title: Removal of Special Authority requirements for clopidogrel improved optimal care following percutaneous coronary intervention across sociodemographic groups.
abstract: OBJECTIVE
  To examine if optimal clopidogrel therapy following percutaneous coronary intervention (PCI) differed systematically by sociodemographic characteristics during and after special authority (SA) restrictions, which required hospital-specialist approval for full funding.
  
  
  METHODS
  National health databases were anonymously linked for New Zealanders discharged following publicly-funded PCI between 1/07/2009-31/12/2009 when SA criteria applied and from 1/09/2010-28/02/2011 after funding restrictions ceased. The proportion of days that patients were dispensed clopidogrel in the two 6-month periods post-discharge was calculated (medicine possession ratio;MPR). Optimal clopidogrel-dispensing (defined as a MPR>0.8) was analysed by sociodemographic characteristics.
  
  
  RESULTS
  During the first discharge period, 74% (95% CI 72-75%) of patients (n=2416) had optimal dispensing compared with 81% (95% CI 79-82%) of discharges from 1/09/2010-28/02/2011 (n=2347). In both discharge periods, 2-3% of patients received no therapy. Minimal relative differences in optimal dispensing were noted by age, sex, or deprivation status in either discharge period. However, optimal clopidogrel-dispensing was 13-14% less likely among Maori and Pacific peoples relative to 'Other' patients during funding restrictions. Relative ethnic differences changed little once funding restrictions ended despite absolute increases in dispensing.
  
  
  CONCLUSIONS
  Optimal clopidogrel coverage following PCI improved by 7% across sociodemographic groups after funding restrictions ceased, but ethnic disparities were unaltered.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, Tamaki Campus, University of Auckland, Private Bag 92019, Auckland, New Zealand. suneela.mehta@auckland.ac.nz.
authors.forename: Suneela
authors.initials: S
authors.lastname: Mehta
authors.forename: Sue
authors.initials: S
authors.lastname: Wells
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.forename: Jeff
authors.initials: J
authors.lastname: Harrison
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000368:Aged; D000077144:Clopidogrel; D004335:Drug and Narcotic Control; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine