title: The effect of deinsuring chlorpropamide on the prescribing of oral antihyperglycemics for Nova Scotia Seniors' Pharmacare beneficiaries.
abstract: On behalf of the Nova Scotia Seniors' Pharmacare Program, the Drug Evaluation Alliance of Nova Scotia developed a multicomponent intervention plan to facilitate the removal of chlorpropamide as an insured benefit. Chlorpropamide has caused serious hypoglycemia in seniors to a greater extent than some other agents. Pharmacy administrative claims were used to compute monthly use rates for insulin and each oral antihyperglycemic drug from January 1, 2000-December 30, 2002, in an intervention cohort (patients receiving chlorpropamide) and a control cohort (patients receiving an antihyperglycemic agent other than chlorpropamide). Initially, 630 patients were receiving chlorpropamide therapy. By the time chlorpropamide was deinsured, only 10% of the treatment cohort continued receiving chlorpropamide; shortly after deinsurance, no beneficiaries continued receiving the drug. The antihyperglycemics with the greatest increase in prescription were glyburide and gliclazide. The deinsuring of chlorpropamide and the educational strategies that accompanied it resulted in the selection of more appropriate antihyperglycemics for Nova Scotia seniors.
authors.affiliation: College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada. Ingrid.sketris@dal.ca
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Sketris
authors.forename: George C
authors.initials: GC
authors.lastname: Kephart
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Frail
authors.forename: Chris
authors.initials: C
authors.lastname: Skedgel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Allen
mesh_terms: D000368:Aged; D002747:Chlorpropamide / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing; D005569:Formularies as Topic; D006078:Government Programs; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D007356:Insurance, Pharmaceutical Services; D009674:Nova Scotia; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D002747:Chlorpropamide