Providing care in a patient’s preferred language improves health outcomes and patient satisfaction. In Ontario, access to French-speaking physicians (FSPs) is estimated using FSP-to-Francophone population ratios and compared with total physician-to-total population ratios. This approach fails to consider the fact that FSPs also serve non-Francophone patients and that Francophones must compete with the entire population to access FSPs. As a result, this approach inaccurately suggests that Francophones have better access to language-concordant care than Anglophones/Allophones. We propose a novel approach to address this issue, enabling unbiased comparisons of access to language-concordant care across linguistic groups.

This secondary analysis of publicly available data containing linguistic variables for the Ontario population (Statistics Canada, 2021 Census) and for family physicians (FPs) (College of Physicians and Surgeons of Ontario, January 2024) calculated competition-adjusted ratios and probabilities of accessing language-concordant care.

Ontario, Canada.

Census and publicly available data on FPs (ie, those providing comprehensive family medicine care to the community) and the Ontario population were obtained.

Province-wide, the crude ratio of FSPs per 1000 Francophones was 3.46. After adjusting for competition, the ratio of FSP per 1000 population was 0.12, compared with a general physicians-per-1000 population ratio of 1.05. Anglophones/Allophones attached to a FP have a 100% probability of receiving care in English compared with an 11.4% probability for Francophones to receive care from a FSP. Expressed otherwise, Anglophones/Allophones are 8.8 times more likely to receive language-concordant care (ie, care in English) than Francophones.

Although crude physician-to-population ratios overestimate Francophones’ access to FSPs, competition-adjusted ratios and probabilities demonstrate that they are much less likely to access language-concordant care than Anglophones/Allophones. This novel approach has equity implications for health human resources planning and can be applied to other linguistic minority groups and healthcare providers.

Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern among the elderly, especially in low-income and middle-income countries such as Iran. This study aims to explore the prevalence and patterns of polypharmacy among the elderly in Iran, using health insurance claims data to identify common drug classes and coprescribed medications, with a focus on informing policy decisions and improving medication management.

Retrospective population-based observational study.

Nationwide data from the Iran Health Insurance Organization (IHIO) across 24 provinces.

1 876 527 individuals aged 65 years and older, insured by the IHIO from 2014 to 2017. Individuals with incomplete demographic information or lacking medication records in the database were excluded from the analysis.

Prevalence and patterns of polypharmacy, demographic factors associated with polypharmacy, and common drug classes used. Medications were classified using the Anatomical Therapeutic Chemical system. Polypharmacy was defined as the use of five or more medications, with cumulative polypharmacy considering total drug use over time, and consecutive polypharmacy focusing on the frequency of monthly drug use. Logistic regression and association rule mining were applied to explore demographic factors and medication patterns associated with polypharmacy.

Of the study population, 74.9% experienced cumulative polypharmacy over 6 months and 64.6% over 1 month, with 7.6% experiencing consecutive polypharmacy. Females and those aged 75–79 were more prone to polypharmacy. Systemic glucocorticoids were the most commonly used medications (50.02%), followed by HMG-CoA reductase inhibitors (42.73%) and platelet aggregation inhibitors (41.92%). Polypharmacy was most strongly associated with medications related to the alimentary tract and metabolism, cardiovascular system, nervous system and blood and blood-forming organs.

Polypharmacy is highly prevalent among the elderly in Iran, with significant variations by gender, age, insurance fund and region. The findings highlight the need for targeted interventions to manage polypharmacy and improve medication safety in this population.