Prescription pattern

🕔Mar 09, 2006

According to a recently released report from UBC’s Centre for Health Services and Policy Research, B.C.’s North is leading the province: we spend the most on prescription drugs.

Billed by its authors as “the world’s most detailed portrait of the determinants of the use and cost of pharmaceuticals to date,” The British Columbia Rx Atlas crunched the numbers from Pharmanet records of most of B.C.’s 4.1 million residents to look at our expenditure between 1996 and 2003, on a region-by-region basis, for prescription drugs. It further breaks the numbers down into expenditure per capita and per age group.

The effort to tally 214 million Pharmanet records may sound utterly mind-numbing, but there are very good reasons to study this.

The cost of prescription drugs is the second largest cost component of public health care. Between 1996 and 2003, expenditure on prescription drugs—including the costs born by individuals and those covered by Fair Pharmacare—grew at rates which would double total expenditures in six to eight years.

Interestingly, individuals are shouldering more of the burden. The Rx Atlas concludes that changes to B.C.’s Pharmacare rules have reduced the provincial subsidy for drug costs from 52 per cent in 2001 to 44 per cent in 2003, bringing it more into line with the national average of 40 per cent.

Northerners spend more per capita on drugs than anywhere else in B.C. Increased utilization of drugs, rather than aging, rising drug prices, and choice of more expensive options, appears to be the biggest factor. And in the Northwest, expenditure is increasing faster than anywhere else in B.C.

But before anyone starts blaming First Nations, veterans or cops for all this drug use, we must point out that these three groups were not included in the study’s numbers.

A significant omission? Perhaps. Combined, these groups represent approximately four per cent of the population provincially. But their omission could skew our picture of B.C.’s North, where First Nations, at least, account for more than 40 per cent of the population in some regions. However, these groups’ drug usage patterns were not included in the research because they get their supplies through federal plans, not the BC Medical Services Plan—and therefore don’t show up in Pharmanet records.

Alana Froese is a regional pharmacist tasked with analyzing prescription patterns in Northern Health Authority hospitals. Froese agrees that rising drug costs are a huge problem.

She observed that northerners generally experience a higher incidence of chronic medical conditions, such as diabetes. She linked this to fewer medical amenities and health care professionals, as well as harsher weather which means more car accidents and more physically demanding lifestyles.

However, she’s also concluded that prescribing patterns, in hospitals at least, aren’t being properly or routinely monitored by pharmacists.

“The fewer the health care staff you have in a community, the less chance we’ll be able to do a thorough job of our monitoring of patient care,” she said from her office in Smithers. “The same goes for physicians. If they are extremely overworked, and aren’t able to do follow-up … that could be why we’re seeing a higher incidence of medication use… they’re tending to send [patients] off, and unable to monitor them for possible reductions or discontinuations of medication.”

Would this phenomenon be more common in the North? “Absolutely,” says Froese, attributing this to the difficulty of recruiting health professionals to this region.

Froese revealed that the Northern Health Authority is currently examining hospital prescription patterns with a view to improving patient outcomes, safety and costs.

Sometimes, says Froese, physicians may not know that cheaper alternatives exist. One drug is being carefully scrutinized: Pantaloc IV, which is used to reduce acid in the stomach. A single dose of Pantaloc IV can cost $14—or just one cent, depending on the method of delivery (injection or tablet). Many patients are getting more expensive treatment when they could reasonably take the cheaper tablets.

“What I’m seeing is that the smaller the facility, the less control we have on drug costs,” she said. A comparative lack of continuing education opportunities for remote physicians could also be part of the problem.

Some interesting drug use tidbits

During the five-year period studied, the Northern Interior experienced more than a ten-fold increase (1,087 per cent)— B.C.’s highest—in costs for immunosuppressants, which are used to treat autoimmune disease and reduce risk of rejection of transplanted organs.

The Northeast led the province in its 2,959 per cent increase of expenditure on immunostimulants, which are used in treatments of febrile neutropenia, chronic hepatitis, multiple sclerosis, and some cancers.

When it comes to use of psychoanaleptics (drugs commonly used to treat depression, anxiety, attention deficit disorder, dementia), South Vancouver beats the Northwest hands-down: 117 per 1,000 people versus 95 in the Northwest. However, during the period studied, B.C.’s northwest registered the highest increase in use of these drugs: a 97 per cent increase.

Generally speaking, psychoanaleptics are the second-largest category of medicine in terms of spending in 2003. “There’s a real move toward the treatment and awareness of depression, and more confidence among the population about the effectiveness of medication for depression,” said Froese.

For at least some regions, “getting it up” in the morning—or any time of day, for that matter—is getting easier. Between 1996 and 2003, B.C.’s Northwest outpaced the province with a 352 per cent increase on expenditures on urological drug treatments, which include treatments for erectile dysfunction.

Why the Northwest is particularly ready to shell out for these drugs remains unclear. But according to Dr. David McKenzie, PhD, one of B.C.’s top sex therapists, 90 per cent of all males have experienced erectile dysfunction by age 40. “Until about seven years ago, there wasn’t much you could do if this was caused by a medical condition,” said McKenzie from his Vancouver office. “This miracle drug has saved many marriages.”

© Larissa Ardis 2006