Objectives

We study the impact of the pharmacy dispensing channel (as a proxy for access to drugs) on the drug purchases, health outcomes, and health care utilization (emergency room visits or hospitalizations) of chronically ill patients in Liguria, Italy, in 2017.

Methods

We use the coarsened exact matching algorithm to compare the health outcomes for a treated group of patients living in a local health authority (LHA) where drug distribution through community pharmacies was restricted. These patients were matched to a control group of patients living in other LHAs, where drugs were also dispensed through a broad network of community pharmacies. We exploit a unique administrative dataset with information on the socio-demographic characteristics and health care services utilization of Ligurian patients with chronic cardiovascular and respiratory ailments. We restrict our analysis to patients 65 years of age or older who were admitted to hospitals from 2013 to 2016 with either a principal or secondary diagnosis connected to chronic cardiovascular and respiratory diseases.

Results

Reduced access to drugs leads to lowered drug consumption, a higher probability of adverse health outcomes including mortality, and a higher consumption of medical services in terms of hospitalizations and emergency room visits. These effects increase with patients’ age.

Conclusion

The pharmacy dispensing channel significantly affects drug consumption and acts as a proxy for adherence among chronically ill patients. Thus, health outcomes and health care utilization should be carefully evaluated when comparing the costs of alternative dispensing channels.

中文翻译：

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超越价格：非金融障碍对获取药物和健康结果的影响

目标

我们研究了 2017 年意大利利古里亚的药房配药渠道（作为获取药物的代理）对慢性病患者的药品购买、健康结果和医疗保健利用（急诊室就诊或住院）的影响。

方法

我们使用粗化的精确匹配算法来比较居住在当地卫生当局 (LHA) 的一组接受治疗的患者的健康结果，其中通过社区药店的药物分发受到限制。这些患者与居住在其他 LHA 的对照组患者相匹配，这些患者也通过广泛的社区药房网络分发药物。我们利用一个独特的行政数据集，其中包含有关利古里亚慢性心血管和呼吸系统疾病患者的社会人口特征和医疗保健服务利用的信息。我们将我们的分析限制在 2013 年至 2016 年入院且主要或次要诊断与慢性心血管和呼吸系统疾病相关的 65 岁或 65 岁以上的患者。

结果

减少获得药物会导致药物消耗量降低，出现包括死亡率在内的不良健康结果的可能性更高，以及住院和急诊室就诊方面的医疗服务消耗量增加。这些影响随着患者年龄的增长而增加。

结论

药房配药渠道显着影响药物消费，并充当慢性病患者依从性的代理。因此，在比较替代配药渠道的成本时，应仔细评估健康结果和医疗保健利用率。