CMAJ • February 12, 2008; 178 (4).
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Highlights of this issue

Differences in provincial drug plans and out-of-pocket expenses


Figure 1
Photo by: Andrew Young

In this comparative study using simulated patient scenarios to represent various sociodemographic backgrounds, Demers and colleagues found marked variation across provinces in the burden of prescription drug costs borne by the patient. The authors advocate for a national pharmaceutical strategy to address these inequities. In a related commentary, Dhalla and Laupacis argue for greater transparency in how drug approval and reimbursement decisions are made. In another commentary, Tierney, Manns and colleagues describe how the Common Drug Review of the Canadian Agency for Drugs and Technologies in Health operates.

See pages 405, 428 and 432

Restricted access to clopidogrel and mortality after stent implantation

Clopidogrel has been shown to reduce mortality after coronary stent implantation. In this population-based retrospective cohort study involving 13 633 patients in Quebec, Sheehy and colleagues investigated the effect of the provincial drug plan's restrictive access on patient prescription filling and on all-cause mortality after stenting. They report that the restricted-access policy was associated with a delay filling clopidogrel prescriptions and patients not filling their prescriptions. These outcomes were associated with an increase in mortality. In a related commentary, Suissa examines potential sources of bias in this study and cautions clinicians in interpreting these findings.

See pages 413 and 425

Availability of emergency contraception after deregulation

In 2005 the emergency contraception formulation of levonorgestrel (Plan B) became available in Canada from pharmacists without a prescription. In this longitudinal survey of randomly selected pharmacies in Ontario, Dunn and colleagues found a significant increase in the availability of Plan B and widespread willingness to dispense it following the regulatory change.

See page 423

Protecting Canadian travellers

In a guest editorial, Keystone discusses the increasing burden of travel-related illnesses among Canadians and argues that the unwillingness of provincial health plans to cover pre-travel consultations and vaccinations is preventing many of the most vulnerable individuals from receiving appropriate preventive care.

See page 373

Practice

In this Teaching Case Report, Kapadia and Bassett describe the case of a 24-year-old woman with 22q11.2 deletion syndrome and discuss the difficulties in describing this syndrome (page 391).

In Interesting Images, Singh and colleagues provide images suggesting horseshoe lung in a 14-year-old boy, but their diagnosis revealed something different (page 394).


Figure 1
Clubbing of digits in a 43-year-old woman.

In the Clinical Quiz column, readers are asked to determine the cause of leg pains, clubbing of digits and lung mass in a 43-year-old woman (page 395).

Leptospirosis is a zoonotic bacterial disease that is becoming more prevalent in Canada. In 2 Public Health articles, Prescott and Brown discuss this disease from the perspectives of a family physician and a veterinarian. They encourage physicians to be aware of the danger that this disease poses to humans (pages 397 and 399).


Related Articles

Protecting Canadian travellers: Prevention is better than cure
Jay S. Keystone, MD MSc(CTM
Can. Med. Assoc. J. 2008 178: 373. [Full Text] [PDF]

Recognizing a common genetic syndrome: 22q11.2 deletion syndrome
Ronak K. Kapadia, BSc and Anne S. Bassett, MD
Can. Med. Assoc. J. 2008 178: 391-393. [Full Text] [PDF]

Pseudohorseshoe lung
Navneet Singh, MD DM, Ritesh Agarwal, MD DM, and Dheeraj Gupta, MD DM
Can. Med. Assoc. J. 2008 178: 394. [Full Text] [PDF]

Leg pains, clubbing of digits and lung mass: What is your call?
Jenn-Yu Wu, MD and Jin-Yuan Shih, MD PhD
Can. Med. Assoc. J. 2008 178: 395-396. [Full Text] [PDF]

Canine leptospirosis in Canada: a veterinarian's perspective
John Prescott, VetMB PhD
Can. Med. Assoc. J. 2008 178: 397-398. [Full Text] [PDF]

Leptospirosis in the family dog: a public health perspective
Ken Brown, BASc MPA and John Prescott, VetMB PhD
Can. Med. Assoc. J. 2008 178: 399-401. [Full Text] [PDF]

Comparison of provincial prescription drug plans and the impact on patients' annual drug expenditures
Virginie Demers, BSc, Magda Melo, BScPharm M, Cynthia Jackevicius, PharmD MSc, Jafna Cox, MD, Dimitri Kalavrouziotis, MD, Stéphane Rinfret, MD MSc, Karin H. Humphries, DSc, Helen Johansen, PhD, Jack V. Tu, MD PhD, and Louise Pilote, MD PhD
Can. Med. Assoc. J. 2008 178: 405-409. [Abstract] [Full Text] [PDF]

Restrictive access to clopidogrel and mortality following coronary stent implantation
Odile Sheehy, MSc, Jacques LeLorier, MD PhD, and Stéphane Rinfret, MD MSc
Can. Med. Assoc. J. 2008 178: 413-420. [Abstract] [Full Text] [PDF]

Availability of emergency contraception after its deregulation from prescription-only status: a survey of Ontario pharmacies
Sheila Dunn, MD, Thomas E.R. Brown, PharmD, and Jason Alldred, BSc Pharm
Can. Med. Assoc. J. 2008 178: 423-424. [Abstract] [Full Text] [PDF]

Mortality benefit from unrestricted access to clopidogrel: Too good to be true?
Samy Suissa, PhD
Can. Med. Assoc. J. 2008 178: 425-427. [Full Text] [PDF]

Moving from opacity to transparency in pharmaceutical policy
Irfan Dhalla, MD and Andreas Laupacis, MD MSc
Can. Med. Assoc. J. 2008 178: 428-431. [Full Text] [PDF]

Optimizing the use of prescription drugs in Canada through the Common Drug Review
Mike Tierney, BScPhm MSc, Braden Manns, MD MSc with the Members of the Canadian Expert Drug Advisory Committee
Can. Med. Assoc. J. 2008 178: 432-435. [Full Text] [PDF]




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