Aim: To examine if optimal clopidogrel therapy following percutaneous coronary intervention (PCI) differed systematically by sociodemographic characteristics during and after special authority (SA) restrictions, which required hospital-specialist approval for full funding.
Method: National health databases were anonymously linked for New Zealanders discharged following publicly-funded PCI between 1/07/2009-31/12/2009 when SA criteria applied and from 1/09/2010-28/02/2011 after funding restrictions ceased. The proportion of days that patients were dispensed clopidogrel in the two 6-month periods post-discharge was calculated (medicine possession ratio;MPR). Optimal clopidogrel-dispensing (defined as a MPR>0.8) was analysed by sociodemographic characteristics.
Results: During the first discharge period, 74% (95% CI 72-75%) of patients (n=2416) had optimal dispensing compared with 81% (95% CI 79-82%) of discharges from 1/09/2010-28/02/2011 (n=2347). In both discharge periods, 2-3% of patients received no therapy. Minimal relative differences in optimal dispensing were noted by age, sex, or deprivation status in either discharge period. However, optimal clopidogrel-dispensing was 13-14% less likely among Maori and Pacific peoples relative to 'Other' patients during funding restrictions. Relative ethnic differences changed little once funding restrictions ended despite absolute increases in dispensing.
Conclusions: Optimal clopidogrel coverage following PCI improved by 7% across sociodemographic groups after funding restrictions ceased, but ethnic disparities were unaltered.