Predictors of ceasing or reducing statin medication following a large increase in the consumer copayment for medications: a retrospective observational study.

OBJECTIVES: Previous Australian research has shown that following the 21% increase in patient copayments for medications on the Pharmaceutical Benefits Scheme (PBS) in 2005, the use of lipid-lowering therapy declined by 5%. This study aimed to determine the demographic and clinical characteristics of individuals who continued, reduced or ceased their use of statin medication in 2005. STUDY TYPE: Retrospective observational study using routinely collected administrative data. METHOD: We used pharmaceutical claims, hospital separations and mortality records from 2000 to 2005 for the Western Australian population. The cohort comprised stable users of statin medication in 2004. Based on changes in statin use between 2004 and 2005, we identified individuals who: 1) continued using statins; 2) reduced their use by ≥20%; or 3) ceased therapy for at least the first 6 months in 2005. Multivariate logistic regression models were used to determine whether the demographic and clinical characteristics of the three groups differed. RESULTS: There were 205 924 statin users identified in Western Australia as of December 2004. After the January 2005 Pharmaceutical Benefits Scheme (PBS) copayment increase, 3.2% of users ceased their regular statin therapy, 12.9% reduced statin use and 83.9% continued statin use. This represented a 2.1% increase in statin users reducing or ceasing therapy compared to 2004. Predictors of cessation and reduction of statin therapy included younger age, greater socio-economic disadvantage, residing in very remote areas, having general beneficiary status, being a new statin user, having no prior history of ischaemic heart disease, having no prior history of a coronary artery revascularisation procedure, taking no other cardiovascular medication or diabetic medication, taking an increased number of medications, and having a lower level of adherence to statin medication in 2004. CONCLUSION: Compared to 2004, an additional 2.1% of statin users reduced or discontinued medication use in 2005, which may be attributed to an increase in the medication copayment. Individuals with general beneficiary status, and younger and healthier people were at particular risk of cessation or reduction in statin use in 2005.

Medication safety programs in primary care: a scoping review.

BACKGROUND: Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. OBJECTIVE: The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review considered participants of any age and any condition using care obtained from any primary care services. CONCEPT: We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. CONTEXT: The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. TYPES OF STUDIES: We considered all quantitative studied published in English. SEARCH STRATEGY: A three-step search strategy was utilized in this review. DATA EXTRACTION: Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome measures. RESULTS: The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a protocol that was previously published. This scoping review included nine studies published over an eight-year period that investigated or described the effects of medication safety programs in primary care settings. We classified each of the nine included studies into three main sections according to whether they included an organizational, professional or patient component. The organizational component is aimed at changing the structure of the organization to implement the intervention, the professional component is aimed at the healthcare professionals involved in implementing the interventions, and the patient component is aimed at counseling and education of the patient. All of the included studies had different types of medication safety programs. The programs ranged from complex interventions including pharmacists and teams of healthcare professionals to educational packages for patients and computerized system interventions. The outcome measures described in the included studies were medication error incidence, adverse events and number of drug-related problems. CONCLUSION: Multi-faceted medication safety programs are likely to vary in characteristics. They include educational training, quality improvement tools, informatics, patient education and feedback provision. The most likely outcome measure for these programs is the incidence of medication errors and reported adverse events or drug-related problems.

Medication safety programs in primary care: a scoping review protocol.

REVIEW OBJECTIVE/QUESTION: The objective of this scoping review is to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety.The current review will be guided by the following research questions.

Anticholinesterase duration in the Australian veteran population.

OBJECTIVE: The aim of the present study was to determine the duration of initial anticholinesterase treatment in veteran patients in Australia. Three anti-dementia medications were investigated (donepezil, rivastigmine and galantamine) and two different setting were compared (community and residential aged care facilities). METHOD: A retrospective cohort study was performed using the Department of Veterans' Affairs pharmacy claims data. Patients were included in the cohort if they had been dispensed at least one anticholinesterase prescription (index) between 2003 and 2006, were aged 65 years or over at the time of that index dispensing, and had not been dispensed any anticholinesterase medicine in the previous 12 months. Patients were followed until discontinuation (ceased or switched), death or 1 year of follow up. Time to treatment discontinuation was analysed utilizing the Kaplan-Meier method. Cox proportional hazards models were used to compare the risk of treatment discontinuation among the three treatment groups adjusting for the effect of patients' characteristics. RESULTS: Of the new users of anticholinesterases (n = 10088), 47% of those on donepezil, 46% of those on galantamine, and 47% of rivastigmine patients discontinued their initial therapy within 6 months. A total of 32% of patients who ceased therapy reinitiated it during the study period; 28% returned to the same index medication and 4% restarted therapy with a different anticholinesterase. The median treatment duration was: 199 days (95% CI, 182-208) for donepezil patients (n = 6705), 233 days (95% CI, 212-259) for galantamine patients (n = 2898), and 219 days (95% CI, 176-260) for rivastigmine patients (n = 394). Patients in community settings were more likely to discontinue their initial anticholinesterases earlier compared to those living at residential aged care facilities (relative risk, RR=1.21; 95% CI, 1.12, 1.31). CONCLUSIONS: Almost half of the Australian veteran patients who initiated anticholinesterases treatment discontinued (ceased or switched) therapy within 6 months. However, one-third of those who ceased therapy reinitiated it during the study period.