Urban-rural Differences in Oral Bisphosphonate Utilization in Ontario Following Formulary Changes and Introduction of New Formulations

Rural populations often have less access to health services and information, potentially resulting in regional variation in drug utilization. We examined urban-rural differences in oral bisphosphonate utilization in Ontario following formulary changes and introduction of new formulations. The Rurality Index of Ontario was used to define urban, nonmajor urban, and rural regions. There were 16,367,752 oral bisphosphonate claims dispensed (77% urban, 18% nonmajor urban, 5% rural) to community-dwelling seniors from 2000/01-2014/03. Trends in dispensing following formulary changes were similar between regions. When examining trends in dispensing of new formulations, urban regions had significantly faster uptake than rural regions, and consistently dispensed a higher proportion of claims. These temporal and regional differences persisted over time. Rural physicians may be less aware of new drugs, indicating a need to improve information dissemination to these areas. Further research examining whether urban-rural differences in dispensing translates into differences in clinical outcomes is warranted.M.Sc