HOW COMPLETE ARE DRUG HISTORY PROFILES THAT ARE BASED ON PUBLIC DRUG BENEFIT CLAIMS?

Main Article Content

J Michael Paterson
Ali Suleiman Suleiman
Janet E Hux
Chaim Bell

Keywords

Drug history profiles, prescription drug insurance, emergency department, drug adverse events

Abstract

Background


In Canada, programs are being developed to supply hospital emergency departments and family doctors with electronic access to their patients’ drug history profiles. While some of these programs have access to  databases  that  capture  information  about  all  out-patient  prescriptions  that  are  dispensed  to  an individual, regardless of payer; others do not, and rely upon claims paid by their provincial drug benefit plans. The completeness of these latter profiles is unknown.


 Objectives


To estimate the percentage of Ontario seniors who use private drug insurance (as an indicator of the potential for a ‘public’ drug history profile to be incomplete) and to describe the kinds of medications for which private insurance is used.


 Methods


Cross-sectional time series analysis of Ontario Drug Benefit (ODB) claims and private drug insurance claims  for Ontario  residents  aged  65  years  or  older  (seniors)  covering  the  period  January  2000  to December 2005.


 Results


During the study period, approximately 95% of Ontario seniors filled at least one prescription paid by the provincial drug benefit plan. By comparison, approximately 15-20% filled a prescription paid by a private insurer. Compared to the 20 drugs most frequently subsidized by the ODB Program (all but one of which had ODB full benefit status), the top privately-purchased drugs were more diverse: 8 had ODB full benefit status; 4 had ODB Limited Use status (which requires that patients meet prespecified clinical criteria for coverage); 3 required individual clinical review (prior authorization) by the ODB Program; and 5 were ODB non-benefits.


 Conclusions


Many Ontario seniors are at risk for an incomplete ODB drug history profile. Further research is needed to confirm whether this causes problems for physicians and patients.

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