Exploring the experiences of people in Ontario, Canada who have trouble affording medicines: a qualitative concept mapping study

Yaphe, Hannah; Adekoya, Itunuoluwa; Steiner, Liane; Maraj, Darshanand; O’Campo, Patricia; Persaud, Nav

doi:10.1136/bmjopen-2019-033933

Cited by 10 publications

(11 citation statements)

References 27 publications

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“…A 2019 qualitative concept mapping study in Canada reported that those with access to free medicine had reduced stress, better communication with physicians, improved quality of life and a decreased need to sacrifice other essential items for health and well-being. 41 It is possible that OHIP+ had a positive effect on other important patient-reported outcome measures such as diabetes distress, diabetes-related quality of life and those described in this mapping study.…”

Section: Ohip+mentioning

confidence: 89%

Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Giruparajah

Everett

Shah

et al. 2022

cmajo

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T ype 1 diabetes is a common chronic disease of childhood with substantial morbidity and mortality. 1 Optimizing glycemic management is key to preventing complications. 2,3 There are known socioeconomic status (SES) disparities in diabetes management and outcomes. 4,5 For Canadians, financial barriers to medications continue to be an important adverse social determinant of health. 6 This is important because insulin is life sustaining for people with type 1 diabetes.Ontario residents (population 14.5 million) have publicly funded coverage for medically necessary services but not for prescription medications. On Jan. 1, 2018, the Ontario government introduced publicly funded pharmacare (Ontario Health Insurance Plan [OHIP]+), the first payer for drugs for Ontarians younger than 25 years.Before the introduction of OHIP+, only people older than 64 years and those eligible for social assistance had access to publicly funded medications; all others paid out of pocket, through private insurance or were supported, in part, by the Trillium Drug Program (a government program that provides drug coverage for out-of-pocket expenses that are more than 4% of household income). The OHIP+ program covered the cost of medications on the provincial formulary, with no deductible or copayment. Fifteen months after its introduction, the Ontario government changed OHIP+ to exclude those patients with private drug coverage. 7 Thus, Ontario provides a unique "natural experiment" to assess the impact of 15 months of publicly funded pharmacare.Competing interests: Rayzel Shulman has received speaker fees from Dexcom. No other competing interests were declared. This article has been peer reviewed.

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Section: Ohip+mentioning

confidence: 89%

Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Giruparajah

Everett

Shah

et al. 2022

cmajo

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“… 60 This continuous and cyclical relationship can have a negative impact on women’s ability to access health professionals that are not covered by provincial health insurance programs or medications or other therapies that may support optimal health. Findings from Yaphe et al’s 61 qualitative study revealed the financial burden of accessing medications and called for policies that support universal, government funded pharmacare programs in order to reduce this burden. Pharmacare programs could help women with episodic disabilities by reducing the burden of medication costs; however, more research is needed to understand the benefits of pharmacare for women with episodic disabilities and chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Women’s experiences of navigating chronic pain within the context of living with an episodic disability

Campbell

Ford‐Gilboe

Kennedy

et al. 2022

Womens Health (Lond Engl)

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Objectives: Of the 6.2 million Canadians aged 15 years or older who live with disability, 61% have disabilities that are not static or continuous. These dynamic conditions are known as episodic disabilities and many disproportionately experienced by women. Chronic pain is also a common feature associated with many episodic disabilities. The purpose of this article is to explore the experience of chronic pain for women living with episodic disabilities. Methods: This qualitative study draws on the tenets of interpretive description. Thirty women, with one or more episodic disabilities and chronic pain, participated in a semi-structured interview and answered questions about their chronic pain levels, using Von Korff et al.’s graded chronic pain scale. Results: Women experienced gendered treatment within the healthcare system and reported that they were frequently dismissed by their healthcare providers, most often physicians. Healthcare professionals’ practices around pain assessment were another common challenge for women. Women who were able to access financial support from government disability programs were more likely to access allied health professionals. Many of the holistic strategies that women researched and used to treat chronic pain were self-enacted. While diet, exercise, and other self-care activities are general health promotion strategies for all, they were seen as essential aspects of living that helped women have control over chronic pain and modifying the course of their episodic disability. Conclusion: Living with chronic pain and an episodic disability is complex. The findings of this study present the impact that gendered treatment in the healthcare system has on women who live with an episodic disability and experience chronic pain. It is evident that the current system did not meet the needs of the women in our study and system changes could result in better experiences, more disclosure of alternative therapies, and increase women’s agency in their care.

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“…As per concept mapping methods, data from the statement sorting and the ratings of importance/changeability were then analyzed using the free, open‐source software R‐CMap, as described by Bar and Mentch, 41 and used in other health‐related publications 42,43 . The first analysis step involved multidimensional scaling which produces a two‐dimensional visualization plot illustrating how participants judged similarity between the generated statements 41,44 .…”

Section: Methodsmentioning

confidence: 99%

“…As per concept mapping methods, data from the statement sorting and the ratings of importance/changeability were then analyzed using the free, open-source software R-CMap, as described by Bar and Mentch, 41 and used in other health-related publications. 42,43 The first analysis step involved multidimensional scaling which produces a two-dimensional visualization plot illustrating how participants judged similarity between the generated statements. 41,44 For example, statement 49 from the tertiary facility "Local services require upskilling to provide ongoing management and care" and statement 10 "We need to offer education/training and support for our rural/ community clinicians for them to feel confident at providing follow up care for HNC patients" were frequently sorted into similar piles indicating a high level of agreement between staff, and hence these two statements appear close together on the plot.…”

Section: Stage 4-representation and Stage 5-interpretation Stagesmentioning

confidence: 99%

Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change

et al. 2021

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Background Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach. Methods Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change. Results Between the two participating health services, 30 actionable goals were identified within the “green‐zone” on the go‐zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills. Conclusions This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas.

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Exploring the experiences of people in Ontario, Canada who have trouble affording medicines: a qualitative concept mapping study

Cited by 10 publications

References 27 publications

Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Women’s experiences of navigating chronic pain within the context of living with an episodic disability

Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change

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