PATTERN OF DIABETES THERAPEUTIC PRESCRIPTION IN RURAL AND URBAN AREAS IN QUEBEC

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1 PATTERN OF DIABETES THERAPEUTIC PRESCRIPTION IN RURAL AND URBAN AREAS IN QUEBEC COMPARAISON DES PROFILS THÉRAPEUTIQUES CHEZ LES PATIENTS DIABÉTIQUES ENTRE RÉGIONS RURALES ET URBAINES AU QUÉBEC

2 Research Team Alain Vanasse MD, PhD, FCMF Professor of the Department of Family Medicine & Director of the PRIMUS Research Group, University of Sherbrooke ShabnamAsghari MD, MPH, PhD Researcher, PRIMUS Research Group &Assistant Professor of the Department of Family Medicine Memorial University of Newfoundland JosianeCourteau PhD Researcher, PRIMUS Research Group,University of Sherbrooke Catherine Drouin PhD(C) PhD candidate, PRIMUS Research Group, University of Sherbrooke André C. Carpentier MD Professor of the Department of Medicine, University of Sherbrooke

3 Introduction Progress in medications for diabetes management means there are more options than before for people with diabetes. (Vauzelle Kervroedan F; 2000) What do Canadian guidelines say? Benefits of early medication initiation Vascular protection (ASA and ACEIs/ARB)

4 Factors influencing the use of medication Patient factors Physician decision Drug insurance Access to health Geographic location (living in a rural area)? (DiMatteo MR 2004; Hertz RP, 2005; Usher C, 2005)

5 Rural urban variation in treatment and medical consultations were previously documented for chronic diseases. (Vanasse A; 2007) Rural challenges Distance to health care Limited supply Health care workers, Facilities Social isolation Financial constraints (Grymonpre RE,2008)

6 These barriers raise concern that rural inhabitants might be experiencing different patterns of medication use compared to urban inhabitants. Aim To describe the rural urban variation in medication use in adults with diabetes in Quebec.

7 Methodology Study Population An exhaustive cohort of patients with diabetes between 1997 and 2002 who were followed for one year after the diagnosis. Data Sources Quebec provincial health service registries Hospital discharge database (MedEcho) Death register (MSSS) Beneficiary database (RAMQ) Pharmacological database (RAMQ)

8 Selection criteria Inclusion criteria: Diabetic 20 years old* Living in the province of Quebec Covered by the public drug insurance Exclusion criteria: Death or hospitalization in the first year after the index date Gestational diabetes (all ICD codes related to pregnancy events) *NDSS definition: Two physician claims over 2 years / one hospital discharge (ICD 9 Code 250) (Sensitivity 92%; Specificity 97%; positive predictive value 86%)

9 Antidiabetic medications Biguanide Sulfonylurea Alpha glucosidase inhibitor Thiazolidinedione Meglitinide Insulin Vascular protection medications ASA ACE/ARB (Canadian diabetes guidelines)

10 Outcome Medication possession ratio (MPR) The total days' supply divided by the number of calendar days. The MPR is expressed in percentages. An MPR threshold of 80%. (Christopher M;2001) Non users: 0 day (0%) Irregular users: <292 days (1 79%) Regular users: 292 days (80%) (Hertz,Robin P. 2005; Cooke,C.E. 2006)

11 Main variable Place of residence (rural vs urban area): Urban area includes: Metropolitan area (urban core of at least 100,000 peoples and its adjacent municipalities Agglomeration area (urban core of 10,000 99,999 peoples and its adjacent municipalities) Rural area includes: Area with less than 10,000 peoples (Statistical Area Classification Statistics Canada) Co variables Age Gender

12 Results A total of187,956 patients met the selection criteria (mean age: 64 years ± 13; female: 53%).

13 Anti diabetic medication in adults with diabetes mellitus in Quebec 47% 33% Nonusers Irregular users Regular users 20%

14 Antidiabetic medication use by diabetic patients

15 Rural diabetic patients were more likely to use medication. Oral medications: OR=1.20; 95% CI: Insulin: OR=1.35; 95% CI: Both: OR=1.34; 95% CI:

16 Vascular protection in adults with diabetes mellitus in Quebec Nonusers Irregular users Regular users 34% 16% 50%

17 Rural diabetic patients were more likely to use medication for vascular protection (P<0.0001). 100% 90% 80% 17% 9% 14% 9% 28% 23% 70% 11% 11% Regular users Irregular users 60% Nonusers 50% 40% 30% 74% 77% 61% 65% 20% 10% 0% Rural Urban Rural Urban ASA ACE/ARB

18 Conclusion Surprisingly, after controlling for age and gender, diabetic patients living in rural regions were more likely to use regularly anti diabetic and vascular protection medication.

19 These disparities may not be related to the quality of care and should be interpreted with caution The following factors should be considered : Physician patient relationship Role of family physician in rural areas and adherence to medication Specific culture in rural areas

20 Questions? Groupe de recherche PRIMUS Telephone : , poste 15130