Max Rady College of Medicine

Deliverables: Prescription Drugs

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2021


Outpatient Antibiotic Prescribing by Manitoba Clinicians
Ruth C, Fanella S, Raymond C, Dragan R, Prior H, Dik N, Stevenson D, Koseva I, Valdivia J
Antibiotics are essential to the health of Manitobans. However, the more they are used the more bacteria can develop resistance, making the antibiotics less effective. This study looked at antibiotics dispensed in the community from 2011 to 2016, and how they linked to physician visits and diagnoses. The study found that antibiotic use increased from 2011 to 2016, with highest use in adults aged 65+ and in children under age 5; rates of inappropriate antibiotic use was high and increasing. For conditions that may need antibiotics, the antibiotics being given were often not the ones recommended by guidelines. Physicians and other providers varied widely in how often they prescribed antibiotics for a given condition. The study findings clearly indicate the need for antibiotic stewardship programs to improve antibiotic use in the community. Several other recommendations are also included in the report.
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2019


The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba
Katz A, Avery Kinew K, Star L, Taylor C, Koseva I, Lavoie J, Burchill C, Urquia M, Basham A, Rajotte L, Ramayanam V, Jarmasz J, Burchill S
This deliverable is the product of a strong and developing relationship between MCHP and the First Nations Health and Social Secretariat of Manitoba. It looks at health and healthcare use patterns of First Nations people living in Manitoba. The analyses provide comparisons between First Nations and all other Manitobans, comparisons between on and off reserve First Nations, and regional comparisons by Regional Health Authority and by Tribal Council Areas. It is the first study to use the Regional Health Survey which includes on-reserve First Nation peoples. The results demonstrate the widening gap between the health of First Nations and all other Manitobans and point to inequities in service provision.
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2018


Outpatient Oral Anticancer Agents in Manitoba
Raymond C, Leong C, Fransoo R, Geirnaert M, Dragan R, Yogendran M, Thomson T, Rajotte L, Koseva I, Schultz J, Burchill S
Most Manitobans who receive treatment for cancer do so with intravenous therapy at Cancer Care Manitoba. However, in recent years, the use of oral anticancer agents has increased. Traditionally, prescriptions for these medications are filled at community pharmacies through the usual system of prescription drug coverage, including a deductible for eligible Pharmacare prescriptions. In 2012, the Home Cancer Drug (HCD) Program was launched. This is a program for Manitobans diagnosed with cancer that allows access to eligible outpatient oral cancer and specific supportive care drugs at no cost to the patient (with no deductible). This research project sought to determine usage of oral medications in Manitoba, changes in patterns of use and prescription filling over time, and the impact of the HCD program on prescription filling patterns. Using prescription drug data for outpatients we examined prescription utilization trends, costs associated with such therapies and patterns of health services use.
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Health and Social Outcomes Associated with High-Risk Alcohol Use
Nickel NC, Bolton J, MacWilliam L, Ekuma O, Prior H, Valdivia J, Leong C, Konrad G, Finlayson G, Nepon J, Singal D, Burchill S, Walld R, Rajotte L, Paille M
Alcohol is enjoyed by many Canadians and has special social and cultural significance in Canadian society. However, over-consumption of alcohol is linked with many, far-reaching harms. Recent data suggest that one in five Canadian drinkers exceed Canada’s low-risk drinking guidelines. This study examined high-risk drinking behaviours and associated outcomes among Manitobans. We used linked data housed in the Manitoba Population Research Data Repository to answer the following questions: (1) How many Manitobans are drinking more alcohol than is recommended by Canada’s low-risk drinking guidelines and has this number changed over time? (2) How many Manitobans have been diagnosed with an Alcohol Use Disorder over the past 20 years? (3) What are the patterns in healthcare utilization, social service use, and interactions with the justice system among individuals with a diagnosed Alcohol Use Disorder? Our analyses suggest several opportunities where supports can be put in place sooner to help Manitobans who are dealing with harmful consequences of high-risk drinking.
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2017


Describing Patient Populations for the My Health Team Initiative
Chateau D, Katz A, Metge C, Taylor C, McDougall C, McCulloch S
The province of Manitoba is in the process of restructuring primary care through the development of My Health Teams, which are networks consisting of primary care providers (physicians and nurse practitioners) and other professionals from health or related disciplines (e.g., dieticians, mental health counsellors, social workers). This study describes the patient populations that current or future My Health Teams could expect to provide care to. We examined where patients access primary care in relation to where they live in order to provide a more accurate description of patient populations. We also examined if patients were high users of services, medically complex, or socially complex. The last category addresses the social determinants of health and this is the first study to apply these social complexity indicators across the province. In addition, we examined the overlap between these three types of patients to determine how distinct patients with social complexities and medical complexities were, and whether these patients were also high user of services.
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2015


Evaluation of the Manitoba IMPRxOVE Program
Chateau D, Enns M, Ekuma O, Koseva I, McDougall C, Kulbaba C, Allegro E
In June 2011 Manitoba Health launched the IMPRxOVE program (Improving Medication Prescribing and Outcomes Via medical Education). The program is a first of its kind in Canada and is expected to improve the safety and health outcomes for Manitobans receiving medications for mental-health conditions. IMPRxOVE is administered by Comprehensive Neurosciences of Canada (CNSC), using proprietary clinical algorithms and a proven audit-and-feedback intervention. CNSC conducts monthly reviews of Drug Program Information Network (DPIN) pharmacy claims data to evaluate the appropriateness of the prescriptions of psychiatric and related behavioral medications, in order to identify patients at risk due to potentially inappropriate prescriptions. If a potentially inappropriate pattern of prescriptions is identified, a feedback alert in the form of an educational mailing package is sent to the prescriber. Prior to launch, Provincial Drug Programs (PDP) obtained input from Dr. Murray Enns (Professor and Head, Department of Psychiatry, University of Manitoba), the Manitoba Centre for Health Policy (MCHP), and Dr. Harold Carmel (Vice President, Care Management Technologies) to establish preliminary research objectives and hypotheses, criteria for evaluation, and data requirements for a full evaluation of the IMPRxOVE's impact. As part of this process, 1,417 physicians eligible to receive the educational mailing packages were randomly assigned to a control group or an active mailing group. The purpose of this study was to evaluate IMPRxOVE by examining changes in prescribing practices of physicians, and what characteristics of physicians or their practices may be associated with a positive impact of the educational mailing packages.
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2010


Pharmaceutical Use in Manitoba: Opportunities to Optimize Use
Raymond C, Metge C, Alessi-Severini S, Dahl M, Schultz J, Guenette W.
This report provides a snapshot of prescribing across several categories of medications for all Manitobans over an 11-year period (1997/98-2008/09). It describes a population-based profile of utilization for antipsychotics and benzodiazepines and the related medications in older adults; medications and glucose test strips for diabetes mellitus; inhalers for asthma and chronic obstructive lung disease; and biologic agents to treat rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, and psoriasis. The report assesses a range of influences on medication utilization, such as patient sociodemographic factors and prescriber characteristics. Some literature suggests that, for a variety of reasons, these groups of medications are not always prescribed optimally. The report evaluates the impact of patient and prescriber characteristics on measures of optimal medication use based on recent literature and guidelines including: the use of inhaled or oral corticosteroids prior to the use of inhaled long acting beta agonists (LABA) for asthma, the use of LABA with concomitant inhaled or oral corticosteroids, avoiding the use of high dose second generation antipsychotics (SGAs) in older adults, and reserving higher cost new medications for diabetes mellitus as second line therapy.
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2009


Effects of Manitoba Pharmacare Formulary Policy on Utilization of Prescription Medications
Kozyrskyj A, Raymond C, Dahl M, Ekuma O, Schultz J, Sklepowich M, Bond R
Prescription drug coverage policies vary widely across Canada and drug benefit managers are frequently searching for good quality evidence on real-world medication cost-effectiveness and safety, in order to make informed decisions on formulary listing policies. Manitoba Health offers a province-wide, income-based drug insurance program, according to a published list of prescription benefits in its Pharmacare Formulary that are reimbursed as open listing (Part 1), according to established criteria (Part 2) or with prior approval (Part 3). This MCHP deliverable evaluated the impact of Manitoba's Pharmacare Formulary policies and other societal factors on the utilization of prescription medications in Manitoba.
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2005


High-cost Users of Pharmaceuticals: Who are They?
Kozyrskyj A, Lix L, Dahl M, Soodeen R
In Manitoba, over 40% of prescription dollars get consumed by only 5% of the Manitobans taking prescription drugs. This study looks at these "high-cost" users and compares them to other Manitobans taking prescriptions. What drug categories account for higher prescription costs? What explains the higher drug costs? Are there signs or predictors that someone will become a high-cost user?
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2003


Pharmaceuticals: Focussing on Appropriate Utilization
Metge C, Kozyrskyj A, Dahl M, Yogendran M, Roos NP
Public spending on prescription drugs has increased 58% in only five years to $170 million. Yet little is known about the appropriateness of drug prescribing. This study uses administrative data to assess appropriateness for two drug classes: antihypertensives and cholesterol-lowering drugs. (
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Pharmaceuticals: Therapeutic interchange and pricing policies
Morgan SG, Kozyrskyj A, Metge C, Roos NP
How much would Manitobans and the government save if generic drugs were prescribed or substituted instead of name brands? This project looks at policies designed to improve the cost-effectiveness of prescription drugs.
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1999


Analysis of Patterns of Pharmaceutical Use in Manitoba, 1996: Key Findings - A POPULIS Project
Metge C, Black C, Peterson S, Kozyrskyj A, Roos NP, Bogdanovic B
This study marks the first time we've had information about one of the fastest growing areas of health care spending: prescription drugs. Retail pharmacy data were analyzed to answer questions like: What kinds of drugs are Manitobans prescribed? How often? At what cost?
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Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada

204-789-3819