Health Services/Policy
Access to and health outcomes associated with pharmacist-initiated prescribing services among equity-deserving groups Fiona Chan* Fiona Chan Colin Dormuth
Evidence suggest that certain equity-deserving groups (EDGs) have reduced access to independent pharmacist prescribing services, such as those support by the Pharmacist Prescribing for Minor Ailments and Contraceptives policy (PPMAC) in British Columbia, Canada. More rigorous studies are needed to assess for access issues and differences in outcomes for these groups. The study objective is to evaluate, by social strata, the differences in rates of access to PPMAC for treatment of uncomplicated urinary tract infections (UTI) and in the outcome of the consult. In the first year since policy implementation on Jun 1, 2023, there were approximately 83,000 PPMAC claims for UTIs, representing the most common PPMAC claim. A cohort of PPMAC service recipients for UTI from Jun 1, 2023 to Dec 31, 2024 will be assembled using administrative health data. Key EDGs of interest include older adults, females, rural residents, and lower income individuals. To understand the effects at various intersections of social identity, social strata will be defined for each patient as the combination of status in each EDG. The main outcome of whether a prescription was issued and/or the patient referred following the consult will be identified through unique claims codes. Rate of visitation will first be calculated by social strata. To estimate the odds of prescription and/or referral receipt for each social strata adjusted for health status, fixed effect logistic regression models will be used with interaction terms for status in various EDGs included. ORs, predicted probabilities, and their 95%CIs will be reported. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) will also be conducted to understand the extent that the variation between social strata is not explained by the additive effects of the individual social identities. The results will be crucial to guide policymakers on how to revise the current policy to reduce inequities.