title: Does variation among provincial drug formulary antimicrobial listings in Canada influence prescribing rates?
abstract: BACKGROUND
  The financial accessibility of antimicrobial drugs to the outpatient community in Canada is governed at the provincial level through formularies. Each province may choose to list particular drugs or impose restriction criteria on products in order to guide prescribing and/or curtail costs. Although changes to formularies have been shown to change patterns in the use of individual products and alter costs, no comparison has been made among the provincial antimicrobial formularies with regards to flexibility/stringency, or an assessment of how these formularies impact overall antimicrobial use in the provinces.
  
  
  OBJECTIVE
  To summarize provincial antimicrobial formularies and assess whether their relative flexibility/stringency had a statistical impact upon provincial prescription volume during a one year period.
  
  
  METHODS
  Provincial drug plan formularies were accessed and summarized for all prescribed antimicrobials in Canada during 2010. The number of general and restricted benefits for each plan was compiled by antimicrobial classification. Population-adjusted prescription rates for all individual antimicrobials and by antimicrobial class were obtained from the Canadian Integrated Program for Antimicrobial Resistance Surveillance. Correlations between the number of general benefits, restricted benefits, and total benefits with the prescription rate in the provinces were assessed by Spearman rank correlation coefficients.
  
  
  RESULTS
  Formularies varied considerably among the Canadian provinces. Quebec had the most flexible formulary, offering the greatest number of general benefits and fewest restrictions. In contrast, Saskatchewan's formulary displayed the lowest number of general benefits and most restrictions. Correlation analyses detected a single significant result; macrolide prescription rates decreased as the number of general macrolide benefits increased. All other rates of provincial antimicrobial prescribing and measures of flexibility/stringency revealed no significant correlations.
  
  
  CONCLUSIONS
  Although antimicrobial formulary listings are used to guide prescribing rates within a province, our analysis of one year's data of the impact of the antimicrobial formulary structure did not correlate with antimicrobial prescribing rates, and other factors are likely to be at play.
authors.affiliation: Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: Shiona K
authors.initials: SK
authors.lastname: Glass-Kaastra
authors.affiliation: Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: Rita
authors.initials: R
authors.lastname: Finley
authors.affiliation: Division of Medical Microbiology, Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.
authors.forename: Jim
authors.initials: J
authors.lastname: Hutchinson
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Patrick
authors.affiliation: Department of Infectious Diseases and Microbiology, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec, Canada.
authors.forename: Karl
authors.initials: K
authors.lastname: Weiss
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada, and Synder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Conly
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002170:Canada; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D010045:Outpatients; D055553:Prescription Drugs / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D055553:Prescription Drugs