Frequent general practitioner visits are protective against statin discontinuation after a Pharmaceutical Benefits Scheme copayment increase
Karla L. Seaman
A B H , Frank M. Sanfilippo C , Max K. Bulsara D , Tom Brett E , Anna Kemp-Casey F G , Elizabeth E. Roughead F , Caroline Bulsara D and David B. Preen G
A School of Health Sciences, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia.
B School of Nursing and Midwifery, Edith Cowan University, Building 21, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
C Cardiovascular Research Group, School of Population and Global Health, University of Western Australia, M431, 35 Stirling Highway, Perth, WA 6009, Australia. Email: frank.sanfilippo@uwa.edu.au
D Institute for Health Research, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia. Email: max.bulsara@nd.edu.au; caroline.bulsara@nd.edu.au
E School of Medicine, University of Notre Dame, Fremantle, 19 Mouat Street, P.O. Box 1225, WA 6959, Australia. Email: tom.brett@nd.edu.au
F Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Email: anna.kemp@uwa.edu.au; Libby.Roughead@unisa.edu.au
G Center of Health Services Research, School of Population and Global Health, M431, 35 Stirling Highway, University of Western Australia, Crawley, WA 6009, Australia. Email: david.preen@uwa.edu.au
H Corresponding author. Email: karla.seaman1@my.nd.edu.au
Australian Health Review 44(3) 377-384 https://doi.org/10.1071/AH19069
Submitted: 20 March 2019 Accepted: 5 December 2019 Published: 11 May 2020
Abstract
Objective This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention.
Methods The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase.
Results In December 2004, there were 22 495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy.
Conclusions Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs.
What is known about the topic? Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention.
What does this paper add? Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase.
What are the implications for practitioners? This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.
Additional keywords: data linkage, health policy, out-of-pocket costs, primary health care.
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