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Background: Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications. Methods: Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions. Results: Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any. Conclusion: By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD. Contexte : La maladie artérielle périphérique (MAP) affectant de manière disproportionnée les personnes à faible statut socioéconomique, les dépenses personnelles liées aux médicaments préventifs restreignent fortement leur utilisation. Nous avons comparé les coûts des traitements médicamenteux de la MAP pour cerner des stratégies de prescription qui réduisent au minimum les dépenses personnelles associées. Méthodes : Entre mars et juin 2019, nous avons contacté des pharmacies pour patients externes à Hamilton (Ontario, Canada) afin d'évaluer la tarification de traitements pharmacologiques aux doses incluses dans la ligne directrice de prise en charge de la MAP des membres inférieurs publiée en 2016 par l'American College of Cardiology et l'American Heart Association. Nous avons aussi recueilli des informations sur les frais supplémentaires, dont ceux pour la livraison, la coupe des comprimés et l'emballage. Nous avons calculé le prix d'un approvisionnement de 30 jours de médicaments d'ordonnance génériques et de marque et d'un approvisionnement de 90 jours de médicaments d'ordonnance génériques avec et sans frais d'exécution d'ordonnance. Résultats : Notre échantillon comprenait 24 pharmacies, dont des pharmacies d'hôpital, indépendantes et faisant partie d'une chaîne. La différence la plus élevée pour le prix total d'un approvisionnement de 90 jours de médicaments a atteint 1377,26 $. Les paramètres de variation des coûts comprenaient l'agent choisi dans une classe de médicaments, l'emploi d'un médicament générique ou de marque, la quantité délivrée, les frais d'exécution d'ordonnance et les frais de livraison, le cas échéant. Conclusion : Pour réduire au minimum les dépenses personnelles liées aux médicaments, les médecins prescripteurs peuvent privilégier une ordonnance de 90 jours ou d'une durée aussi longue que possible, choisir les médicaments génériques les moins chers dans chaque classe et repérer les établissements de distribution aux frais inférieurs. Cela peut améliorer l'adhésion aux thérapies recommandées par la ligne directrice pour la prévention secondaire d'accidents vasculaires chez les patients atteints de MAP., An estimated 1.5 million Canadians older than 40 years live with symptomatic peripheral artery disease (PAD), and globally it affects more than 230 million people, a burden that will rise [...]

The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management , 7 th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7 th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7 th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.