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DISTINCT: AT ANY PRICE?

A study reported in Canadian J. Clinical Pharmacology (vol 2, no 4 Winter 1995, p 167- 174) provides support for M. Bouchard’s repeated assertion that Quebec is a "Distinct Society". The authors Hogan, Ebly and Fung used data collected as part of the Canadian Study of Health and Aging to determine factors significantly associated with use of potentially inappropriate medications across different regions. They divided the country into 5 such regions: Atlantic, Quebec, Ontario, Prairies and British Columbia.

For the purposes of their study, they regarded inappropriate prescribing as including ‘overuse’, ‘underuse’ and ‘misuse’. They found that overall 7.6% of all Canadian seniors were taking one or more medications that could be labeled inappropriate. From their paper, I have selected and re-fashioned some of their data. As the authors were from Calgary, I have normalised the data to that observed in the Prairie provinces to get a "Flat rate" (see Table).

PROVINCE	Inappropriate Medication	Inappropriate Benzodiazepine
Atlantic	1.75	1.71
Quebec	2.7	3.23
Ontario	1.29	1.35
Prairies	1.00	1.00
British Columbia	1.02	1.19

M. Bouchard’s Quebec may be even more distinct than he thinks.

Comments:

The data provided suggested regional differences in prescribing patterns. Once again a number of explanations can be given and students came up with a variety of explanations ranging from differences in formularies, fiscal problems leading to inadequate care in long term facilities, problems in gathering data, language difficulties leading to incomplete translations of guidelines for prescribing, more aggressive marketing strategies in some provinces etc.