Impact of a publicly-funded pharmacare program policy on benzodiazepine dispensing among children and youth: a population-based natural experiment

BMC Pediatrics

Research

Melanie Penner¹  Kathleen Pajer²  Daniel McCormack³  Sophie Kitchen³  Yona Lunsky⁴  David N. Juurlink⁵  Mina Tadrous⁶  William Gardner⁷  Tony Antoniou⁸  Tara Gomes⁹  Muhammad Mamdani^1,10 

[1] Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada;Department of Pediatrics, University of Toronto, Toronto Ontario, Canada;Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada;Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada;ICES, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Department of Pediatrics, University of Toronto, Toronto Ontario, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;ICES, Toronto, ON, Canada;School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada;Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;Institute of Health Policy, Management, and Evaluation (Mamdani), University of Toronto, Toronto, ON, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health, Toronto, ON, Canada;Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada;Institute of Health Policy, Management, and Evaluation (Mamdani), University of Toronto, Toronto, ON, Canada;

关键词: Child;    Adolescent;    Benzodiazepines;    Policy;    Prescriptions / statistics & numerical data;   

DOI  :  10.1186/s12887-023-04331-4

 received in 2022-10-12, accepted in 2023-09-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn January 2018, the Government of Ontario, Canada, initiated a universal pharmacare program (OHIP+) for all individuals aged 24 years and younger. In April 2019, the program was amended to cover only children and youth without private insurance. Because benzodiazepines are commonly prescribed to children and youth despite their potential hazards, we examined whether changes in publicly-funded drug coverage influenced benzodiazepine dispensing trends in this demographic.MethodsWe conducted a population-based natural experiment study of benzodiazepine dispensing to children and youth in Ontario between January 2013 and March 2020. We used interventional autoregressive integrated moving average models to estimate the impact of OHIP + and its subsequent modification on these trends.ResultsThe implementation of OHIP + was associated with an immediate increase in the monthly rate of benzodiazepine dispensing of 12.9 individuals per 100,000 population (95% confidence interval [CI]; 7.5 to 18.3 per 100,000). Benzodiazepine dispensing rates rose from 214.2 to 241.5 per 100,000 from December 2017 to March 2019, a 12.8% (95% CI 9.6–16.0%) increase. In stratified analyses, increases were most pronounced among females, children and youth living in the lowest income neighbourhoods and individuals aged 20 to 24. The April 2019 modification to OHIP + was not associated with changes in monthly benzodiazepine dispensing trends (0.39 individuals per 100,000; 95% CI -1.3 to 2.1 per 100,000). However, rates remained elevated relative to the period preceding OHIP + implementation.ConclusionsImplementation of a publicly-funded pharmacare program resulted in more children and youth being prescribed benzodiazepines.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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Fig. 1