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Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation.

ABSTRACT: OBJECTIVES:To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free. DESIGN:Natural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data. SETTING:General practices, Scotland, UK. PARTICIPANTS:732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005-December 2013). INTERVENTION:Reduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions. PRIMARY AND SECONDARY OUTCOMES:Hospital admissions recorded in the Scottish Morbidity Record - 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS). RESULTS:The ITS analysis identified marked step reductions in adult (19-59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis. CONCLUSIONS:This study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland.

SUBMITTER: Williams AJ

PROVIDER: S-EPMC6303621 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation.

Williams Andrew James AJ Henley William W Frank John J

BMJ open 20181218 12

<h4>Objectives</h4>To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which ...[more]

PMID: 30567818

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Project description:ObjectivesHead injury is a common reason for emergency department (ED) attendance. Around 1% of patients have life-threatening injuries, while 80% of patients are discharged. National guidelines (Scottish Intercollegiate Guidelines Network (SIGN)) were introduced in Scotland with the aim of achieving early identification of those with acute intracranial lesions yet safely reducing hospital admissions.This study aims to assess the impact of these guidelines and any effect the national 4-hour ED performance target had on hospital admissions for head injury.SettingAll Scottish hospitals between April 1998 and March 2016.ParticipantsPatients admitted to hospital for head injury or traumatic brain injury (TBI) diagnosed by CT imaging identified using administrative Scottish Information Services Division data. There are 275 hospitals in Scotland. In 2015/2016, there were 571 221 emergency hospital admissions in Scotland.InterventionsThe SIGN head injury guidelines introduced in 2000 and 2009. The 4-hour ED target introduced in 2004.OutcomesThe monthly rate of hospital admissions for head injury and traumatic brain injury.Study designAn interrupted time series analysis.ResultsThe first guideline was associated with a reduction in monthly admissions of 0.14 (95% CI 0.09 to 4.83) per 100 000 population. The 4-hour target was associated with a monthly increase in admissions of 0.13 (95% CI 0.06 to 0.20) per 100 000 population. The second guideline reduced monthly admissions by 0.09 (95% CI-0.13 to -0.05) per 100 000 population. These effects varied between age groups.The guidelines were associated with increased admissions for patients with injuries identified by CT imaging-guideline 1: 0.06 (95% CI 0.004 to 0.12); guideline 2: 0.05 (95% CI 0.04 to 0.06) per 100 000 population.ConclusionIncreased CT imaging of head injured patients recommended by SIGN guidelines reduced hospital admissions. The 4-hour ED target and the increased identification of TBI by CT imaging acted to undermine this effect.

Project description:ObjectiveTo investigate the association between helmet legislation and admissions to hospital for cycling related head injuries among young people and adults in Canada.DesignInterrupted time series analysis using data from the National Trauma Registry Minimum Data Set.SettingCanadian provinces and territories; between 1994 and 2003, six of 10 provinces implemented helmet legislation.ParticipantsAll admissions (n=66,716) to acute care hospitals in Canada owing to cycling related injury between 1994 and 2008.Main outcome measureRate of admissions to hospital for cycling related head injuries before and after the implementation of provincial helmet legislation.ResultsBetween 1994 and 2008, 66,716 hospital admissions were for cycling related injuries in Canada. Between 1994 and 2003, the rate of head injuries among young people decreased by 54.0% (95% confidence interval 48.2% to 59.8%) in provinces with helmet legislation compared with 33.1% (23.3% to 42.9%) in provinces and territories without legislation. Among adults, the rate of head injuries decreased by 26.0% (16.0% to 36.3%) in provinces with legislation but remained constant in provinces and territories without legislation. After taking baseline trends into consideration, however, we were unable to detect an independent effect of legislation on the rate of hospital admissions for cycling related head injuries.ConclusionsReductions in the rates of admissions to hospital for cycling related head injuries were greater in provinces with helmet legislation, but injury rates were already decreasing before the implementation of legislation and the rate of decline was not appreciably altered on introduction of legislation. While helmets reduce the risk of head injuries and we encourage their use, in the Canadian context of existing safety campaigns, improvements to the cycling infrastructure, and the passive uptake of helmets, the incremental contribution of provincial helmet legislation to reduce hospital admissions for head injuries seems to have been minimal.

Project description:BackgroundThe unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures in a tertiary Children's Hospital in southwest China, which might be used to predict long-term effects related to health-seeking behavior of parents/caregivers.MethodsThis study included newborns enrolled over a span of 86 weeks between January 4, 2019, and August 27, 2020. We designated two time periods for analysis purposes: a stable pre-COVID period(55 weeks between January 4, 2019, and January 23, 2020) and a COVID-impacted period (31 weeks between January 24, 2020, and August 27, 2020). An interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectra before and after the period of nonpharmaceutical interventions (NPIs). Furthermore, this study was conducted to evaluate whether the health-seeking behavior of parents/caregivers was influenced by pandemic factors.ResultsOverall, 16,640 infants were admitted to the neonatology department during the pre-COVID period (n = 12,082) and the COVID-impacted period (n = 4,558). The per week neonatal admissions consistently decreased following the first days of NPIs (January 24, 2020). The average weekly admission rates of 220/week pre-COVID period and 147/week COVID-impacted period. There was an evident decrease in the volume of admissions for all disease spectra after the intervention, whereas the decrease of patients complaining about pathological jaundice-related conditions was statistically significant (p<0.05). In the COVID-impacted period, the percentage of patients who suffered from respiratory system diseases, neonatal encephalopathy, and infectious diseases decreased, while the percentage of pathological jaundice-related conditions and gastrointestinal system diseases increased. The neonatal mortality rates (NMRs) increased by 8.7% during the COVID-impacted period compared with the pre-COVID period.ConclusionsIn summary, there was a significant decline in neonatal admissions in a tertiary care hospital during the COVID-19 Pandemic and the associated NPIs. Additionally, this situation had a remarkable impact on disease spectra and health-seeking behavior of parents/caregivers. We, therefore, advise continuing follow-ups and monitoring the main health indicators in vulnerable populations affected by this Pandemic over time.

Project description:BackgroundBased on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence.ObjectiveThe overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (>60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study.MethodsWe will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days' worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications - statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) - will be assessed.ResultsEnrollment began in September 2017, and results are expected to be analyzed in late 2020.ConclusionsThe results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled.Trial registrationClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579.International registered report identifier (irrid)DERR1-10.2196/18981.

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Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation.

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Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation.

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