Toronto, ON - Three in four Canadian doctors (75%) have witnessed a patient's health suffer at some point in the past year because they were unable to afford better medications, according to an Ipsos poll conducted on behalf of the International Federation on Ageing. The survey looked at perceptions of healthcare and prescription medications among doctors and Canadians aged 45+, and found that in some cases, doctor and patient differ noticeably in their points of view.
For instance, while 75% of doctors say they have seen patients' health suffer because they couldn't afford better medications, only 9% of Canadians said that their health has suffered because they were unable to afford better medications, suggesting a general unawareness among patients about what medication options might be available to them and at what price.
Canadians Trust their Doctors
That said, both patients and doctors had similar views on prescribing in general. Among Canadians at large, the overwhelming majority (92%) agree (53% strongly/39% somewhat) that when they need medication, they `typically leave the choice of drug to my doctor because they are the medical expert.' More than eight in ten (86%) agree (44% strongly/42% somewhat) that `when deciding on a particular treatment, my doctor always provides me with all the options available' (14% disagree), while nearly as many (83%) agree (32% strongly/52% somewhat) that `when I am prescribed a medication, I always feel I have enough information to feel confident that this drug is the best choice for me' (17% disagree).
When it comes to seeking out alternate sources of information, the numbers begin to drop: two in three Canadians (64%) agree (15% strongly/48% somewhat) they `actively seek out health information from sources other than my doctor.'
Women (70%) are significantly more likely than men (58%) to say they actively look for health information from sources beyond their doctor, while Canadians aged 45-54 are the most likely (70%) to seek out this information from other sources (those aged 75 and over are the least likely, at 50%).
Conversely, one in three Canadians (36%) disagree (10% strongly/26% somewhat) with this statement, indicating that they rarely if ever look for information on their conditions from anyone beyond their GP. Indeed, information that comes from sources other than patients' regular doctors is often viewed with a healthy dose of skepticism: only one in four Canadians (24%) agree (3% strongly/21% somewhat) that they `trust health information that comes from a friend or family member as much as I do information that comes from my doctor.' This means that a significant majority of three in four (76%) disagree (28% strongly/48% somewhat) that health information from a loved one is as trustworthy as that from their GP.
Perhaps unsurprisingly, family doctors emerged top of the list when Canadians were asked how much they trusted the advice of a variety of sources that provide them with health information. Nearly all Canadians (98%) trust their family doctor (67% very much/31% somewhat), and nearly as many (97%) trust medical specialists (59% very much/38% somewhat). Local pharmacists (96%) are the next most trusted (53% very much/43% somewhat), followed by hospitals at 92% (40% very much/52% somewhat). Eight in ten Canadians (80%) say they trust the health advice coming from universities (18% very much/62% somewhat), while seven in ten (71%) say the same about family and friends (15% very much/56% somewhat). Trust dips significantly when it comes to the internet, with less than half (44%) of Canadians saying they trust the health advice they read online (2% very much/42% somewhat). Least trusted of all is the health advice seen on TV: only two in ten Canadians (22%) say they trust television advertising (1% very much/22% somewhat) to give them advice on health issues.
Link Between Health and Treatment Cost?
Some Canadians see a direct impact on the state of their health: two in ten (21%) agree (5% strongly/15% somewhat) their health suffers because they can't afford better medications. A further two in ten (18%) agree (2% strongly/16% somewhat) with the belief that `more expensive drugs are more effective.'
Interestingly, comparatively younger Canadians are more likely to feel their health suffers because they can't afford better medications: 28% of those aged 45-54 agree, compared to 8% of those 75 and older. Likewise, 24% of Canadians in the 45-54 group believe more expensive drugs are more effective, vs. 16% of those 75+ and 15% of those 65-74.
When Canadian doctors were asked to think about how the cost of treatments impacts patient health, many saw a direct correlation that leaves cause for concern: more than nine in ten doctors (94%) say that `being unable to prescribe the most appropriate treatment because of cost means a patient's health may suffer,' while nearly as many (93%) say it `is a barrier to good patient care.'
Digging deeper into doctors' perceptions, nine in ten (91%) agree (49% strongly/42% somewhat) that overall quality of life of patients is negative affected when treatment choice is impacted by cost, while 90% agree (57% strongly/33% somewhat) they should be able to prescribe the most effective medication for patients regardless of cost.
Cost-Based Prescribing a Regular Affair for Many
Prescribing decisions influenced by cost are reasonably common occurrences across the country: four in ten Canadians aged 45+ (42%) say their doctor has prescribed a generic medication for them instead of a brand-name medication. Some Canadians are more actively involved in their prescribing decisions than others, with a third (32%) having questioned their doctor's advice about a medication that was prescribed to them, and one in four (24%) having asked their doctor for a particular drug, by name. Only a small number of Canadians (4%) believe that their doctor has prescribed them a medication that isn't approved for their condition.
Doctors were even more inclined than patients to say that Canadians tend to be proactive when it comes to what they are prescribed: nearly nine in ten physicians (87%) agree (21% strongly/66% somewhat) that `patients generally ask questions and seek to be well informed about their health issues,' while only 58% agree (23% strongly/35% somewhat) that `patients generally do not question the medications/procedures I recommend', indicating that 42% of doctors disagree with this statement. Further, when asked about their patient consulting work over the past twelve months, nine in ten doctors (89%) said that a patient had asked them for a particular medication (by name), and eight in ten (83%) said a patient had questioned their advice about the medication being prescribed.
As for their own prescribing practices, a majority of doctors readily admit to making cost- based decisions on a regular basis: 86% agree (43% strongly/43% somewhat) they will prescribe medication off-label in cases where the medication is more effective, and 76% agree (23% strongly/53% somewhat) they will do so in cases where the medication is more affordable. Fully eight in ten doctors (83%) agree (36% strongly/47% somewhat) that the cost of certain drugs regularly prevents them from prescribing the best medication for their patients.
Looking back at their own consulting work over the past year, 75% say a patient's health suffered because they couldn't afford better medications.
Cost considerations play out at different levels within the healthcare system, and doctors' original prescribing decisions are often substituted for alternate medications at the pharmacy counter. Asked if they had ever experienced such a substitution, nearly six in ten (57%) Canadians said their pharmacist had suggested a substitute for the drug their doctor prescribed because it was less expensive for them as the patient. Separately, one in four (26%) said their pharmacists had suggested a substitution for a reason other than cost. Canadians with some degree of vision loss were particularly likely to have seen their prescriptions substituted by a pharmacist:
|Which of the following has happened to you:(% `Yes')|
|Canadians with Vision Loss||Canadians with No Vision Loss|
|My pharmacist has suggested a substitute for the drug my doctor prescribed because it was less expensive for me||69%||55%|
|My pharmacist has suggested a substitute for the drug my doctor prescribed for a reason other than cost||34%||25%|
Canadians Want the Best, Despite Cost
While most seem to be generally satisfied with the treatments they've been prescribed, even if they happen to be lower-cost, there is strong consensus that Canadians deserve the best medications available for their conditions - in other words, that cost should come second to health. Canadians are virtually unanimous (97%) in agreeing (71% strongly/26% somewhat) that they `have a right to the best medications that are approved for use in Canada.' Likewise, more than nine in ten (95%) agree (64% strong/31% somewhat) that their physician `should have the right to prescribe the best medication for me regardless of the cost to the healthcare system.' The same number (95%) also agrees (65% strongly/30% somewhat) that `physicians need to have the ability to offer patients the most appropriate and best available treatment/medication option without financial restriction.' A majority (94%) agrees (69% strongly/25% somewhat) it's important to them that `the drugs they are prescribed for a specific condition are approved for that use in Canada,' and nearly as many (93%) agree (62% strongly/30% somewhat) that `treatment/medication decisions should not be based on cost.'
Mirroring the trend seen throughout the survey, patients' trust in their healthcare professionals contributes to their feeling confident in the choice of prescription drugs they receive: among those whose pharmacist has suggested a substitute for the drug they were prescribed, nine in ten (91%) `typically agree (40% strongly/51% somewhat) to the medication substitution recommendations their pharmacists makes,' while more than eight in ten (84%) Canadians agree (36% strongly/48% somewhat) that they `trust their pharmacist to choose whatever version of a medication they feel is most appropriate for them.'
In general, however, many Canadians feel that cost-based prescribing decisions have the potential to harm patient health, and that they are prepared to take action to avoid this situation happening to them. Nine in ten (90%) agree (47% strongly/44% somewhat) that `patients suffer when treatment decisions are influenced by the cost of a medication', and two in three (67%) agree (18% strongly/49% somewhat) that `doctors feel pressure to prescribe drugs based on the cost to the healthcare system.' When it comes to their own wallets, seven in ten Canadians (72%) agree (25% strongly/47% somewhat) that they are prepared to pay out of pocket for medical treatments and/or procedures that will improve their quality of life, while two in three (67%) agree (22% strongly/45% somewhat) they are prepared to pay out of pocket for a medical treatment and/or procedure that is more effective than less expensive options.
In other words, while Canadians expect the system to pay for the best treatment available, in instances where this isn't the case, a majority of Canadians are prepared to pay to make it happen.
Vision Loss a Source of Concern for Many
Sight is by far the most important of the five senses for Canadians aged 45 and over, chosen as top by more than nine in ten (94%):
|Which of the 5 senses is most important to you?|
Concern about vision loss as people get older is, understandably, quite strong. More than eight in ten (86%) Canadians agree (46% strongly/40% somewhat) they worry about how they will be able to live independently if their vision is lost or significantly impaired. Eight in ten (81%) agree (37% strongly/44% somewhat) they are simply concerned about vision loss as they get older.
Approximately one in six (16%) Canadians surveyed say they already suffer from vision loss, such as eye- or vision-related problems not fixable by wearing glasses (examples include macular degeneration or cataracts). Concern among this group is, unsurprisingly, much higher: nine in ten (93%) Canadians with vision loss agree (60% strongly/34% somewhat) they are concerned about vision loss as they get older, compared to 79% (33% strongly/45% somewhat) of those with no vision loss. Similarly, 90% of those with vision loss agree (53% strongly/37% somewhat) they worry about living independently if their vision is lost or significantly impaired, vs. 85% of those currently living without vision loss.
These are some of the findings of two Ipsos polls conducted on behalf of the International Federation on Ageing. The first poll was between June 2 and June 6, 2016. For this survey, a sample of 1,005 Canadians aged 45+ from Ipsos' online panel was interviewed online. Weighting was then employed to balance demographics to ensure that the sample's composition reflects that of the adult population according to Census data and to provide results intended to approximate the sample universe. The second poll was conducted between June 2 and June 10, 2016. For this survey, a sample of 100 physicians based in Canada was interviewed online, including subgroups of 50 general practitioners, 25 ophthalmologists and 25 other medical specialists. The precision of Ipsos online polls is measured using a credibility interval. A poll of 1,005 Canadians is accurate to within +/ - 3.5 percentage points, 19 times out of 20, had all Canadian adults aged 45+ been polled. A poll of 100 physicians is accurate to within +/ - 11.2 percentage points, 19 times out of 20. The credibility interval will be wider among subsets of the population. All sample surveys and polls may be subject to other sources of error, including, but not limited to coverage error, and measurement error.
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