Growth in prescription drug spending among insured elders

Medical Treatment Behaviour of the Elderly Population in Shanghai: Group Features and Influencing Factor Analysis

BACKGROUND

While Chinese cities are pursuing economic development, meeting citizen demand for medical treatment has only gradually been put on the agenda. Theoretically, in the second half of a person's life, demand for medical treatment will rise sharply. Given limited medical resources, the match between demand and supply becomes more difficult. We conducted questionnaires in Shanghai to describe whether there are obvious group differences in the elderly population's medical treatment options and provide empirical evidence on the determinants.

METHOD

We collected 439 Shanghai Elderly Medical Demand Characteristics Questionnaires, which included five parts: personal information, health status, elderly person's medical preference and expectation, satisfaction level for hospitals services, and medical insurance. We set up virtual explanatory variables according to the different medical behaviours of the elderly, and control variables composed of individual characteristics, socioeconomic characteristics, medical needs, medical resource availability, and medical expenditure. We used the MLR model to investigate medical treatment behaviour choice.

RESULTS

The medical treatment behaviour of the elderly population in Shanghai is affected by multiple factors. When experiencing physical discomfort, most of them choose to go to the hospital (64.69%). Age, income, household registration, and medical insurance reimbursement policy play a role in their decision-making. For general diseases, the proportion choosing specialist hospitals or community clinics is the highest (40.78%). Age, marital status, residential status, physical state, objective distance, medical expenses, and other factors have a significant impact. For severe diseases, they are more inclined (71.07%) to visit general hospitals, with the individual's physical condition, living status, and accessibility to hospital resources more likely to affect their behaviour.

CONCLUSION

Firstly, the importance of each factor varies depending on the conditions. Secondly, it may be more appropriate for China's elderly health insurance system to set reimbursement rates based on the patient's condition and disease type. Thirdly, medical behaviour has a distance friction effect, but the allocation of public service resources shows a strong centripetal concentration. It is necessary for the government to show due care about the regional distribution of the elderly population and to promote the rational distribution of medical resources in Shanghai.

The impact of medical insurance on medical expenses for older Chinese: Evidence from the national baseline survey of CLHLS

With the deepening population aging process in China, the medical expenses of older adults has become a widespread concerned. Medical insurance is a major source of Chinese medical financing and payment. The study aims to understand the current status of medical expenses for older adults and explore the effect of different types of health insurance on medical expenses in China.The data came from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. The Kruskal-Wallis test and general multivariate linear regression model were applied to analyze the current situation and to explore how medical insurance as the main payment impacts medical expenses.A total of 4376 older participants were included in this study. The median of medical expenses of a total was 1500 Yuan per year. The proportions of participants who had the urban employee-based basic medical insurance (UE-BMI), the urban residents basic medical insurance (UR-BMI), the new rural cooperative medical insurance scheme (NCMS), and the commercial medical insurance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively. 34.8% of older adults paid the health care service via the NCMS and 11.9% paid via the UE-BMI. Participating in the NCMS and UR-BMI are significantly related to the level of the medical fees of older adults. UE-BMI, UR-BMI, and NCMS as main payment eased the pressure of medical expenses.The influence of different types of medical insurances as main payments on the medical expenses of older adults is varied. Implementation of medical insurance should be taken to further relieve the medical expenses of older adults.

Access to Ambulatory Medicines for the Elderly in Georgia

Pensioners in Republic of Georgia are covered by the Universal Healthcare Program. In addition, socially vulnerable chronic patients additionally benefit from the Program for Providing Medicine for the Chronic Diseases (PPMCD). The research aims to assess the financial accessibility to outpatient medicines for the elderly in Georgia. Totally, 700 pensioners were surveyed within the quantitative research. The study showed that PPMCD (launched in 2017) has facilitated the affordability of medicines for elderly, especially the socially vulnerable chronic patients. However, the out-of-pocket spending on medicine is still high for most respondents. The main problem for the family is the high unaffordable price (26%). Nearly a third of respondents (31%) could not fully purchase all the outpatient medicine prescribed by the doctor, and 15% could not purchase them at all due to the high costs. Most of the respondents (57%) buy outpatient medicine without visiting family doctor and 37% self-medicate. This shows the irrational choice of elderly people during their health problems. In this regard, the pharmacy and self-treatment play an important role in the informal network of medical service. A significant part of the respondents (36%) does not know about PPMDC. The low level of awareness of the PPMCD among pensioners increases the risk of impoverishment. It is necessary to increase pensioners’ awareness about PPMCD. It is recommended to include not only socially vulnerable people in the PPMDC, but also chronic patients of pension age, because the expenses may often be catastrophic for them.

Profile of drug spend among elderly individuals from different socioeconomic groups

Abstract The increase in the elderly population is associated with increased health care costs. The objective of the present study was to describe the results of research conducted in groups of elderly persons from different socioeconomic classes in Porto Alegre in the state of Rio Grande do Sul, and to compare the drugs spending profiles of different groups. A cross-sectional study was performed using a sample of individuals aged 60 years or older who participated in community groups. Analysis of variance (ANOVA) and the Tukey test were used to analyze the difference in costs of drugs among different socioeconomic classes. A total of 225 seniors were interviewed and females were predominant in all classes. The most common chronic diseases included hypertension, which occurred in 21.0%, 36.0% and 38.0% of elderly persons in social classes A, C and E, respectively. The average number of medications was 5.34 (±2.64) in social class A, 4.07 (±2.73) in social class C and 4.28 (±2.39) in social class E. The share of household income spent on medication for elderly persons in classes A, C and E was 4.0%, 5.7% and 10.0%, respectively. The drugs with the highest monthly cost for each patient in class A, C and E, respectively, were antipsychotic and anti-Parkinson's medication, diabetes medicine, and medication for the treatment of bone disease. It was concluded that there are specific differences in the cost and expenses incurred on spending on medication for the elderly of different socioeconomic classes.

Policy versus practice: a community-based qualitative study of the realities of pharmacy services in Nunavut, Canada

Objectives

Nunavut is an Arctic territory in Canada subject to many social, economic and health disparities in comparison to the rest of the nation. The territory is affected by health care provision challenges caused by small, geographically isolated communities where staffing shortages and weather related access barriers are common concerns. In addition to national universal healthcare, the majority of the inhabitants of Nunavut (~85 %) are Inuit beneficiaries of no-charge pharmaceuticals provided through federal and/or territorial budgetary allocations. This research examines how existing pharmaceutical administration and distribution policies and practices in Nunavut impact patient care.

Methods

This grounded theory research includes document analysis and semi-structured interviews conducted in 2013/14 with patients, health care providers, administrators and policy makers in several communities in Nunavut. Thirty five informants in total participated in the study. Interviews were audiotaped, transcribed and analyzed with qualitative data analysis software for internal consistency and emerging themes.

Results

Four distinct themes emerge from the research that have the potential to impact patient care and which may provide direction for future policy development: 1) tensions between national versus territorial financial responsibilities influence health provider decisions that may affect patient care, 2) significant human resources are utilized in Community Health Centres to perform distribution duties associated with retail pharmacy medications, 3) large quantities of unclaimed prescription medications are suggestive of significant financial losses, suboptimal patient care and low adherence rates, and 4) the absence of a clear policy and oversight for some controlled substances, such as narcotics, leaves communities at risk for potential illegal procurement or abuse.

Conclusions

Addressing these issues in future policy development may result in system-wide economic benefits, improved patient care and adherence, and reduced risk to communities. The interview informants who participated in this research are best positioned to identify issues in need of attention and will benefit the most from policy development to address their concerns.

Living arrangements, chronic diseases, and prescription drug expenditures among Korean elderly: vulnerability to potential medication underuse

Background

Insufficient social security combined with family structure changes has resulted in a poverty of the elderly. The objective of this study was to examine an association of living arrangements of the elderly with chronic disease prevalence and prescription drug use.

Methods

2008 Korea Health Panel Survey (KHPS) data were used in this study. Information on living arrangements, socio-demographics, health behaviors, chronic disease prevalence and healthcare expenditures including out-of-pocket (OOP) prescription drug expenditures for elderly aged 65 or older were collected from self-reported diaries and receipts. OOP prescription drug expenditure as a total cost that subject paid to a pharmacy for prescription drugs was examined. Logistic regression was used to identify differences in major chronic disease prevalence by living arrangements. The association of living arrangements with prescription drug use was analyzed using generalized linear model with a log link and a gamma variance distribution.

Results

Proportions of elderly living alone, elderly living with a spouse only, and elderly living with adults aged 20–64 were 14.5%, 48.3%, and 37.2%, respectively. Elderly living alone showed 2.43 odds ratio (OR) (95% confidence interval (CI) = 1.66-3.56) for having major chronic diseases prevalence compared to elderly living with adults. Despite a higher major chronic disease prevalence, elderly living alone showed lower OOP prescription drug expenditures (Cost Ratio = 0.80, 95% CI = 0.67-0.97) after adjusting for the number of major chronic diseases. Total OOP prescription drug expenditures were significantly lower in patients with a low income level versus high income level.

Conclusions

Even though elderly living alone had a higher risk of chronic disease, they spent less on OOP prescription drug expenditures. Optimal drug use is important for elderly with chronic diseases to achieve good health outcomes and quality of life. Public health policies should be supplemented to optimize medical treatment for vulnerable elderly living alone.

Drug expenditure of high-cost patients and their characteristics in Finland

BACKGROUND

Little information exists on how constantly growing pharmaceutical expenditures are distributed in large representative samples of national populations in Western countries.

OBJECTIVE

This study analyzes the distribution of pharmaceutical expenditures in ambulatory care and explores the basic characteristics of the high-cost drug users.

METHOD

Reimbursed prescription drug purchases in 2009 were derived from the National Prescription Register for a 50% sample of the adult Finnish population. The high-cost users who were among the top 5% in terms of drug expenditures were identified based on annual drug costs.

RESULTS

The distribution of pharmaceutical costs is strongly skewed in Finland; only 5% of the population accounts for about half of the costs. These high-cost drug users were older than the low-cost drug users, with more than one-fourth of them being over 75 years old. The high-cost drug users used, on average, more drugs than the low-cost drug users, but approximately 15% of them used only 1-5 drugs. Almost 50% of the high-cost drug users used more than 10 drugs per year. They had chronic diseases more often than the low-cost drug users, especially uremia requiring dialysis, post-transplant conditions, severe anemia associated with chronic renal failure and multiple sclerosis were common among the high-cost users.

CONCLUSION

The skewness of the cost distribution indicates a need for more patient-specific cost-containment methods, and the high number of drugs in the high-cost group calls for exploring the possibilities of disease management and patient monitoring techniques in cost containment.

Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia

Low-income older adults are at increased risk of cutting back on basic needs, including food and medication. This study examined the relationship between food insecurity and cost-related medication non-adherence (CRN) in low-income Georgian older adults. The study sample includes new Older Americans Act Nutrition Program participants and waitlisted people assessed by a self-administered mail survey (N = 1000, mean age 75.0 + so - 9.1 years, 68.4% women, 25.8% African American). About 49.7% of participants were food insecure, while 44.4% reported practicing CRN. Those who were food insecure and/or who practiced CRN were more likely to be African American, low-income, younger, less educated, and to report poorer self-reported health status. Food insecure participants were 2.9 (95% CI 2.2, 4.0) times more likely to practice CRN behaviors than their counterparts after controlling for potential confounders. Improving food security is important inorder to promote adherence to recommended prescription regimens.

Treatment of addiction in the elderly

Although it is often not considered and frequently undiagnosed, addiction disorders are a significant problem in the elderly. Elders are at a higher risk for the consequences of abuse or addiction owing to changes related to aging, multiple medications and chronic illness. The consequences of addiction disorders in this population include delirium, memory loss, suicide, falls and fractures, as well as drug–drug or drug–disease interactions. Abuse or addiction to alcohol or prescription or illicit drugs often presents differently in the elderly, may be inadvertent or prescriber-related and requires a different approach to assessment. Coexisting psychiatric or physical disorders together with addiction need to be considered in the overall functional status of the elderly. Treatment should be individualized based on the patient’s needs, readiness for change and available resources, and should vary from brief outpatient intervention to inpatient care. Treatment outcomes for elders are as good as or better than the outcome of younger adults. With an increasing proportion of the population becoming elders and the aging of ‘baby boomers,’ an increase in addiction in this population, including to illicit drugs, is expected in the near future. Education of the public, as well as healthcare professionals, along with reassessment of the prevalence of these disorders in this population using age-appropriate criteria, are needed, since more resources will be required in order to treat these individuals in the near future.

"It's just routine." A qualitative study of medicine-taking amongst older people in New Zealand

AIM

To explore how New Zealanders aged 65 years and older manage their medicines in their own homes, and determine the problems and concerns they might have with taking them.

SETTING

Urban setting, Dunedin (population 120,000), New Zealand.

METHODS

Twenty in-depth semi-structured interviews were undertaken of community-dwelling people 65 years and older. Sixty people, from a random sample of 80 from the electoral roll, met the recruitment criteria and were invited to participate. The first ten men and ten women agreeing to participate were interviewed. Interviews were taped and transcribed verbatim. Transcriptions were thematically coded and analysed using grounded theory and constant comparison.

MAIN OUTCOME MEASURES

Emerging themes were explored under the topics: accessing medicines, remembering to take medicines, following instructions, practical problems, adverse effects, concerns about medicines, and beliefs about medicines.

RESULTS

Ten of thirteen men and 10/20 women contacted (61%) agreed to participate. The men were aged 71, 67-82 years (median, range) and women 77, 69-87 years. They were using 140 prescription medicines (median 7, range 3-16) and 34 non-prescription medicines (1, 0-6); mainly for the nervous system (28%), or the cardiovascular system (22%). Participants felt that they had good access to medicines, could afford them, managed them well, and had systems and routines to help them remember to take them. Occasional doses were missed following a change in routine. Practical problems were found such as difficulty swallowing or halving tablets. Three-quarters of participants had experienced adverse effects during their lives. These were managed by dose or drug changes or by taking practical measures. People were worried about adverse effects occurring whether or not they had experienced them previously. Beliefs about medicines were mainly positive, although some people disliked taking them.

CONCLUSION

The people 65 years and over in this study felt that they could access, afford and manage their medicines well. Although many participants had experienced adverse effects, their beliefs about medicines were mainly positive. Practical problems and concerns should be routinely inquired about and addressed, and prescribing and monitoring optimised to minimise adverse effects, in order to assist older people take their medicines.

Composição dos gastos privados com medicamentos utilizados por aposentados e pensionistas com idade igual ou superior a 60 anos em Belo Horizonte, Minas Gerais, Brasil

O objetivo do presente estudo foi analisar a composição dos gastos privados com medicamentos utilizados por indivíduos com 60 anos ou mais de idade, em Belo Horizonte, Minas Gerais, Brasil. A população estudada foi uma amostra representativa de aposentados e pensionistas do Instituto Nacional do Seguro Social (INSS) nessa faixa etária e residentes no Município de Belo Horizonte, entrevistados em um inquérito domiciliar. Foram calculados os gastos mensais com medicamentos obtidos no setor privado e analisada a sua composição considerando as características dos medicamentos. Responderam ao inquérito 667 indivíduos. Foi observado um gasto mensal privado médio de R$ 122,97 (US$ 38,91) com os medicamentos utilizados pelos participantes. Os grupos terapêuticos que representaram uma maior proporção dos gastos totais foram: sistema cardiovascular (26%), sistema nervoso (24%) e trato alimentar e metabolismo (15%). Em relação à categoria de registro dos medicamentos utilizados, os medicamentos de referência foram responsáveis por uma maior proporção dos gastos totais (54%). Os resultados deste estudo podem subsidiar políticas destinadas a melhorar o acesso a medicamentos e às condições sanitárias da população idosa brasileira.

Psychoactive drug abuse in older adults

BACKGROUND

Misuse and abuse of legal and illegal drugs constitute a growing problem among older adults.

OBJECTIVE

This article reviews the prevalence, risks and protective factors, and screening and diagnosis of drug abuse in older adults. Treatment concerns and the consequences of drug problems are examined briefly.

METHODS

MEDLINE and PsychInfo were searched using the terms substance-related disorders, drug-use disorders, abuse, dependency, opioid-related disorders, stimulant-related disorders, cocaine-related disorders, marijuana-related disorders, and withdrawal syndrome. The review included articles published in English between January 1, 1990, and May 31, 2006.

RESULTS

Despite a wealth of information on the epidemiology and treatment of alcohol abuse in older adults, few comparable data are available on drug abuse in this population. The evidence suggests that although illegal drug use is relatively rare among older adults compared with younger adults and adolescents, there is a growing problem of the misuse and abuse of prescription drugs with abuse potential. It is estimated that up to 11% of older women misuse prescription drugs and that nonmedical use of prescription drugs among all adults aged > or =50 years will increase to 2.7 million by the year 2020. Factors associated with drug abuse in older adults include female sex, social isolation, history of a substance-use or mental health disorder, and medical exposure to prescription drugs with abuse potential. No validated screening or assessment instruments are available for identifying or diagnosing drug abuse in the older population. Special approaches may be necessary when treating substance-use disorders in older adults with multiple comorbidities and/or functional impairment, and the least intensive approaches should be considered first.

CONCLUSIONS

Psychoactive medications with abuse potential are used by at least 1 in 4 older adults, and such use is likely to grow as the population ages. The treatment of disorders of prescription drug use in older adults may involve family and caretakers, and should take into account the unique physical, emotional, and cognitive factors of aging. Further research is needed on the epidemiologic, health services, and treatment aspects of drug abuse in older adults, as well as the development of appropriate screening and diagnostic tools.

How do seniors use their prescription drug discount cards?

This study examines how seniors enrolled in a major national prescription drug discount program used their cards in the year before the Medicare discount card program's implementation, to establish baseline information. Seniors who actively enrolled relied heavily on the card for their purchases. They saved 20 percent overall but still spent more than dollar 1,300 annually on prescriptions, on average. Fewer than half of those who were automatically enrolled as a free Medigap benefit used the card. This suggests that some had other options or that more effort is needed to assure that seniors understand the value of drug savings programs and how to use them.

What are the public health effects of direct-to-consumer drug advertising?

Only two industrialized countries, the United States and New Zealand, allow direct-to-consumer advertising (DTCA) of prescription medicines, although New Zealand is planning a ban. The challenge for these governments is ensuring that DTCA is more beneficial than harmful. Proponents of DTCA argue that it helps to inform the public about available treatments and stimulates appropriate use of drugs for high-priority illnesses (such as statin use in people with ischemic heart disease). Critics argue that the information in the adverts is often biased and misleading, and that DTCA raises prescribing costs without net evidence of health benefits.

Health Plans’ Strategies To Control Prescription Drug Spending

A number of recent studies have documented the sizable impact of consumer cost sharing without accounting for the other drug management strategies being adopted simultaneously. This qualitative case study of five of California's largest health plans examines the strategies and methods used to control prescription drug use and spending. Higher cost sharing is being used increasingly. Concurrently, major administrative efforts directed at physicians-including rules, incentives, and education-are being undertaken. These efforts have focused on lowering the cost per prescription by emphasizing generic substitution and therapeutic interchange of less costly drugs.

Out-of-pocket health care expenditures among older Americans with dementia

The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.

Looking Inside The Nation’s Medicine Cabinet: Trends In Outpatient Drug Spending By Medicare Beneficiaries, 1997 And 2001

We examine trends in outpatient prescription drug spending by the Medicare civilian, noninstitutionalized population in 1997 and 2001 using nationally representative data from the Medical Expenditure Panel Survey. We find that the 72 percent increase in drug spending over this period, in excess of price inflation for all goods and services, is primarily attributable to increases in the number of prescriptions per drug user and in the price per prescription. We also find, however, that an increase in the number of users is the primary reason for growth in a number of the fastest-growing subclasses of drugs.

Pharmacy data in the VA health care system

Recent advances in Department of Veterans Affairs (VA) health care data systems have greatly increased access to operational pharmacy information. This article presents a brief guide to VA pharmacy data sources: the Veterans Health Information Systems and Technology Architecture files, the Pharmacy Benefits Management database, Decision Support System (DSS) National Data Extracts for inpatient and outpatient care, the planned DSS National Pharmacy Extract, DSS databases at local VA facilities, and the Non-VA Fee Basis files. Depending on the source, available data elements include patient demographics, clinical care information, characteristics of the medication and of the prescribing physician, and cost. Access policies are detailed for VA and non-VA researchers. Linking these sources to VA databases containing data on inpatient and outpatient services offers a comprehensive view of health care within several VA populations of general interest, including people over age 65 and those with physical and psychiatric disabilities.

Out-of-pocket health-care expenditures among older Americans with cancer

OBJECTIVE

There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx).

METHODS

We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated.

RESULTS

Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01).

CONCLUSIONS

Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.

Spending For Specialized Mental Health Treatment In The VA: 1995–2001

The mid-1990s saw dramatic changes in mental health care in the Department of Veterans Affairs (VA), the largest provider of such care in the United States. Spending for specialized inpatient mental health care fell 21 percent from 1995 to 2001, while spending for specialized outpatient care rose 63 percent. The shift from inpatient to outpatient care was accompanied by rapid increases in outpatient medication costs. Overall, the VA reduced the average cost (per VA user) of specialized mental health care by 22 percent while it increased the number of users of these services by 35 percent.

Communication of Drug Affordability between Physicians and Elderly Patients

Objective:

To identify characteristics among elderly patients associated with patient–provider communications regarding affordability of medications in prescribing and dispensing.

Methods:

Telephone survey data from consumers ≥65 years old collected in the Texas Tech 5000 Survey were used. The sample size for the analyses was 2,360. Demographics, insurance, financial factors, nonfinancial factors, prescription drug use, and health status were used to identify which subgroup of elderly patients recalled communication with their providers regarding the affordability of prescriptions. Statistical analyses included bivariate analyses and a multivariate logistic regression.

Results:

Eleven percent of the respondents reported being asked by their physicians whether they could afford prescription drugs. In the multivariate analysis, gender, race, insurance coverage for prescriptions, income, number of physician visits, out-of-pocket expenditure for prescriptions, health, and physicians' participatory decision-making score were found to be associated with patient–provider communications regarding affordability of medications.

Conclusions:

Further research needs to be conducted to identify ways to improve patient–provider relationships to facilitate communication regarding affordability of medications among elderly patients. Improved communication or sensitivity to prescription affordability has the potential to increase patient medication adherence and improve clinical outcomes.

Cost of pharmacological care of the elderly: implications for healthcare resources

Expenditures on prescribed medicines are significantly higher among those aged 65 years and over than among younger people. As populations in developed countries age so the cost of pharmacological care associated with the older population can be expected to increase. While pharmacological care represents only one component of healthcare, its costs are increasing rapidly because of advances in technology and increasing use. However, such costs should be considered within a context of decreasing disability in the elderly population, improving economic conditions among seniors and the relationship of these costs with those in other aspects of healthcare. Where medications have been demonstrated to be cost-effective, attempts to curtail expenditure growth may prove a false economy resulting in significantly higher growth elsewhere such as in the hospital and long-term care sectors. Policy responses to this issue should encompass the inclusion of elderly patients in clinical trials, the use of evidence-based principles of practice and strategies to ensure that this population obtain maximum benefit from medication through education and counselling.

Challenges to the pharmacist profession from escalating pharmaceutical demand

Unexpected growth in medication use has escalated demand for pharmacists that has outpaced supply. Responses to the pharmacist shortage include larger workloads and greater use of pharmacist extenders and technology. As the profession has moved from a product orientation (dispensing medications) to a patient focus, clinical training requirements have expanded. However, structural and process barriers, particularly in community and retail pharmacies, must be addressed to improve the medication-use process. These issues merit greater attention from health care leaders and policymakers.