Evidence map›Paper›PMID 33407875›Full record

SynthesisSystematic reviews2021

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact.

Anne M Holbrook, Mei Wang, Munil Lee, Zhiyuan Chen, Michael Garcia, Laura Nguyen, Angela Ford, Selina Manji, Michael R Law

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Systematic reviews, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Disparities in cost-related prescription nonadherence between Black and White adults in Canada.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
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  10. Predictors of cost-related medication nonadherence in Canada: a repeated cross-sectional analysis of the Canadian Community Health Survey.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024
    Article
  11. Article
  12. Socioeconomic burden of cystic fibrosis in Canada.BMJ open respiratory research · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Anne M HolbrookDivision of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada. holbrook@mcmaster.ca.ORCID 0000-0002-3371-4187
Mei WangDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Munil LeeSchulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Zhiyuan ChenDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Michael GarciaBachelor of Health Studies Program, University of Waterloo, Waterloo, ON, Canada.
Laura NguyenBachelor of Health Sciences Program, McMaster University, Hamilton, ON, Canada.
Angela FordSchool of Medicine, Queen's University, Kingston, ON, Canada.
Selina ManjiGlobal Health Program, McMaster University, Hamilton, ON, Canada.
Michael R LawThe Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.

Funding

CIHR FRN-148803CIHR MOP-126020
6 · The paper itself

Abstract

backgroundCost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear.

objectivesOur objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes.

methodsWe searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools.

resultsTwenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year.

conclusionCRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

Indexed as

Insurance, Pharmaceutical ServicesMedication AdherenceCanadaHealth ExpendituresHumansPrevalenceRandomized Controlled Trials as TopicCanadaMedication adherenceMedication costsSystematic review

Identifiers

PMID33407875
PMCPMC7788798

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.