSION The 5% high-cost families in Jiangsu Province accounted for approximately half of medical expenditures. The effectiveness of Chinese Social Health Insurance in lowering high-cost families' risk of catastrophic health expenditure was modest. Policymakers need to ascertain the priority of lowering the burden of high-cost families' out-of-pocket expenses through improving the reimbursement proportion and reducing avoidable medical services.
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Affiliation(s)
- Yudong Miao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dongfu Qian
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sandeep Sandeep
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ting Ye
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yadong Niu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Hu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Weymann D, Smolina K, Gladstone EJ, Morgan SG. High-Cost Users of Prescription Drugs: A Population-Based Analysis from British Columbia, Canada. Health Serv Res 2016; 52:697-719. [PMID: 27087391 PMCID: PMC5346502 DOI: 10.1111/1475-6773.12492] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To examine variation in pharmaceutical spending and patient characteristics across prescription drug user groups. Data Sources British Columbia's population‐based linked administrative health and sociodemographic databases (N = 3,460,763). Study Design We classified individuals into empirically derived prescription drug user groups based on pharmaceutical spending patterns outside hospitals from 2007 to 2011. We examined variation in patient characteristics, mortality, and health services usage and applied hierarchical clustering to determine patterns of concurrent drug use identifying high‐cost patients. Principal Findings Approximately 1 in 20 British Columbians had persistently high prescription costs for 5 consecutive years, accounting for 42 percent of 2011 province‐wide pharmaceutical spending. Less than 1 percent of the population experienced discrete episodes of high prescription costs; an additional 2.8 percent transitioned to or from high‐cost episodes of unknown duration. Persistent high‐cost users were more likely to concurrently use multiple chronic medications; episodic and transitory users spent more on specialized medicines, including outpatient cancer drugs. Cluster analyses revealed heterogeneity in concurrent medicine use within high‐cost groups. Conclusions Whether low, moderate, or high, costs of prescription drugs for most individuals are persistent over time. Policies controlling high‐cost use should focus on reducing polypharmacy and encouraging price competition in drug classes used by ordinary and high‐cost users alike.
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Affiliation(s)
- Deirdre Weymann
- University of British Columbia (UBC) School of Population and Public Health, Vancouver, BC, Canada
| | - Kate Smolina
- University of British Columbia (UBC) School of Population and Public Health, Vancouver, BC, Canada
| | - Emilie J Gladstone
- University of British Columbia (UBC) School of Population and Public Health, Vancouver, BC, Canada
| | - Steven G Morgan
- University of British Columbia (UBC) School of Population and Public Health, Vancouver, BC, Canada
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Lo T, Parkinson L, Cunich M, Byles J. A 6-year trend of the healthcare costs of arthritis in a population-based cohort of older women. Expert Rev Pharmacoecon Outcomes Res 2015; 16:383-91. [PMID: 26523846 DOI: 10.1586/14737167.2016.1096199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To provide an accurate representation of the economic burden of arthritis by estimating the adjusted incremental healthcare cost of arthritis at multiple percentiles and reporting the cost trends across time. METHODS A healthcare cost study based on health survey and linked administrative data, where costs were estimated from the government's perspective in dollars per person per year. Quantile regression was used to estimate the adjusted incremental cost at the 25th, 50th, 75th, 90th, and 95th percentiles. RESULTS Data from 4287 older Australian women were included. The median incremental healthcare cost of arthritis was, in 2012 Australian dollars, $480 (95% CI: $498-759) in 2009; however, 5% of individuals had 5-times higher costs than the 'average individual' with arthritis. Healthcare cost of arthritis did not increase significantly from 2003 to 2009. CONCLUSION Healthcare cost of arthritis represents a substantial burden for the governments. Future research should continue to monitor the economic burden of arthritis.
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Affiliation(s)
- Tkt Lo
- a 1 Research Centre for Gender, Health and Ageing, HMRI, C/- University Drive, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Lynne Parkinson
- b 2 Central Queensland University, School of Human Health and Social Sciences, Rockhampton, QLD 4701, Australia
| | - Michelle Cunich
- c 3 Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.,d 4 The University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan NSW 2308, Australia
| | - Julie Byles
- a 1 Research Centre for Gender, Health and Ageing, HMRI, C/- University Drive, University of Newcastle, Callaghan, NSW 2308, Australia
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Øymoen A, Pottegård A, Almarsdóttir AB. Characteristics and drug utilization patterns for heavy users of prescription drugs among the elderly: a Danish register-based drug utilization study. Eur J Clin Pharmacol 2015; 71:751-758. [PMID: 25912712 DOI: 10.1007/s00228-015-1849-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The objectives of this study were to (1) identify and characterize heavy users of prescription drugs among persons aged 60 years and above; (2) investigate the association of demographic, socioeconomic, and health-related variables with being a heavy drug user; and (3) study the most frequently used drugs among heavy drug users and development in use over time. METHOD This is a descriptive study. Heavy drug users were defined as the accumulated top 1 percentile who accounted for the largest share of prescription drug use measured in number of dispensed defined daily doses (DDDs). The nationwide Danish registers were used to obtain data. Multivariable logistic binary regression was used to determine which factors were associated with being a heavy drug user. RESULTS Heavy drug users among persons aged 60 years and above accounted for 6.8, 6.0, and 5.5% of prescription drug use in 2002, 2007, and 2012, respectively. Male gender, those aged 60-69 years, being divorced, shorter education, low annual income, and recent hospitalization were all significantly associated with being in the top 1 percentile group of drug users (p < 0.05). The ten most frequently used drug classes among heavy drug users accounted for 75.4% of their use in 2012, and five of these were cardiovascular drugs. The development over time for the ten most used drug classes followed the same pattern among heavy drug users and in the general population. CONCLUSION There is a skewed utilization of prescription drugs. Contrary to earlier findings, being male was associated with heavy prescription drug use both with respect to number of drugs used and drug expenditure.
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Affiliation(s)
- Anita Øymoen
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, 2, 5000, Odense C, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, 2, 5000, Odense C, Denmark
| | - Anna Birna Almarsdóttir
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, 2, 5000, Odense C, Denmark.
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.
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Saastamoinen LK, Verho J. Register-based indicators for potentially inappropriate medication in high-cost patients with excessive polypharmacy. Pharmacoepidemiol Drug Saf 2015; 24:610-8. [PMID: 25728165 DOI: 10.1002/pds.3764] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 12/19/2014] [Accepted: 01/26/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Excessive polypharmacy is often associated with inappropriate drug use. Because drug expenditures are heavily skewed and a considerable share of patients in the top 5% of the cost distribution have excessive polypharmacy, the appropriateness of their drug use should be reviewed. OBJECTIVES The aim of this study was to review the quality of drug use in patients with extremely high costs and excessive polypharmacy and to compare them with all drug users. RESEARCH DESIGN This is a nationwide register study. SUBJECTS The subjects of this study were all drug users in Finland over 15 years of age, n = 3,303,813. MEASURES The measures used were annual total costs, average costs, and number of patients. The background characteristics used included gender, age, morbidity, number of prescribers, active substances, and indicators of potentially inappropriate drug use, for example, Beers criteria. RESULTS The patients with high costs and excessive polypharmacy accounted for 22% of the total pharmaceutical expenditures but only 3% of drug users. One-third of them were elderly, compared with 11.3% of all drug users (p < 0.001). Almost all of them, 93.6%, had chronic disease compared with 34.0% of all the drug users (p < 0.001). The high-cost polypharmacy patients used more potentially inappropriate (28.0% vs 19.9%, p < 0.001) and anticholinergic drugs (26.7% vs. 9.6%, p < 0.001) and psychotropics more often simultaneously (20.4% vs. 3.8%, p < 0.001) than all drug users. CONCLUSIONS Excessive polypharmacy with inappropriate medication use should be prevented using all the methods. The patients with excessive polypharmacy and high-drug costs provide a most interesting group for containing pharmaceutical costs via medication reviews.
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Affiliation(s)
| | - Jouko Verho
- Research Department, The Social Insurance Institution, Helsinki, Finland
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Vivas-Consuelo D, Usó-Talamantes R, Trillo-Mata JL, Caballer-Tarazona M, Barrachina-Martínez I, Buigues-Pastor L. Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups. Health Policy 2014; 116:188-95. [DOI: 10.1016/j.healthpol.2014.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 12/18/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
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