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Abstract: Poster Presentations |

DO RESTRICTIVE REIMBURSEMENT PROCESSES INHIBIT PHYSICIANS FROM ADOPTING AND IMPLEMENTING GUIDELINES INTO THEIR PRACTICE: THE CANADIAN ASTHMA EXPERIENCE FREE TO VIEW

Andrew R. Mc Ivor, MD*; Laureen Rance, PharmD
Author and Funding Information

Dalhousie University, Bedford, NS, Canada


Chest


Chest. 2005;128(4_MeetingAbstracts):240S. doi:10.1378/chest.128.4_MeetingAbstracts.240S
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Abstract

PURPOSE:  Provincial drug programs are increasingly listing pharmaceutical products with restrictions. This may be to ensure appropriate use of a drug or serve as a cost containment strategy to control the provincial formulary budget. To determine if physicians treat asthma patients who are beneficiaries of the provincial drug plan differently than patients who have private drug plan.

METHODS:  On-line market research was conducted using a structured questionnaire with 284 general practitioners (GPs) from across Canada. The sample was weighted by province. Physicians were provided scenario-based questions to determine their preferences for treating patients. They were presented with two scenarios for patients uncontrolled on moderate doses of inhaled corticosteroids (ICS), provincial plan beneficiary vs. private drug plan beneficiary. These asked whether they would increase the dose of ICS or add additional therapy.

RESULTS:  Physicians ranked asthma symptoms, treatment guidelines and insurance coverage (public versus private) as the three most important factors impacting drug therapy choice. Eighty percent of physicians (80%) reported that they ask patients about drug coverage (private vs. public) before making a prescribing decision. 37% of physicians reported that they would increase the dose of ICS for public versus 22% for privately insured patients uncontrolled on moderate doses of ICS. This trend remained consistent across the regions, however in Atlantic Canada there was no difference at 35%.For provincial drug plan patients, the majority reported adding a long acting beta agonist (LABA) via a separate inhaler vs. those with private drug plans where the physicians opted for a combination of ICS + LABA in one inhaler.

CONCLUSION:  Asthma treatment approaches differ for patients with public vs. private drug plans. Patients uncontrolled on ICS alone with public drug coverage, physicians continue to increase the dose of ICS, despite the fact that this approach is misaligned with current guideline recommendations.

CLINICAL IMPLICATIONS:  Patients with private drug coverage are treated more closely to national guidelines developed to improve outcomes. The market research used to prepare this document was performed by PSL Inc.,Toronto, Ontario, Canada.

DISCLOSURE:  Andrew Mc Ivor, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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