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Corbeil O, Brodeur S, Courteau J, Béchard L, Huot-Lavoie M, Angelopoulos E, Di Stefano S, Marrone E, Vanasse A, Fleury MJ, Stip E, Lesage A, Joober R, Demers MF, Roy MA. Treatment with psychostimulants and atomoxetine in people with psychotic disorders: reassessing the risk of clinical deterioration in a real-world setting. Br J Psychiatry 2024; 224:98-105. [PMID: 38044665 PMCID: PMC10884826 DOI: 10.1192/bjp.2023.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Although attention-deficit hyperactivity disorder (ADHD) is often comorbid with schizophrenia spectrum and other psychotic disorders (SZSPD), concerns about an increased risk of psychotic events have limited its treatment with either psychostimulants or atomoxetine. AIMS To examine whether the risk of hospital admission for psychosis in people with SZSPD was increased during the year following the introduction of such medications compared with the year before. METHOD This was a retrospective cohort study using Quebec (Canada) administrative health registries, including all Quebec residents with a public prescription drug insurance plan and a diagnosis of psychotic disorder, defined by relevant ICD-9 or ICD-10 codes, who initiated either methylphenidate, amphetamines or atomoxetine, between January 2010 and December 2016, in combination with antipsychotic medication. The primary outcome was time to hospital admission for psychosis within 1 year of initiation. State sequence analysis was also used to visualise admission trajectories for psychosis in the year following initiation of these medications, compared with the previous year. RESULTS Out of 2219 individuals, 1589 (71.6%) initiated methylphenidate, 339 (15.3%) amphetamines and 291 (13.1%) atomoxetine during the study period. After adjustment, the risk of hospital admission for psychosis was decreased during the 12 months following the introduction of these medications when used in combination with antipsychotics (adjusted HR = 0.36, 95% CI 0.24-0.54; P < 0.0001). CONCLUSIONS These findings suggest that, in a real-world setting, when used concurrently with antipsychotic medication, methylphenidate, amphetamines and atomoxetine may be safer than generally believed in individuals with psychotic disorders.
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Affiliation(s)
| | - Sébastien Brodeur
- Department of Psychiatry and Neurosciences, Laval University, Quebec, Canada; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Josiane Courteau
- PRIMUS Research Group, Research Centre of Sherbrooke University Hospital Center (CRCHUS), Sherbrooke, Canada
| | | | | | | | | | - Erica Marrone
- Faculty of Pharmacy, Laval University, Quebec, Canada
| | - Alain Vanasse
- PRIMUS Research Group, Research Centre of Sherbrooke University Hospital Center (CRCHUS), Sherbrooke, Canada; and Department of Family Medicine and Urgent Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Marie-Josée Fleury
- Douglas Research Centre, Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Montreal, Canada
| | - Emmanuel Stip
- Department de Psychiatry and Addictology, University of Montreal, Montreal, Canada; and Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, UAE
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada; and Research Centre, Montreal University Institute of Mental Health, Montreal, Canada
| | - Ridha Joober
- Douglas Research Centre, Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Laval University, Quebec, Canada; and CERVO Research Centre, Quebec, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Quebec, Canada; and CERVO Research Centre, Quebec, Canada
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Carrier JD, Gallagher F, Vanasse A, Roberge P. Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study. Front Health Serv 2024; 3:1266987. [PMID: 38274712 PMCID: PMC10808741 DOI: 10.3389/frhs.2023.1266987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024]
Abstract
Introduction Anxiety disorders are impactful mental health conditions for which evidence-based treatments are available, notably cognitive-behavioral therapies (CBTs). Even when CBTs are available, demand-side factors limit their access, and actors in a position to perform demand management activities lack a framework to identify context-appropriate actions. Methods We conducted a constructivist grounded theory study in Quebec, Canada, to model demand management targets to improve access to CBTs for anxiety disorders. We recruited key informants with diverse experiences using purposeful, then theoretical sampling. We analyzed data from 18 semi-directed interviews and 20 documents through an iterative coding process centered around constant comparison. Results The resulting model illustrates how actors can target clinical-administrative processes fulfilling the demand management functions of detection, evaluation, preparation, and referral to help patients progress on the path of access to CBTs. Discussion Modeling clinical-administrative processes is a promising approach to facilitate leveraging the competency of actors involved in demand management at the local level to benefit public mental health.
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Affiliation(s)
- Jean-Daniel Carrier
- PRIMUS Research Group, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Psychiatry, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frances Gallagher
- School of Nursing, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Alain Vanasse
- PRIMUS Research Group, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Pasquale Roberge
- PRIMUS Research Group, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Psychiatry, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
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Lesage A, Courteau J, Vanasse A. Erratum in Lesage A, Courteau J, Brodeur S, et al. Urbanicity, Schizophrenia and Equitable Specialist Services Allocation. Can J Psychiatry. 2022;67(2):160-161. doi: 10.1177/07067437211040606. Epub 2021 Sep 6. PMID: 34482764; PMCID: PMC8892047. Can J Psychiatry 2023; 68:701. [PMID: 37165518 PMCID: PMC10585134 DOI: 10.1177/07067437231173818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal (IUSMM), Montréal (QC), Canada
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal (QC), Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (QC), Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (QC), Canada
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke (QC), Canada
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Racine-Hemmings F, Vanasse A, Lacasse A, Chiu Y, Courteau J, Dépelteau A, Hudon C. Association between sustained opioid prescription and frequent emergency department use: a cohort study. J Accid Emerg Med 2023; 40:4-11. [PMID: 35288454 DOI: 10.1136/emermed-2021-211180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/21/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic non-cancer pain (CNCP) is common among frequent emergency department (ED) users, although factors underlying this association are unclear. This study estimated the association between sustained opioid use and frequent ED use among patients with CNCP. METHODS Retrospective cohort study using a Canadian provincial health insurer database (Régie d'Assurance Maladie du Québec). The database included adults with both ≥1 chronic condition and ≥ 1 ED visit in 2012 or 2013. Inclusion in the study further required a CNCP diagnosis, public drug insurance coverage and 1-year survival after the first ED visit in 2012 or 2013 (index visit). Multivariable logistic regression was used to derive ORs of frequent ED use (≥5 visits in the year following the index visit) subsequent to sustained opioid use (≥60 days opioids prescription within 90 days preceding the index visit), adjusting for important covariables. RESULTS From 576 688 patients in the database, 58 237 were included in the study. Of these, 4109 (7.1%) had received a sustained opioid prescription and 4735 (8.1%) were frequent ED users in the follow-up year. Sustained opioid use was not associated with frequent ED use in the multivariable model (OR: 1.06, 95% CI 0.94 to 1.19). Novel associated covariables were benzodiazepine prescription (OR: 1.21, 95% CI 1.12 to 1.30) and polypharmacy (OR: 1.23, 95% CI 1.13 to 1.34). CONCLUSIONS Due to confounding by social and medical vulnerability, patients with CNCP with sustained opioid use appear to have a higher propensity for frequent ED use in unadjusted models. However, sustained opioid use was not associated with frequent ED use in these patients after adjustment.
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Affiliation(s)
- François Racine-Hemmings
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada .,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Département des Sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Yohann Chiu
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josiane Courteau
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Andréa Dépelteau
- École de Réadaptation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Nguena Nguefack HL, Pagé MG, Choinière M, Vanasse A, Deslauriers S, Angarita-Fonseca A, Blanchette MA, Lacasse A. Distinct care trajectories among persons living with arthritic conditions: A two-year state sequence analysis. Front Pain Res (Lausanne) 2022; 3:1014793. [PMID: 36444387 PMCID: PMC9699830 DOI: 10.3389/fpain.2022.1014793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Developing solutions to optimize care trajectories (CareTs) requires examining patient journeys through the health care system. This study aimed to describe CareTs among people living with arthritis and evaluate their association with self-reported health outcomes. METHODS Analyses were conducted using the TorSaDE Cohort (n = 102,148), which connects the 2007 to 2016 Canadian Community Health Surveys (CCHS) with Quebec administrative databases (longitudinal claims). CareTs of participants living with arthritis according to CCHS (n = 16,631), over the two years before CCHS completion, were clustered using state sequence analysis (months as a time unit). CareT group membership was then put in association with self-reported outcomes (pain intensity and interference, self-perceived general and mental health). RESULTS The analysis revealed five CareT groups characterized predominantly by: (1) arthritis-related visits to a specialist (n = 2,756; 16.6%), (2) arthritis-related emergency department visits (n = 2,928; 17.6%), (3) very high all-cause health care utilization and arthritis-related hospitalizations (n = 1,570; 9.4%), (4) arthritis-related medical visits to general practitioners and specialists (n = 2,708; 16.3%), (5) low all-cause health care utilization (n = 6,669; 40.1%). Multivariable results revealed that CareT group membership was associated with higher levels of pain interference (CareT group #3 vs. #5: OR: 1.4, 95%CI: 1.1-1.8) and fair/poor self-perceived general health (CareT group #1 vs. #5: OR: 1.551, 95%CI: 1.319-1.824; #2 vs. #5: OR: 1.244, 95%CI: 1.062-1.457; #3 vs. #5: OR: 1.771, 95%CI: 1.451-2.162; #4 vs. #5: OR: 1.481, 95%CI: 1.265-1.735). DISCUSSION Sate sequence analysis is an innovative method of studying CareTs and valuable for making evidence-based decisions taking into account inter- and intra-individual variability.
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Affiliation(s)
| | - M. Gabrielle Pagé
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Manon Choinière
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Deslauriers
- VITAM – Centre de recherche en santé durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Adriana Angarita-Fonseca
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marc-André Blanchette
- Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
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Chiu YM, Dufour I, Courteau J, Vanasse A, Chouinard MC, Dubois MF, Dubuc N, Elazhary N, Hudon C. Profiles of frequent emergency department users with chronic conditions: a latent class analysis. BMJ Open 2022; 12:e055297. [PMID: 36175089 PMCID: PMC9528600 DOI: 10.1136/bmjopen-2021-055297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Frequent emergency department users represent a small proportion of users while cumulating many visits. Previously identified factors of frequent use include high physical comorbidity, mental health disorders, poor socioeconomic status and substance abuse. However, frequent users do not necessarily exhibit all these characteristics and they constitute a heterogeneous population. This study aims to establish profiles of frequent emergency department users in an adult population with chronic conditions. DESIGN This is a retrospective cohort study using administrative databases. SETTING All adults who visited the emergency department between 2012 and 2013 (index date) in the province of Quebec (Canada), diagnosed with at least one chronic condition, and without dementia were included. Patients living in remote areas and who died in the year following their index date were excluded. We used latent class analysis, a probability-based model to establish profiles of frequent emergency department users. Frequent use was defined as having five visits or more during 1 year. Patient characteristics included sociodemographic characteristics, physical and mental comorbidities and prior healthcare utilisation. RESULTS Out of 4 51 775 patients who visited emergency departments at least once in 2012-2013, 13 676 (3.03%) were frequent users. Four groups were identified: (1) 'low morbidity' (n=5501, 40.2%), (2) 'high physical comorbidity' (n=3202, 23.4%), (3) 'injury or chronic non-cancer pain' (n=2313, 19.5%) and (4) 'mental health or alcohol/substance abuse' (n=2660, 16.9%). CONCLUSIONS The four profiles have distinct medical and socioeconomic characteristics. These profiles provide useful information for developing tailored interventions that would address the specific needs of each type of frequent emergency department users.
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Affiliation(s)
- Yohann Moanahere Chiu
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Josiane Courteau
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicole Dubuc
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, Quebec, Canada
| | - Nicolas Elazhary
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Brodeur S, Vanasse A, Courteau J, Stip E, Lesage A, Fleury MJ, Courteau M, Roy MA. Comparative effectiveness and safety of antipsychotic drugs in patients with schizophrenia initiating or reinitiating treatment: A Real-World Observational Study. Acta Psychiatr Scand 2022; 145:456-468. [PMID: 35158404 DOI: 10.1111/acps.13413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of various second-generation antipsychotics (SGAs), newer oral and long-acting injectable (LAI) SGAs, and first-generation antipsychotics (FGAs) treatments in patients with schizophrenia or schizoaffective disorder (SCZ). METHODS This retrospective cohort study included medical administrative information for patients with a diagnosis of SCZ living in Quebec (Canada), initiating or reinitiating at least one antipsychotic (AP) drug (with a clearance baseline period of 12 months without any APs). Effectiveness was defined by a reduced risk of hospitalization for mental disorder and discontinuation, and safety by a reduced risk of all-cause death and hospitalization for non-mental disorder, 2 years after AP initiation or reinitiation. Cox proportional hazard models were used to estimate the events associated with different antipsychotics compared with oral olanzapine. RESULTS The study cohort included 19,615 patients initiating or reinitiating an antipsychotic drug between January 2006 and December 2015. Results showed better effectiveness of clozapine (adjusted HR 0.36, 95% CI 0.30-0.42, p < 0.0001) and LAI SGAs (adjusted HR 0.56, 95% CI 0.51-0.61, p < 0.0001) compared with oral olanzapine when adding discontinuation to hospitalizations for mental disorder as a composite measure of effectiveness, as opposed to oral FGAs (adjusted HR 1.36, 95% CI 1.27-1.46, p < 0.0001) and LAI FGAs (adjusted HR 1.22, 95% CI 1.12-1.32, p < 0.0001). Most APs were as safe as oral olanzapine. CONCLUSION The effectiveness of LAI SGAs and clozapine appears to justify their use and are as safe as a recognized treatment (oral olanzapine) in Quebec (Canada).
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada
| | - Alain Vanasse
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada.,Département de Médecine de Famille et de Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, Québec, Canada.,Research Centre, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Mireille Courteau
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada.,Centre de Recherche CERVO, Québec City, Québec, Canada
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Brodeur S, Vanasse A, Courteau J, Courteau M, Stip E, Fleury MJ, Lesage A, Demers MF, Roy MA. Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach. Acta Psychiatr Scand 2022; 145:469-480. [PMID: 35152415 DOI: 10.1111/acps.13411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aims to describe the utilization patterns of antipsychotic (AP) medication in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP. METHODS Based on medico-administrative information on patients living in Quebec (Canada), this retrospective cohort study included 6444 patients with a previous diagnosis of SCZ initiating or reinitiating AP medication between January 1, 2012, and December 31, 2014, with continuous coverage by public drug insurance. For each day of follow-up (1092 days), patient was either exposed to one of the chosen categories of APs, or to none. This patient's sequence of AP exposure overtime has been referred to as the "antipsychotic utilization trajectory". These trajectories were analyzed using a State Sequence Analysis, an innovative approach which provides useful visual information on the continuation and discontinuation patterns of use over time. RESULTS Clozapine and long-acting injectable second-generation APs had the best continuation and discontinuation patterns over 3 years among all other groups, including less switching of APs, while oral first-generation APs had the poorest patterns. These findings were comparable among incident and non-incident cohorts. Oral second-generation antipsychotics, excluding clozapine, had a poorer continuation and discontinuation pattern than long-acting injectable antipsychotics. CONCLUSION State Sequence Analysis provides a clear representation of treatment adherence in comparison with dichotomous indicators of adherence or discontinuation. Consequently, this innovative method has shed light on the impact of the AP chosen to initiate or reinitiate treatment in SCZ, which has been identified as a key factor for long-term treatment continuation and discontinuation.
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, QC, Canada.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, UAE
| | - Marie-Josée Fleury
- Institut universitaire en santé mentale, Université McGill, Montréal, QC, Canada.,Département de Psychiatrie, Université McGill, Montréal, QC, Canada
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Montréal, QC, Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Québec, QC, Canada.,Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO, Québec, QC, Canada
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9
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Carrier JD, Gallagher F, Vanasse A, Roberge P. Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review. PLoS One 2022; 17:e0264368. [PMID: 35231039 PMCID: PMC8887746 DOI: 10.1371/journal.pone.0264368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. Objective Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. Methods Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. Results We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. Implications This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.
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Affiliation(s)
- Jean-Daniel Carrier
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- * E-mail:
| | - Frances Gallagher
- School of nursing, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Alain Vanasse
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
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Lesage A, Courteau J, Brodeur S, Stip E, Fleury MJ, Courteau M, Roy MA, Vanasse A. Urbanicity, Schizophrenia and Equitable Specialist Services Allocation. Can J Psychiatry 2022; 67:160-161. [PMID: 34482764 PMCID: PMC8892047 DOI: 10.1177/07067437211040606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal
(IUSMM), Montréal, Quebec
- Département de Psychiatrie et d’Addictologie, Université de Montréal,
Montréal, Quebec
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
| | - Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Quebec
| | - Emmanuel Stip
- Département de Psychiatrie et d’Addictologie, Université de Montréal,
Montréal, Quebec
- Department of Psychiatry and Behavioral Science, College of Medicine and
Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montréal,
Quebec
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Quebec
- Centre de Recherche CERVO, Québec, Quebec
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
- Département de médecine de famille et de médecine d’urgence, Université de
Sherbrooke, Sherbrooke, Quebec
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11
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Brodeur S, Courteau J, Vanasse A, Courteau M, Stip E, Fleury MJ, Lesage A, Demers MF, Corbeil O, Béchard L, Roy MA. Association between previous and future antipsychotic adherence in patients initiating clozapine: real-world observational study. Br J Psychiatry 2022; 220:1-8. [PMID: 35082000 DOI: 10.1192/bjp.2022.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although recognised as the most effective antipsychotic for treatment-resistant schizophrenia, clozapine remains underused. One reason is the widespread concern about non-adherence to clozapine because of poor adherence before initiating clozapine. AIMS To determine if prior poor out-patient adherence to treatmentbefore initiating clozapine predisposes to poor out-patient adherence to clozapine or to any antipsychotics (including clozapine) after its initiation. METHOD This cohort study included 3228 patients with schizophrenia living in Quebec (Canada) initiating (with a 2-year clearance period) oral clozapine (index date) between 2009 and 2016. Using pharmacy data, out-patient adherence to treatment was measured by the medication possession ratio (MPR), over a 1-year period preceding and following the index date. Five groups of patients were formed based on their prior MPR level (independent variable). Two dependent variables were defined after clozapine initiation (good out-patient adherence to any antipsychotics and to clozapine only). Along with multiple logistic regressions, state sequence analysis was used as a visual representation of antipsychotic-use trajectories over time, before and after clozapine initiation. RESULTS Although prior poor adherence to antipsychotics was associated with poor adherence after clozapine initiation, the absolute risk of subsequent poor adherence remained low, regardless of previous adherence level. Most patients adhered to their treatment after initiating clozapine (>68% to clozapine and >84% to any antipsychotics). CONCLUSIONS Despite the fact that poor adherence prior to initiating clozapine is widely recognised by clinicians as a barrier for the prescription of clozapine, the current study supports the initiation of clozapine in all eligible patients.
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada and Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Canada and Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, United Arab Emirates
| | - Marie-Josée Fleury
- Institut universitaire en santé mentale, Université McGill, Canada and Département de Psychiatrie, Université McGill, Canada
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Canada and Centre de Recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Canada and Faculté de pharmacie, Université Laval, Canada
| | | | | | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Canada andCentre de Recherche CERVO, Canada
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Vanasse A, Chiu YM, Courteau J, Dorais M, Bartlett G, Zawaly K, Benigeri M. Cohort Profile: The Care Trajectories-Enriched Data (TorSaDE) cohort. Int J Epidemiol 2021; 50:1066-1066h. [PMID: 33236074 DOI: 10.1093/ije/dyaa167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (QC), Canada.,PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke (QC), Canada.,Québec SPOR-Support Unit, Montréal (QC), Canada
| | - Yohann M Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (QC), Canada.,PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke (QC), Canada
| | - Josiane Courteau
- PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke (QC), Canada
| | | | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montréal (QC), Canada
| | - Kristina Zawaly
- Department of Family Medicine, McGill University, Montréal (QC), Canada
| | - Mike Benigeri
- Québec SPOR-Support Unit, Montréal (QC), Canada.,Public Health School, Université de Montréal, Montréal (QC), Canada
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Blais S, Marelli A, Vanasse A, Dahdah N, Dancea A, Drolet C, Dallaire F. Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot. JAMA Netw Open 2021; 4:e2118141. [PMID: 34313740 PMCID: PMC8317016 DOI: 10.1001/jamanetworkopen.2021.18141] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE The choice of the right surgical technique for correction of tetralogy of Fallot (TOF) is contentious for patients with a moderate to severe right outflow tract obstruction. The use of a transannular patch (TAP) exposes patients to chronic pulmonary regurgitation, while valve-sparing (VS) procedures may incompletely relieve pulmonary obstruction. OBJECTIVE To compare 30-year outcomes of TOF repair after a VS procedure vs TAP. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study was conducted among all patients with TOF born in the province of Quebec, Canada, from 1980 to 2015 who underwent complete surgical repair. Patients who received a TAP or VS procedure were matched using a propensity score based on preoperative factors in a 1:1 ratio. Data were analyzed from March 2020 through April 2021. EXPOSURES The study groups were individuals who received TAP and those who received VS. The VS group was further stratified by the presence of residual pulmonary stenosis. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality, with 30-year survival evaluated using Cox proportional-hazards models. Secondary outcomes included the cumulative mean number of cardiovascular interventions, pulmonary valve replacements (PVRs), and cardiovascular hospitalizations were evaluated using marginal means/rates regressions. RESULTS Among 683 patients with TOF (401 patients who underwent TAP [58.7%] and 282 patients who underwent a VS procedure [41.3%]), adequate propensity score matching was achieved for 528 patients (264 patients who underwent a VS procedure and 264 patients who underwent TAP). Among this study cohort, 307 individuals (58.1%) were men. The median (interquartile range [IQR]) follow-up was 16.0 (8.1-25.4) years, for a total of 8881 patient-years, including 63 individuals (11.9%) followed up for more than 30 years. Individuals who received a VS procedure had an increased 30-year survival of 99.1% compared with 90.4% for individuals who received TAP (hazard ratio [HR], 0.09 [95% CI, 0.02-0.41]; P = .002). Patients who underwent TAP had an increased 30-year cumulative mean number of cardiovascular interventions compared with patients who underwent a VS procedure without residual pulmonary stenosis (2.0 interventions [95% CI, 1.5-2.7 interventions] vs 0.7 interventions [95% CI, 0.5-1.1 interventions]; mean ratio [MR], 0.36 [95% CI, 0.25-0.50]; P < .001) and patients who underwent a VS procedure with at least moderate residual stenosis (1.3 interventions [95% CI, 0.9-1.9 interventions]; MR, 0.65 [0.45-0.93]; P = .02). Results were similar for PVR, with a 30-year cumulative mean 0.3 PVRs [95% CI, 0.1-0.7 PVRs] for patients who underwent a VS procedure without residual pulmonary stenosis (MR, 0.22 [95% CI, 0.12-0.43]; P < .001) and 0.6 PVRs (95% CI, 0.2-1.5 PVRs) for patients with at least moderate residual stenosis (MR, 0.44 [95% CI, 0.21-0.93]; P = .03), compared with 1.4 PVRs (95% CI, 0.8-2.5 PVRs) for the TAP group. No statistically significant difference was found for cardiovascular hospitalizations. CONCLUSIONS AND RELEVANCE This study found that patients who underwent a VS procedure had increased 30-year survival, fewer cardiovascular reinterventions, and fewer PVRs compared with individuals who underwent TAP, even in the presence of significant residual pulmonary stenosis. These findings suggest that it is beneficial to perform a VS procedure when possible, even in the presence of moderate residual stenosis, compared with the insertion of a TAP.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Adrian Dancea
- Division of Pediatric Cardiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Hudon C, Bisson M, Dubois MF, Chiu Y, Chouinard MC, Dubuc N, Elazhary N, Sabourin V, Vanasse A. Correction to: CONECT-6: a case-finding tool to identify patients with complex health needs. BMC Health Serv Res 2021; 21:321. [PMID: 33836732 PMCID: PMC8034114 DOI: 10.1186/s12913-021-06216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Marie-France Dubois
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Yohann Chiu
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Maud-Christine Chouinard
- Nursing Faculty, University of Montreal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Nicole Dubuc
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Véronique Sabourin
- Integrated University Health and Social Services Centre of Saguenay-Lac-Saint-Jean, 930 rue Jacques-Cartier E, Chicoutimi, QC, G7H 7K9, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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15
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Hudon C, Bisson M, Dubois MF, Chiu Y, Chouinard MC, Dubuc N, Elazhary N, Sabourin V, Vanasse A. CONECT-6: a case-finding tool to identify patients with complex health needs. BMC Health Serv Res 2021; 21:157. [PMID: 33596929 PMCID: PMC7891167 DOI: 10.1186/s12913-021-06154-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population. Methods This prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs. Results Two hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool – 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 75% respectively. Conclusions The case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06154-4.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Marie-France Dubois
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Yohann Chiu
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Maud-Christine Chouinard
- Nursing Faculty, University of Montreal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Nicole Dubuc
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Véronique Sabourin
- Integrated University Health and Social Services Centre of Saguenay-Lac-Saint-Jean, 225 rue Saint-Vallier, Chicoutimi, Quebec, G7H 5H6, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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Samadoulougou S, Idzerda L, Dault R, Lebel A, Cloutier A, Vanasse A. Validated methods for identifying individuals with obesity in health care administrative databases: A systematic review. Obes Sci Pract 2020; 6:677-693. [PMID: 33354346 PMCID: PMC7746972 DOI: 10.1002/osp4.450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/24/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Health care administrative databases are increasingly used for health studies and public health surveillance. Cases of individuals with obesity are selected using case-identification methods. However, the validity of these methods is fragmentary and particularly challenging for obesity case identification. OBJECTIVE The objectives of this systematic review are to (1) determine the case-identification methods used to identify individuals with obesity in health care administrative databases and (2) to summarize the validity of these case-identification methods when compared with a reference standard. METHODS A systematic literature search was conducted in six bibliographic databases for the period January 1980 to June 2019 for all studies evaluating obesity case-identification methods compared with a reference standard. RESULTS Seventeen articles met the inclusion criteria. International Classification of Diseases (ICD) codes were the only case-identification method utilized in selected articles. The performance of obesity-identification methods varied widely across studies, with positive predictive value ranging from 19% to 100% while sensitivity ranged from 3% to 92%. The sensitivity of these methods was usually low while the specificity was higher. CONCLUSION When obesity is reported in health care administrative databases, it is usually correctly reported; however, obesity tends to be highly underreported in databases. Therefore, case-identification methods to monitor the prevalence and incidence of obesity within health care administrative databases are not reliable. In contrast, the use of these methods remains relevant for the selection of individuals with obesity for cohort studies, particularly when identifying cohorts of individuals with severe obesity or cohorts where obesity is associated with comorbidities.
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Affiliation(s)
- Sékou Samadoulougou
- Centre for Research on Planning and Development (CRAD)Laval UniversityQuébecCanada
- Evaluation Platform on Obesity PreventionQuebec Heart and Lung Institute Research CenterQuébecCanada
| | - Leanne Idzerda
- Centre for Research on Planning and Development (CRAD)Laval UniversityQuébecCanada
- Evaluation Platform on Obesity PreventionQuebec Heart and Lung Institute Research CenterQuébecCanada
| | - Roxane Dault
- Research Group in Health Informatics (GRIIS)Université de SherbrookeSherbrookeCanada
| | - Alexandre Lebel
- Centre for Research on Planning and Development (CRAD)Laval UniversityQuébecCanada
- Evaluation Platform on Obesity PreventionQuebec Heart and Lung Institute Research CenterQuébecCanada
- Graduate School of Land Management and Regional Planning, Faculty of Planning, Architecture, Art and DesignLaval UniversityQuébecCanada
| | - Anne‐Marie Cloutier
- Research Group in Health Informatics (GRIIS)Université de SherbrookeSherbrookeCanada
| | - Alain Vanasse
- Département de médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santéUniversité de SherbrookeSherbrookeCanada
- Centre de rechercheCIUSSS de l'Estrie‐CHUSSherbrookeCanada
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Nguena Nguefack HL, Pagé MG, Katz J, Choinière M, Vanasse A, Dorais M, Samb OM, Lacasse A. Trajectory Modelling Techniques Useful to Epidemiological Research: A Comparative Narrative Review of Approaches. Clin Epidemiol 2020; 12:1205-1222. [PMID: 33154677 PMCID: PMC7608582 DOI: 10.2147/clep.s265287] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Trajectory modelling techniques have been developed to determine subgroups within a given population and are increasingly used to better understand intra- and inter-individual variability in health outcome patterns over time. The objectives of this narrative review are to explore various trajectory modelling approaches useful to epidemiological research and give an overview of their applications and differences. Guidance for reporting on the results of trajectory modelling is also covered. Trajectory modelling techniques reviewed include latent class modelling approaches, ie, growth mixture modelling (GMM), group-based trajectory modelling (GBTM), latent class analysis (LCA), and latent transition analysis (LTA). A parallel is drawn to other individual-centered statistical approaches such as cluster analysis (CA) and sequence analysis (SA). Depending on the research question and type of data, a number of approaches can be used for trajectory modelling of health outcomes measured in longitudinal studies. However, the various terms to designate latent class modelling approaches (GMM, GBTM, LTA, LCA) are used inconsistently and often interchangeably in the available scientific literature. Improved consistency in the terminology and reporting guidelines have the potential to increase researchers' efficiency when it comes to choosing the most appropriate technique that best suits their research questions.
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Affiliation(s)
- Hermine Lore Nguena Nguefack
- Département des Sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - M Gabrielle Pagé
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Joel Katz
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-lL’île-Perrot, Québec, Canada
| | - Oumar Mallé Samb
- Département des Sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Anaïs Lacasse
- Département des Sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
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Yousif A, Dault R, Courteau M, Blais L, Cloutier AM, Lacasse A, Vanasse A. The validity of diagnostic algorithms to identify asthma patients in healthcare administrative databases: a systematic literature review. J Asthma 2020; 59:152-168. [PMID: 32990481 DOI: 10.1080/02770903.2020.1827425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To review the available evidence supporting the validity of algorithms to identify asthma patients in healthcare administrative databases. METHODS A systematic literature search was conducted on multiple databases from inception to March 2020 to identify studies that reported the validity of case-finding asthma algorithms applied to healthcare administrative data. Following an initial screening of abstracts, two investigators independently assessed the full text of studies which met the pre-determined eligibility criteria. Data on study population and algorithm characteristics were extracted. A revised version of the Quality Assessment of Diagnostic Accuracy Studies tool was used to evaluate the risk of bias and generalizability of studies. RESULTS A total of 20 studies met the eligibility criteria. Algorithms which incorporated ≥1 diagnostic code for asthma over a 1-year period appeared to be valid in both adult and pediatric populations (sensitivity ≥ 85%; specificity ≥ 89%; PPV ≥ 70%). The validity was enhanced when: (1) the time frame to capture asthma cases was increased to two years; (2) ≥2 asthma diagnostic codes were considered; and (3) when diagnoses were recorded by a pulmonologist. Algorithms which integrated pharmacy claims data appeared to correctly identify asthma patients; however, the extent to which asthma medications can improve the validity remains unclear. The quality of several studies was high, although disease progression bias and biases related to self-reported data was observed in some studies. CONCLUSIONS Healthcare administrative databases are adequate sources to identify asthma patients. More restrictive definitions based on both asthma diagnoses and asthma medications may enhance validity, although further research is required to confirm this hypothesis.
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Affiliation(s)
- Alia Yousif
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Roxanne Dault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Courteau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Anne-Marie Cloutier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Alain Vanasse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Blais S, Marelli A, Vanasse A, Dahdah N, Dancea A, Drolet C, Colavincenzo J, Vaugon E, Dallaire F. The 30-Year Outcomes of Tetralogy of Fallot According to Native Anatomy and Genetic Conditions. Can J Cardiol 2020; 37:877-886. [PMID: 33059007 DOI: 10.1016/j.cjca.2020.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/14/2020] [Accepted: 10/04/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The reported survival of tetralogy of Fallot (TOF) is > 97%. Patients with pulmonary atresia and/or genetic conditions have worse outcomes, but long-term estimates of survival and morbidity for these TOF subgroups are scarce. The objective of this study was to describe the 30-year outcomes of TOF according to native anatomy and the coexistence of genetic conditions. METHODS The TRIVIA (Tetralogy of Fallot Research for Improvement of Valve Replacement Intervention: A Bridge Across the Knowledge Gap) study is a retrospective population-based cohort including all TOF subjects born from 1980 to 2015 in Québec. We evaluated all-cause mortality by means of Cox proportional hazards regression, and cumulative mean number of cardiovascular interventions and unplanned hospitalisations with the use of marginal means/rates models. We computed 30-year estimates of outcomes according to TOF types, ie, classic TOF (cTOF) and TOF with pulmonary atresia (TOF-PA), and the presence of genetic conditions. RESULTS We included 960 subjects. The median follow-up was 17 years (interquartile range, 8-27). Nonsyndromic cTOF subjects had a 30-year survival of 95% and had undergone a mean of 2.8 interventions and 0.5 hospitalisations per subject. In comparison, TOF-PA subjects had a lower 30-year survival of 78% and underwent a mean of 8.1 interventions, with 4 times as many hospitalisations. The presence of a genetic condition was associated with lower survival (< 85% for cTOF and < 60% for TOF-PA) but similar numbers of interventions and hospitalisations. CONCLUSIONS The anatomic types and the presence of genetic conditions strongly influence the long-term outcomes of TOF. We provided robust 30-year estimates for key markers of prognosis that may be used to improve risk stratification and provide more informed counselling to families.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Québec, Canada
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Adrian Dancea
- Division of Pediatric Cardiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | | | - Esther Vaugon
- Division of Pediatric Cardiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
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Lacasse A, Cauvier Charest E, Dault R, Cloutier AM, Choinière M, Blais L, Vanasse A. Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review. Pain Med 2020; 21:1825-1839. [PMID: 32142130 PMCID: PMC7553015 DOI: 10.1093/pm/pnaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. OBJECTIVES This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. METHODS Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. RESULTS Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). CONCLUSIONS In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).
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Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Elizabeth Cauvier Charest
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Roxanne Dault
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Cloutier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
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Blais S, Marelli A, Vanasse A, Dahdah N, Dancea A, Drolet C, Dallaire F. The TRIVIA Cohort for Surgical Management of Tetralogy of Fallot: Merging Population and Clinical Data for Real-World Scientific Evidence. CJC Open 2020; 2:663-670. [PMID: 33305226 PMCID: PMC7710944 DOI: 10.1016/j.cjco.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Guidelines for surgical management of tetralogy of Fallot (TOF) are often based on low-quality evidence due to the many challenges of congenital heart disease: heterogeneous cardiac anatomy, consequences from surgical interventions arising years later, and scarcity of hard outcomes. The overarching goal of the Tetralogy of Fallot Research for Improvement of Valve replacement Intervention: A Bridge Across the Knowledge Gap (TRIVIA) study is to evaluate the long-term impact of the surgical management strategies in TOF. The specific objectives are: (1) to describe the long-term outcomes of TOF according to the native anatomy and the presence of genetic conditions, (2) to evaluate the long-term outcomes of surgical repair according to associated residual lesions, and (3) to evaluate the impact of paediatric pulmonary valve replacements on the long-term outcomes. Methods The TRIVIA study is a population-based cohort including all subjects with TOF in the province of Québec between 1980 and 2017. It links patient-level granular clinical data with long-term administrative health care data. We will evaluate mortality, cardiovascular interventions, and hospitalizations for adverse cardiovascular events using survival Cox models and marginal mean/rates models for recurrent events, respectively. Multivariate multilevel models will correct for potential confounders, and risk score matching will mitigate the potential of confounding by indication. Results The current TRIVIA cohort includes 1001 eligible subjects with TOF with complete lifelong follow-up for > 98%. The median follow-up is 17.1 years, totalling > 17,000 patient-years. Conclusions Universal health insurance data combined with granular clinical data enable the development of population-based cohorts, to which contemporary statistical methods are applied to address important research questions in congenital heart disease research.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Adrian Dancea
- Division of Pediatric Cardiology, McGill University Health Center, Montreal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Zhang J, Chen L, Ye Y, Guo G, Chen R, Vanasse A, Wang S. Survival neural networks for time-to-event prediction in longitudinal study. Knowl Inf Syst 2020. [DOI: 10.1007/s10115-020-01472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lacasse A, Pagé MG, Choinière M, Dorais M, Vissandjée B, Nguefack HLN, Katz J, Samb OM, Vanasse A. Conducting gender-based analysis of existing databases when self-reported gender data are unavailable: the GENDER Index in a working population. Can J Public Health 2020; 111:155-168. [PMID: 31933236 PMCID: PMC7109207 DOI: 10.17269/s41997-019-00277-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Growing attention has been given to considering sex and gender in health research. However, this remains a challenge in the context of retrospective studies where self-reported gender measures are often unavailable. This study aimed to create and validate a composite gender index using data from the Canadian Community Health Survey (CCHS). METHODS According to scientific literature and expert opinion, the GENDER Index was built using several variables available in the CCHS and deemed to be gender-related (e.g., occupation, receiving child support, number of working hours). Among workers aged 18-50 years who had no missing data for our variables of interest (n = 29,470 participants), propensity scores were derived from a logistic regression model that included gender-related variables as covariates and where biological sex served as the dependent variable. Construct validity of propensity scores (GENDER Index scores) were then examined. RESULTS When looking at the distribution of the GENDER Index scores in males and females, they appeared related but partly independent. Differences in the proportion of females appeared between groups categorized according to the GENDER Index scores tertiles (p < 0.0001). Construct validity was also examined through associations between the GENDER Index scores and gender-related variables identified a priori such as choosing/avoiding certain foods because of weight concerns (p < 0.0001), caring for children as the most important thing contributing to stress (p = 0.0309), and ability to handle unexpected/difficult problems (p = 0.0375). CONCLUSION The GENDER Index could be useful to enhance the capacity of researchers using CCHS data to conduct gender-based analysis among populations of workers.
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Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), 445, boul. de l'Université, Rouyn-Noranda, Québec, J9X 5E4, Canada.
| | - M Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l'Île-Perrot, Québec, Canada
| | - Bilkis Vissandjée
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche en santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), 445, boul. de l'Université, Rouyn-Noranda, Québec, J9X 5E4, Canada
| | - Joel Katz
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Oumar Mallé Samb
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), 445, boul. de l'Université, Rouyn-Noranda, Québec, J9X 5E4, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
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Vanasse A, Courteau J, Courteau M, Benigeri M, Chiu YM, Dufour I, Couillard S, Larivée P, Hudon C. Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories. BMC Health Serv Res 2020; 20:177. [PMID: 32143702 PMCID: PMC7059729 DOI: 10.1186/s12913-020-5030-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Published methods to describe and visualize Care Trajectories (CTs) as patterns of healthcare use are very sparse, often incomplete, and not intuitive for non-experts. Our objectives are to propose a typology of CTs one year after a first hospitalization for Chronic Obstructive Pulmonary Disease (COPD), and describe CT types and compare patients’ characteristics for each CT type. Methods This is an observational cohort study extracted from Quebec’s medico-administrative data of patients aged 40 to 84 years hospitalized for COPD in 2013 (index date). The cohort included patients hospitalized for the first time over a 3-year period before the index date and who survived over the follow-up period. The CTs consisted of sequences of healthcare use (e.g. ED-hospital-home-GP-respiratory therapists, etc.) over a one-year period. The main variable was a CT typology, which was generated by a ‘tailored’ multidimensional State Sequence Analysis, based on the “6W” model of Care Trajectories. Three dimensions were considered: the care setting (“where”), the reason for consultation (“why”), and the speciality of care providers (“which”). Patients were grouped into specific CT types, which were compared in terms of care use attributes and patients’ characteristics using the usual descriptive statistics. Results The 2581 patients were grouped into five distinct and homogeneous CT types: Type 1 (n = 1351, 52.3%) and Type 2 (n = 748, 29.0%) with low healthcare and moderate healthcare use respectively; Type 3 (n = 216, 8.4%) with high healthcare use, mainly for respiratory reasons, with the highest number of urgent in-hospital days, seen by pulmonologists and respiratory therapists at primary care settings; Type 4 (n = 100, 3.9%) with high healthcare use, mainly cardiovascular, high ED visits, and mostly seen by nurses in community-based primary care; Type 5 (n = 166, 6.4%) with high healthcare use, high ED visits and non-urgent hospitalisations, and with consultations at outpatient clinics and primary care settings, mainly for other reasons than respiratory or cardiovascular. Patients in the 3 highest utilization CT types were older, and had more comorbidities and more severe condition at index hospitalization. Conclusions The proposed method allows for a better representation of the sequences of healthcare use in the real world, supporting data-driven decision making.
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Affiliation(s)
- Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada. .,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Mike Benigeri
- École de santé publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada
| | - Yohann M Chiu
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Isabelle Dufour
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Simon Couillard
- Service de pneumologie, Département de Médecine, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Pierre Larivée
- Service de pneumologie, Département de Médecine, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Catherine Hudon
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
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Blais S, Marelli A, Vanasse A, Drolet C, Dancea A, Dahdah N, Dallaire F. LONG-TERM OUTCOMES AFTER SURGICAL CORRECTION OF TETRALOGY OF FALLOT: VALVE-SPARING REPAIR DECREASES RE-INTERVENTION AND OVERALL BURDEN OF RESIDUAL LESIONS COMPARED TO TRANSANNULAR PATCHES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cardinal MP, Noël C, Gagnon MH, Têtu C, Vanasse A, Roy-Lacroix MÈ, Poder TG, Marelli A, Cavalle-Garrido T, Vaujois L, Bigras JL, Dallaire F. FREQUENCY: VERY LOW YIELD OF FETAL ECHOCARDIOGRAPHY IN HIGH-RISK PREGNANCIES WITH A NORMAL OBSTETRICAL SECOND-TRIMESTER ULTRASOUND. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31251-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiu YM, Vanasse A, Courteau J, Chouinard MC, Dubois MF, Dubuc N, Elazhary N, Dufour I, Hudon C. Persistent frequent emergency department users with chronic conditions: A population-based cohort study. PLoS One 2020; 15:e0229022. [PMID: 32050010 PMCID: PMC7015381 DOI: 10.1371/journal.pone.0229022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/28/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Frequent emergency department users are patients cumulating at least four visits per year. Few studies have focused on persistent frequent users, who maintain their frequent user status for multiple consecutive years. This study targets an adult population with chronic conditions, and its aims are: 1) to estimate the prevalence of persistent frequent ED use; 2) to identify factors associated with persistent frequent ED use (frequent use for three consecutive years) and compare their importance with those associated with occasional frequent ED use (frequent use during the year following the index date); and 3) to compare characteristics of "persistent frequent users" to "occasional frequent users" and to "users other than persistent frequent users". METHODS This is a retrospective cohort study using Quebec administrative databases. All adult patients who visited the emergency department in 2012, diagnosed with chronic conditions, and living in non-remote areas were included. Patients who died in the three years following their index date were excluded. The main outcome was persistent frequent use (≥4 visits per year during three consecutive years). Potential predictors included sociodemographic characteristics, physical and mental comorbidities, and prior healthcare utilization. Odds ratios were computed using multivariable logistic regression. RESULTS Out of 297,182 patients who visited ED at least once in 2012, 3,357 (1.10%) were persistent frequent users. Their main characteristics included poor socioeconomic status, mental and physical comorbidity, and substance abuse. Those characteristics were also present for occasional frequent users, although with higher percentages for the persistent user group. The number of previous visits to the emergency department was the most important factor in the regression model. The occasional frequent users' attrition rate was higher between the first and second year of follow-up than between the second and third year. CONCLUSIONS Persistent frequent users are a subpopulation of frequent users with whom they share characteristics, such as physical and mental comorbidities, though the former are poorer and younger. More research is needed in order to better understand what factors can contribute to persistent frequent use.
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Affiliation(s)
- Yohann Moanahere Chiu
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josiane Courteau
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicole Dubuc
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicolas Elazhary
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Vachon B, Gaboury I, Menear M, Pomey MP, Roy D, Houle L, Breton M, Duhoux A, Émond V, Giasson G, Kaczorowski J, Légaré F, Lussier MT, Pluye P, Vanasse A. Evaluating implementation and impact of a provincial quality improvement collaborative for the management of chronic diseases in primary care: the COMPAS+ study protocol. BMC Fam Pract 2020; 21:3. [PMID: 31910814 PMCID: PMC6947939 DOI: 10.1186/s12875-019-1072-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Yet, evidence points to suboptimal quality of care for these conditions in primary care settings. Quality improvement collaboratives (QICs) are organized, multifaceted interventions that can be effective in improving chronic disease care processes and outcomes. In Quebec, Canada, the Institut national d'excellence en santé et en services sociaux (INESSS) has developed a large-scale QIC province-wide program called COMPAS+ that aims to improve the prevention and management of chronic diseases in primary care. This paper describes the protocol for our study, which aims to evaluate implementation and impact of COMPAS+ QICs on the prevention and management of targeted chronic diseases like diabetes and COPD. METHODS This is a mixed-methods, integrated knowledge translation study. The quantitative component involves a controlled interrupted time series involving nine large integrated health centres in the province. Study sites will receive one of two interventions: the multifaceted COMPAS+ intervention (experimental condition) or a feedback only intervention (control condition). For the qualitative component, a multiple case study approach will be used to achieve an in-depth understanding of individual, team, organizational and contextual factors influencing implementation and effectiveness of the COMPAS+ QICs. DISCUSSION COMPAS+ is a QI program that is unique in Canada due to its integration within the governance of the Quebec healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province. We anticipate that this study will address several important gaps in knowledge related to large-scale QIC projects and generate strong and useful evidence (e.g., on leadership, organizational capacity, patient involvement, and implementation) having the potential to influence the design and optimisation of future QICs in Canada and internationally.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Centre de recherche du CIUSSS de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Matthew Menear
- Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | | | - Denis Roy
- Institut national d’excellence en santé et en services sociaux, Montreal, Canada
| | - Lise Houle
- Institut national d’excellence en santé et en services sociaux, Montreal, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Valérie Émond
- Institut national de santé publique du Québec, Quebec, Canada
| | - Guylaine Giasson
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - France Légaré
- Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | | | - Pierre Pluye
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Alain Vanasse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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Lesage A, Vanasse A, Potvin S, Dumais A. Retraction: Caractérisation des premiers épisodes de schizophrénie à partir de bases de données administratives de santé jumelées. [Characterization of First Episodes of Schizophrenia from Combined Administrative Databases]. Beaudoin, M., Potvin, S., Dellazizzo, L., Surprenant, M., Lesage, A., Vanasse, A., Ngamini-Ngui, A.† et Dumais, A. Santé mentale au Québec. 2018 Fall ; 43(2) : 83-105.PMID : 32338687. Sante Ment Que 2019. [PMID: 33270396 DOI: 10.7202/1058611ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This corrects the article DOI: https://doi.org/10.7202/1058611ar.
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Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Fleury MJ, Delorme A, Benigeri M, Vanasse A. Utilisation et enjeux des données clinico-administratives dans le domaine de la santé
mentale et de la dépendance. smq 2019. [DOI: 10.7202/1058608ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Les banques de données clinico-administratives sont des outils clés pour la prise
de décision publique en santé. Pour soutenir la gestion des services, plusieurs banques sont
disponibles s’intéressant aux besoins des populations et aux ressources disponibles, tout en
intégrant des indicateurs de performance. Depuis les années 2000, des efforts considérables
ont été menés afin de consolider les données et développer des outils visant à mieux
surveiller l’état de santé des populations ou la performance du système sociosanitaire. Dans
le cadre du congrès annuel de l’Association francophone pour le savoir (ACFAS), qui s’est
tenu à l’Université McGill en 2017, un colloque a été organisé pour débattre de leur
exploitation en santé mentale et en dépendance. Le colloque a intégré une discussion
d’experts qui se sont entretenus afin d’identifier les principales banques
clinico-administratives, l’ampleur de leur utilisation, leurs limites et les solutions à
développer pour les optimiser afin de mieux soutenir la gestion des services. Cet article
vise à résumer le contenu de ces discussions. Bien que les banques comportent des forces
importantes, dont un potentiel élevé de généralisation de l’information, elles présentent
des limites se rapportant surtout à leur capacité à répondre aux besoins, à des enjeux de
qualité et de validation, ainsi que d’accessibilité. Diverses recommandations ont été émises
pour améliorer leur gestion et optimiser leur impact, dont leur conservation et traitement
dans un organisme autonome et hautement accessible, et un changement sociétal de culture
favorisant l’évaluation de la performance afin d’améliorer les pratiques et de mieux
monitorer les résultats de santé.
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Affiliation(s)
- Marie-Josée Fleury
- Département de psychiatrie, Université McGill, QC, Canada
- Institut universitaire en santé mentale Douglas, QC, Canada
| | - André Delorme
- Direction générale des services de santé mentale et de psychiatrie légale,
ministère de la Santé et des Services sociaux (MSSS), QC, Canada
| | - Mike Benigeri
- Organisations publiques, consultations : gestion et exploitation des données
clinico-administratives, QC, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d’urgence, Université de
Sherbrooke, QC, Canada
- Direction scientifique, Unité de soutien à la stratégie de recherche axée sur le
patient (SRAP) du Québec, QC, Canada
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Zhang J, Wang S, Courteau J, Chen L, Guo G, Vanasse A. Feature-weighted survival learning machine for COPD failure prediction. Artif Intell Med 2019; 96:68-79. [PMID: 31164212 DOI: 10.1016/j.artmed.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 11/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) yields a high rate of failures such as hospital readmission and death in the United States, Canada and worldwide. COPD failure imposes a significant social and economic burden on society, and predicting such failure is crucial to early intervention and decision-making, making this a very important research issue. Current analysis methods address all risk factors in medical records indiscriminately and therefore generally suffer from ineffectiveness in real applications, mainly because many of these factors relate weakly to prediction. Numerous studies have been done on selecting factors for survival analysis, but their inherent shortcomings render these methods inapplicable for failure prediction in the context of unknown and intricate correlation patterns among risk factors. These difficulties have prompted us to design a new Cox-based learning machine that embeds the feature weighting technique into failure prediction. In order to improve predictive accuracy, we propose two weighting criteria to maximize the area under the ROC curve (AUC) and the concordance index (C-index), respectively. At the same time, we perform a Dirichlet-based regularization on weights, making differences between factor relevance clearly visible while maintaining the model's high predictive ability. The experimental results on real-life COPD data collected from patients hospitalized at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) demonstrate the effectiveness of our learning machine and its great promise in clinical applications.
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Affiliation(s)
- Jianfei Zhang
- College of Mathematics and Informatics, Fujian Normal University, Fuzhou 350117, China; Département d'Informatique, Université de Sherbrooke, Québec J1K 2R1, Canada.
| | - Shengrui Wang
- College of Mathematics and Informatics, Fujian Normal University, Fuzhou 350117, China; Département d'Informatique, Université de Sherbrooke, Québec J1K 2R1, Canada.
| | - Josiane Courteau
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Québec J1H 5N4, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Québec J1H 5N4, Canada.
| | - Lifei Chen
- College of Mathematics and Informatics, Fujian Normal University, Fuzhou 350117, China; Département d'Informatique, Université de Sherbrooke, Québec J1K 2R1, Canada.
| | - Gongde Guo
- College of Mathematics and Informatics, Fujian Normal University, Fuzhou 350117, China.
| | - Alain Vanasse
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Québec J1H 5N4, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Québec J1H 5N4, Canada.
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Li Q, Larivée P, Courteau J, Couillard S, Poder TG, Carrier N, Bélanger M, Vanasse A. Greater eosinophil counts at first COPD hospitalization are associated with more readmissions and fewer deaths. Int J Chron Obstruct Pulmon Dis 2019; 14:331-341. [PMID: 30787603 PMCID: PMC6363487 DOI: 10.2147/copd.s187375] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose The impacts of high blood eosinophil count (HBEC) at admission for COPD exacerbation on posthospitalization outcomes are still unclear. Previous studies have focused on its associations with first readmission rates; yet, its impacts on longitudinal outcomes such as subsequent readmissions still have to be explored. The main objective of this study is to investigate outcomes associated with HBEC following a first hospitalization for COPD exacerbation. Patients and methods This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the HBEC group if the blood eosinophil count at admission was ≥200 cells/µL and/or ≥2% of the total white blood cells. With information on exact dates of subsequent hospitalizations and death, we modeled readmissions and death as states in a multi-state Markov model and estimated transition probabilities to the next states. Sensitivity analyses were performed by varying thresholds for the definition of HBEC (≥300 cells/µL and/or ≥3%). Results A total of 479 patients were included, of which 173 had HBEC. The transition probabilities for a first readmission was 74% (95% CI, 66%–83%) for patients with HBEC vs 70% (95% CI, 63%–77%) for patients with normal blood eosinophil count (NBEC). The transition probabilities for a second readmission were 91% (95% CI, 84%–100%) for HBEC patients in contrast with 83% (95% CI, 74%–92%) for NBEC patients. Meanwhile, transition probability for death was lower in patients with HBEC. The differences enlarged in sensitivity analyses with higher cutoff. Conclusion Greater blood eosinophil cell counts during a first hospitalization for COPD predict increased susceptibility to up to two readmissions. These patients may however have a lower risk of death.
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Affiliation(s)
- Qing Li
- Center for Innovation Management Research of Xinjiang, School of Economics and Management, Xinjiang University, Urumqi, Xinjiang, China
| | - Pierre Larivée
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada,
| | - Simon Couillard
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Thomas G Poder
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada, .,Health Technology Assessment Unit, UETMISSS, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathalie Carrier
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada,
| | - Maryse Bélanger
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alain Vanasse
- Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada, .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Lesage A, Vanasse A, Potvin S, Dumais A. Retraction: Caractérisation des premiers épisodes de schizophrénie à partir de bases de données administratives de santé jumelées. [Characterization of First Episodes of Schizophrenia from Combined Administrative Databases]. Beaudoin, M., Potvin, S., Dellazizzo, L., Surprenant, M., Lesage, A., Vanasse, A., Ngamini-Ngui, A.† et Dumais, A. Santé mentale au Québec. 2018 Fall ; 43(2) : 83–105.PMID : 32338687. Santé mentale au Québec 2019. [DOI: 10.7202/1073586ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Noël C, Gagnon MH, Cardinal MP, Guertin O, Déry A, Têtu C, Vanasse A, Roy-Lacroix MÈ, Poder TG, Marelli AJ, Cavallé-Garrido T, Vaujois L, Bigras JL, Dallaire F. Rationale and Design of the FREQUENCY Study: The Fetal Cardiac Registry of Québec to Improve Resource Utilization in Fetal Cardiology. J Obstet Gynaecol Can 2018; 41:459-465.e12. [PMID: 30591407 DOI: 10.1016/j.jogc.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Prenatal detection of congenital heart diseases (CHD) decreases morbidity and cost. To improve detections rates, most physicians refer pregnant women with high-risk pregnancies to fetal cardiologists even when there is no suspicion of CHD at the second trimester screening. This paper presents the rationale and detailed method of the Fetal Cardiac Registry of Québec to Improve Resource Utilization in Fetal Cardiology (FREQUENCY) study. The overall objective is to assess the impact of second trimester ultrasound screening (U/S) and referral pattern in fetal cardiology on detection rates, health care costs, and resource utilization, as well as perinatal morbidity and mortality. METHODS This multicentre retrospective population-based cohort study will link fetal echocardiography data from all centres performing fetal echocardiography in Québec with administrative health care data. This data linking will allow the determination of a true denominator (all women in Québec who underwent second trimester U/S) with complete follow-up of up to 2 years for offspring. This protocol meets Canadian Task Force Classification II-2. RESULTS The study investigators have collected and cleaned fetal echocardiography data for 24 259 eligible pregnancies referred to fetal cardiology. These data will be matched to approximately 860 000 pregnancies between 2007 and 2015. CONCLUSION The results of the FREQUENCY study will shed light on the impact of the current prenatal CHD screening strategy in Canada.
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Affiliation(s)
- Camille Noël
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Marie-Hélène Gagnon
- Department of Pediatrics, Montréal Children's Hospital, McGill University, Montréal, QC
| | - Mikhail-Paul Cardinal
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Olivier Guertin
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Antoine Déry
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Cassandre Têtu
- Department of Pediatrics, Montréal Children's Hospital, McGill University, Montréal, QC
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC
| | - Marie-Ève Roy-Lacroix
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Thomas G Poder
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Unité D'évaluation des Technologies et des Modes d'Intervention en Santé, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke Sherbrooke, QC
| | - Ariane J Marelli
- MAUDE Unit (McGill Adult Unit for Congenital Heart Disease Excellence), McGill University, Montréal, QC
| | - Tiscar Cavallé-Garrido
- Division of Pediatric Cardiology, Montréal Children's Hospital, McGill University, Montréal, QC
| | - Laurence Vaujois
- Division of Pediatric and Congenital Cardiology, Department of Pediatrics, Laval University Hospital, Faculty of Medicine, Laval University, Québec City, QC
| | - Jean-Luc Bigras
- Department of Pediatric Cardiology, University Hospital Sainte-Justine, University of Montréal, Montréal, QC
| | - Frédéric Dallaire
- Division of Pediatric and Fetal Cardiology, Department of Pediatrics, Faculty of Medicine and Heath Sciences, Université de Sherbrooke, Sherbrooke, QC; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC.
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Poder TG, Carrier N, Bélanger M, Couillard S, Courteau J, Larivée P, Vanasse A. Eosinophil counts in first COPD hospitalizations: a 1-year cost analysis in Quebec, Canada. Int J Chron Obstruct Pulmon Dis 2018; 13:3065-3076. [PMID: 30349220 PMCID: PMC6183549 DOI: 10.2147/copd.s170747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Exacerbations explain much of the cost of COPD. Higher blood eosinophil cell counts at admission for acute exacerbation of COPD increase the risk of subsequent exacerbations and hospitalizations. However, there is no literature on the economic burden of patients with this inflammatory profile. The objective of this study is to assess the cost of health-care service utilization according to different counts of blood eosinophils. METHODS The observational retrospective cohort included all first hospitalizations for COPD exacerbation between April 2006 and March 2013. The eosinophilic group was defined by blood eosinophil counts on admission ≥200 cells/µL and/or ≥2% of the total white blood cell count. Study outcomes were: total costs (2016 Canadian dollars) (index hospitalization and 1-year follow-up), total index hospitalization costs, total 1-year costs (all-cause readmissions, ambulatory and emergency service use), and 1-year COPD-related costs (only cost for COPD after initial discharge). Sensitivity analyses were conducted to evaluate the impact of different eosinophil cut-offs on outcomes. RESULTS In total, 479 patients were included, 173 in the eosinophilic group (92 in the higher cut-off). The average total cost was $18,263 ($6,706 for the index hospitalization), without significant difference between groups (P=0.3). The average 1-year COPD-related cost was higher in the eosinophilic group ($3,667 vs $2,472, P=0.006), with an adjusted mean difference of $1,416. Analysis of data using the higher cut-off of ≥400 cells or ≥3% was associated with a slightly larger difference in 1-year COPD-related costs between groups ($4,060 vs $2,629, P=0.003), with an adjusted mean difference of $1,640. CONCLUSION A higher blood eosinophil cell count at admission for a first hospitalization is associated with an increase in total 1-year COPD-related costs.
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Affiliation(s)
- Thomas G Poder
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Health Technology Assessment Unit, UETMIS, CIUSSS de l'Estrie -CHUS, Sherbrooke, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada,
| | - Nathalie Carrier
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Maryse Bélanger
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Couillard
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Pierre Larivée
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alain Vanasse
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada,
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Bélanger M, Couillard S, Courteau J, Larivée P, Poder TG, Carrier N, Girard K, Vézina FA, Vanasse A. Eosinophil counts in first COPD hospitalizations: a comparison of health service utilization. Int J Chron Obstruct Pulmon Dis 2018; 13:3045-3054. [PMID: 30319252 PMCID: PMC6171756 DOI: 10.2147/copd.s170743] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Current evidence suggests that a higher blood eosinophil cell count at admission for acute exacerbation of COPD (AECOPD) is associated with a favorable response to systemic steroids. However, the impact of blood eosinophil counts at admission on post-hospitalization outcomes is still unclear. The main objective of this study is to investigate readmission outcomes associated with blood eosinophilia following severe COPD exacerbation in patients with infrequent COPD hospitalizations. Patients and methods This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the eosinophilic group if the blood eosinophil count on admission was ≥200 cells/µL and/or ≥2% of the total white blood cell (WBC) count. The primary outcome was 1-year COPD-related readmission. Secondary outcomes included 1-year all-cause mortality, 1-year all-cause readmission, length of stay, time to COPD-related readmission, and number of 1-year COPD-associated emergency department (ED) and ambulatory visits. Results A total of 479 patients were included. Of whom, 173 were stratified into the eosinophilic group. Higher blood eosinophil cell count was associated with an increased risk of 1-year COPD-related readmission (OR, 1.83 [95% CI, 1.16-2.89]; P<0.01), a shorter time to first COPD-related readmission (HR, 1.64 [95% CI, 1.14-2.36]; P<0.01), and an increased number of 1-year COPD-related ED visits (incidence rate ratio, 1.78 [95% CI, 1.21-2.61]; P<0.01). All-cause mortality, all-cause readmission, length of stay, and number of ambulatory visits did not differ between groups. Conclusion Higher blood eosinophil cell count at admission for a COPD exacerbation is associated with increased COPD readmission rates in patients with infrequent COPD hospitalizations.
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Affiliation(s)
- Maryse Bélanger
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Couillard
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Pierre Larivée
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Thomas G Poder
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, .,Health Technology Assessment Unit, UETMIS, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada,
| | - Nathalie Carrier
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Kim Girard
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Felix-Antoine Vézina
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, .,Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alain Vanasse
- Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada,
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Lauzier S, Kadachi H, Moisan J, Vanasse A, Lesage A, Fleury MJ, Grégoire JP. Neighbourhood Material and Social Deprivation and Exposure to Antidepressant Drug Treatment: A Cohort Study Using Administrative Data. Can J Psychiatry 2018; 63. [PMID: 29514506 PMCID: PMC6187437 DOI: 10.1177/0706743718760290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether neighbourhood deprivation is associated with exposure to an antidepressant drug treatment (ADT) and its quality among individuals diagnosed with unipolar depression and insured by the Quebec public drug plan. METHOD We conducted an administrative database cohort study of adults covered by the Quebec public drug plan who were diagnosed with a new episode of unipolar depression. We assessed material and social deprivation using an area-based index. We considered exposure to an ADT as having ≥1 claim for an ADT within the 365 days following depression diagnosis. Among those exposed to ADT, ADT quality was assessed with 3 indicators: first-line recommended ADT, persistence with the ADT, and compliance with the ADT. Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI). RESULTS Of 100,432 individuals with unipolar depression, 65,436 (65%) were exposed to an ADT in the year following the diagnosis. Individuals living in the most materially deprived areas were slightly more likely to be exposed to an ADT than those living in the least deprived areas (aPR, 1.04; 95% CI, 1.03 to 1.06). The likelihoods of being exposed to a first-line ADT, persisting for the minimum recommended duration and complying with the ADT were independent of the deprivation levels. CONCLUSIONS Neighbourhood deprivation was not associated with ADT quality among individuals insured by the Quebec public drug plan. It might be partly attributable to the public drug plan whose goal is to provide equitable access to prescription drugs regardless of income.
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Affiliation(s)
- Sophie Lauzier
- 1 Faculty of Pharmacy, Université Laval Québec, Québec.,2 Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, Québec
| | | | - Jocelyne Moisan
- 1 Faculty of Pharmacy, Université Laval Québec, Québec.,2 Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, Québec
| | - Alain Vanasse
- 4 Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec.,5 Groupe de recherche PRIMUS, Centre de recherche du CHUS, Sherbrooke, Québec
| | - Alain Lesage
- 6 Fernand-Seguin Research Center, Institut universitaire en santé mentale de Montréal, Montréal, Québec
| | - Marie-Josée Fleury
- 7 Department of Psychiatry, McGill University, Montréal, Québec.,8 Douglas Mental Health University Institute Research Centre, Montréal, Québec
| | - Jean-Pierre Grégoire
- 1 Faculty of Pharmacy, Université Laval Québec, Québec.,2 Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, Québec
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Diallo FB, Fombonne É, Kisely S, Rochette L, Vasiliadis HM, Vanasse A, Noiseux M, Pelletier É, Renaud J, St-Laurent D, Lesage A. Prevalence and Correlates of Autism Spectrum Disorders in Quebec: Prévalence et corrélats des troubles du spectre de l'autisme au Québec. Can J Psychiatry 2018; 63:231-239. [PMID: 29056086 PMCID: PMC5894913 DOI: 10.1177/0706743717737031] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the prevalence, comorbidities, and service use of people with autism spectrum disorders (ASDs) based on data from Quebec Integrated Chronic Diseases Surveillance System (QICDSS). METHODS We included all residents up to age 24 eligible for health plan coverage who were in Quebec for at least 1 day from January 1, 1996, to March 31, 2015. To be considered as having an ASD, an individual had to have had at least 1 physician claim or hospital discharge abstract from 2000 to 2015 indicating one of the following ASD diagnosis codes: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents. RESULTS The QICDSS shows that the prevalence of ASD has risen steadily over the past decade to approximately 1.2% ( n = 16,940) of children and youths aged 1 to 17 years in 2014 to 2015. The same prevalence was obtained using Ministry of Education data. Common medical comorbidities included congenital abnormalities of the nervous system, particularly in the first year of life. Psychiatric comorbidity was much more highly prevalent, especially common mental disorders like anxiety and attention-deficit/hyperactivity disorder. Children and youths with ASDs made on average 2.3 medical visits per year compared with 0.2 in the general population. Between 18 and 24 years old, the mental health needs of individuals with ASDs were met less by medical specialists and more by general practitioners. CONCLUSION Information derived from this database could support and monitor development of better medical services coordination and shared care to meet the continuous and changing needs of patients and families over time.
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Affiliation(s)
- Fatoumata Binta Diallo
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | - Éric Fombonne
- 2 Department of Psychiatry, Oregon Health Sciences University, Portland, Oregon, USA
| | - Steve Kisely
- 3 Departments of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.,4 School of Medicine, University of Queensland, Queensland, Australia
| | - Louis Rochette
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | | | - Alain Vanasse
- 6 Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec
| | - Manon Noiseux
- 7 Department of Public Health, Health and Social Services Centre of Montérégie-Centre, Montérégie, Quebec
| | - Éric Pelletier
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | - Johanne Renaud
- 8 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Danielle St-Laurent
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | - Alain Lesage
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec.,9 Department of Psychiatry, Research Centre of the Montreal Mental Health University Institute, University of Montreal, Montreal, Quebec
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Vanasse A, Courteau M, Ethier JF. The '6W' multidimensional model of care trajectories for patients with chronic ambulatory care sensitive conditions and hospital readmissions. Public Health 2018; 157:53-61. [PMID: 29499400 DOI: 10.1016/j.puhe.2018.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To synthesize concepts and approaches related to the analysis of patterns or processes of care and patient's outcomes into a comprehensive model of care trajectories, focusing on hospital readmissions for patients with chronic ambulatory care sensitive conditions (ACSCs). STUDY DESIGN Narrative literature review. METHODS Published studies between January 2000 and November 2017, using the concepts of 'continuity', 'pathway', 'episode', and 'trajectory', and focused on readmissions and chronic ACSCs, were collected in electronic databases. Qualitative content analysis was performed with emphasis on key constituents to build a comprehensive model. RESULTS Specific common constituents are shared by the concepts reviewed: they focus on the patient, aim to measure and improve outcomes, follow specific periods of time and consider other factors related to care providers, care units, care settings, and treatments. Using these common denominators, the comprehensive '6W' multidimensional model of care trajectories was created. Considering patients' attributes and their chronic ACSCs illness course ('who' and 'why' dimensions), this model reflects their patterns of health care use across care providers ('which'), care units ('where'), and treatments ('what'), at specific periods of time ('when'). CONCLUSIONS The '6W' model of care trajectories could provide valuable information on 'missed opportunities' to reduce readmission rates and improve quality of both ambulatory and inpatient care.
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Affiliation(s)
- A Vanasse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada.
| | - M Courteau
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada.
| | - J-F Ethier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; INSERM UMR 1138 Team 22 Centre de Recherche des Cordeliers, Faculté de Médecine, Université Paris Descartes - 15, Rue de L'école de Médecine, 75006 Paris, France.
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Fleury MJ, Delorme A, Benigeri M, Vanasse A. [Databank use and issues in mental health and addiction services]. Sante Ment Que 2018; 43:21-38. [PMID: 32338684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Clinical-administrative databanks are a key tool in support of public health decision-making. A number of databanks are available relevant to population needs, resources available, as well as performance indicators. Since the 2000s, considerable efforts have been dedicated to the consolidation of findings and development of tools aimed at improving surveillance with respect to the health status of populations and performance of the social and healthcare system. At the annual congress of the Association francophone pour le savoir (ACFAS), held in 2017 at McGill University, a seminar was organized on the utilization of databanks in mental health and in addiction. This seminar featured an expert discussion on subjects related to: identification of the principal clinical-administrative databanks, the extent of their use, their limitations, and solutions aimed at optimizing the development of databanks to better support the management of services. This article summarizes the content of this seminar. While databanks entail important strengths, including great potential for the generalization of information, they also present limitations regarding their capacity to respond to needs, quality and validation issues, as well as accessibility. Various recommendations were proposed to improve the management of databanks and optimize their impact, including their centralization in a single, and highly accessible autonomous organism, and societal and cultural change favoring performance evaluation in the interest of improving practices and better monitoring health results.
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Affiliation(s)
- Marie-Josée Fleury
- Département de psychiatrie, Université McGill, QC, Canada ; Institut universitaire en santé mentale Douglas, QC, Canada
| | - André Delorme
- Direction générale des services de santé mentale et de psychiatrie légale, ministère de la Santé et des Services sociaux (MSSS), QC, Canada
| | - Mike Benigeri
- Organisations publiques, consultations : gestion et exploitation des données clinico-administratives, QC, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, QC, Canada ; Direction scientifique, Unité de soutien à la stratégie de recherche axée sur le patient (SRAP) du Québec, QC, Canada
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Beaudoin M, Potvin S, Dellazizzo L, Surprenant M, Lesage A, Vanasse A, Ngamini-Ngui A, Dumais A. [Characterization of First Episodes of Schizophrenia from Combined Administrative Databases]. Sante Ment Que 2018; 43:83-105. [PMID: 32338687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Schizophrenia (SCZ) is a severe chronic disease associated with significant functional impairments. Prior to a diagnosis of SCZ, some nonspecific symptoms may occur (i.e., anxiety, insomnia, depressive symptoms) and may progress into psychosis. While these may be attenuated or not of sufficient severity for psychosis, many will seek help for these symptoms. Understanding the predictors of SCZ remains a considerable challenge for clinicians. Thus, several studies have been conducted to explain the different premorbid trajectories of psychosis. Though, no consensus has been established on the prediagnostic characteristics of patients with SCZ and remains a matter of debate, especially for women and older patients. Hence, our study aims to clarify the psychiatric characteristics of patients from Quebec preceding their first episode of SCZ and address the influence of age and sex. To do so, we used administrative databases from the RAMQ (Physician billings) and MED-ÉCHO (hospital registry in Quebec) between January 1996 and December 2006; 98% of about 7.5 millions of inhabitants are registered with the universal health plan. It recorded 24,883 men and women over the age of 18 diagnosed with a first episode of SCZ between the years 2004 and 2007. Different psychiatric antecedents by groups of age and sex are reported by cumulative frequency. The sample comprised of 53% men. Approximately, 50% and 36% were diagnosed with SCZ by psychiatrists and family physicians respectively. Patients aged from 30 to 54 represented most of the sample; over half of men and women were first diagnosed after 30 years old. Those with no antecedents accounted for 65% of the sample, while overall 35% had at least one ICD-9 diagnosis, specifically and in descending order manic depressive psychosis, depressive disorder, and drug use disorder. In women under 30, anxiety, depressive disorder and adjustment disorder were more frequent. Whereas amongst men under 30, substance use disorder was the most common antecedent, followed by anxiety. Considering the total population coverage, these findings are interesting as they draw a representative global portrait of the population with SCZ before their diagnosis according to their age group and sex. This project recalls the importance of examining the first psychotic episodes to possibly intervene early in the course of the disease by addressing depressive disorders, anxiety disorders and substance use.
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Affiliation(s)
- Mélissa Beaudoin
- Département de psychiatrie et d'addictologie de l'Université de Montréal ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal
| | - Stéphane Potvin
- Département de psychiatrie et d'addictologie de l'Université de Montréal ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal
| | - Laura Dellazizzo
- Département de psychiatrie et d'addictologie de l'Université de Montréal ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal ; Institut Philippe-Pinel de Montréal
| | - Maëlle Surprenant
- Département de psychiatrie et d'addictologie de l'Université de Montréal
| | - Alain Lesage
- Département de psychiatrie et d'addictologie de l'Université de Montréal ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal ; Institut national de santé publique du Québec
| | - Alain Vanasse
- Département de médecine de famille et de médecine d'urgence de l'Université de Sherbrooke ; Centre de recherche du Centre hospitalier universitaire de Sherbrooke
| | | | - Alexandre Dumais
- Département de psychiatrie et d'addictologie de l'Université de Montréal ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal ; Institut Philippe-Pinel de Montréal
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Diallo FB, Pelletier É, Vasiliadis HM, Rochette L, Lin E, Smith M, Langille D, Thompspon A, Noiseux M, Vanasse A, St-Laurent D, Kisely S, Fombonne É, Lesage A. [Estimating the Prevalence and Incidence Rate of Autism Spectrum Disorder (ASD): Interprovincial Comparisons]. Sante Ment Que 2018; 43:65-81. [PMID: 32338686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective The prevalence of diagnosed autism spectrum disorders (ASD) has risen steadily over time. There is therefore a need for the monitoring of treated ASD for timely policy making. The objective of this study is to report and compare over a 10-year period the prevalence and incidence rate of diagnosed ASD in four Canadian provinces. Methods This study utilized data from the provinces of Manitoba, Ontario, Quebec and Nova Scotia with access to linked administrative database sources used in the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence rate of a physician diagnosis of ASD. Estimates were produced using health datasets for outpatient and inpatient care (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the three other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were extracted. The target population consisted of all residents aged 24 and under eligible for healthcare coverage under provincial law between 1999 and 2012. To be considered as having ASD, an individual had to have at least one physician claim or hospital discharge abstract indicating one of the following: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents, F84.0 to F84.9. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by sex and age groups. The main analyses focused on those aged 17 years or less, with the 18 to 24 years group added to show the subsequent progression of the disorder. Results Our findings show that the annual prevalence of ASD rose steadily between 1999 and 2012 in all provinces and for all age groups although this increase varied across Canadian provinces. There were higher annual prevalence estimates in Ontario (4.8 per 1,000) and Nova Scotia (4.2 per 1,000) compared to Quebec (3.0 per 1,000) and Manitoba (2.5 per 1,000), among persons aged 17 years and younger in 2011. As compared to 1999, Quebec and Ontario reported a fivefold and fourfold increase in 2010-2012, the highest among provinces. The prevalence was four times higher in boys than in girls. By age group, the highest prevalence was observed in those aged between 1 to 4 and 5 to 9 years depending on the province. ASD was generally diagnosed before age 10. Incident cases were more frequently diagnosed by pediatricians followed by either psychiatrists or general practitioners depending on the province. Conclusion Our research confirms that ASD has risen steadily in terms of prevalence and incidence rate and that it varies considerably across provinces. It also demonstrates that health administrative databases can be used as registers for ASD. Information derived from these databases could support and monitor development of improved coordination and shared care to meet the continuous and changing needs of patients and families over time. Implication for future research include exploring the etiology of ASD in more recent cohorts as well as investigating the association between variations in health service availability and the prevalence of ASD.
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Affiliation(s)
- Fatoumata Binta Diallo
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | - Helen-Maria Vasiliadis
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke ; Centre de recherche Charles-Le Moyne - Saguenay - Lac-Saint-Jean sur les innovations en santé (CR-CSIS)
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | - Elizabeth Lin
- Centre for Addiction and Mental Health, Research Scientist
| | | | | | | | - Manon Noiseux
- Centre intégré de santé et de services sociaux de la Montérégie
| | - Alain Vanasse
- Université de Sherbrooke, Département de médecine de famille et de médecine d'urgence
| | - Danielle St-Laurent
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | | | - Éric Fombonne
- Oregon Health & Science University, Departments of Psychiatry, Pediatrics & Behavioral Neuroscience Sciences
| | - Alain Lesage
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal
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Gagnon M, Noel C, Cardinal M, Tetu C, Cavallé-Garrido T, Vaujois L, Bigras J, Roy-Lacroix M, Poder T, Vanasse A, Marelli A, Dallaire F. LOW YIELD OF FETAL ECHOCARDIOGRAPHY WHEN NO SUSPICION OF HEART DISEASE BY REFERRING OBSTETRICIAN. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Vanasse A, Talbot D, Chebana F, Bélanger D, Blais C, Gamache P, Giroux JX, Dault R, Gosselin P. Effects of climate and fine particulate matter on hospitalizations and deaths for heart failure in elderly: A population-based cohort study. Environ Int 2017; 106:257-266. [PMID: 28709636 DOI: 10.1016/j.envint.2017.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There are limited data on the effects of climate and air pollutant exposure on heart failure (HF) within taking into account individual and contextual variables. OBJECTIVES We measured the lag effects of temperature, relative humidity, atmospheric pressure and fine particulate matter (PM2.5) on hospitalizations and deaths for HF in elderly diagnosed with this disease on a 10-year period in the province of Quebec, Canada. METHODS Our population-based cohort study included 112,793 elderly diagnosed with HF between 2001 and 2011. Time dependent Cox regression models approximated with pooled logistic regressions were used to evaluate the 3- and 7-day lag effects of daily temperature, relative humidity, atmospheric pressure and PM2.5 exposure on HF morbidity and mortality controlling for several individual and contextual covariates. RESULTS Overall, 18,309 elderly were hospitalized and 4297 died for the main cause of HF. We observed an increased risk of hospitalizations and deaths for HF with a decrease in the average temperature of the 3 and 7days before the event. An increase in atmospheric pressure in the previous 7days was also associated with a higher risk of having a HF negative outcome, but no effect was observed in the 3-day lag model. No association was found with relative humidity and with PM2.5 regardless of the lag period. CONCLUSIONS Lag effects of temperature and other meteorological parameters on HF events were limited but present. Nonetheless, preventive measures should be issued for elderly diagnosed with HF considering the burden and the expensive costs associated with the management of this disease.
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Affiliation(s)
- Alain Vanasse
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, J1H 5N4, QC, Canada; Research Center of the Centre hospitalier universitaire de Sherbrooke - Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, J1H 5N4, QC, Canada.
| | - Denis Talbot
- Research Center of the Centre hospitalier universitaire de Québec - Université Laval, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada.
| | - Fateh Chebana
- The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada.
| | - Diane Bélanger
- Research Center of the Centre hospitalier universitaire de Québec - Université Laval, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, QC, Canada; The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada.
| | - Claudia Blais
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, G1V 5B3, QC, Canada; Faculty of Pharmacy, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada.
| | - Philippe Gamache
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, G1V 5B3, QC, Canada.
| | - Jean-Xavier Giroux
- The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada.
| | - Roxanne Dault
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, J1H 5N4, QC, Canada.
| | - Pierre Gosselin
- Research Center of the Centre hospitalier universitaire de Québec - Université Laval, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada; The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada; Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, G1V 5B3, QC, Canada; Faculty of Pharmacy, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada.
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Hudon C, Courteau J, Krieg C, Vanasse A. Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study. BMC Health Serv Res 2017; 17:525. [PMID: 28778161 PMCID: PMC5544976 DOI: 10.1186/s12913-017-2453-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources. Being able to properly identify chronic frequent ED users, i.e. frequent ED users over a multiple-year period, would allow healthcare professionals to intervene before it occurs and, if possible, redirect these patients to more appropriate health services. The objective of this study was to explore the factors associated with chronic frequent ED utilization in a population with diabetes. METHODS A population-based retrospective cohort study using administrative data was conducted on 62,316 patients with diabetes living in metropolitan areas of Quebec (Canada), having visited an ED during 2006, and still alive in 31 December 2009. The dependant variable was being a chronic frequent ED user, defined as having at least 3 ED visits per year during three consecutive years (2007-2009). Independent variables, measured during 2006, included age, sex, neighbourhood deprivation, affiliation to a general practitioner, and number of physical and mental health comorbidities. Logistic regression and tree-based method were used to identify factors associated with chronic frequent ED use. RESULTS A total of 2.6% of the cohort (patients with diabetes and at least one ED visit in 2006) was identified as chronic frequent ED users. These patients accounted for 16% of all ED visits made by the cohort during follow-up. The cumulative effect of a high illness burden combined with mental health disorders was associated with an increased risk of chronic frequent ED use. CONCLUSIONS Interventions must target the population at higher risk of becoming chronic frequent ED users and should be designed to manage the complex interaction between high illness burden and mental health.
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Affiliation(s)
- Catherine Hudon
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada. .,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Cynthia Krieg
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
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47
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Vanasse A, Courteau J, Couillard S, Beauchesne MF, Larivée P. Predicting One-year Mortality After a "First" Hospitalization for Chronic Obstructive Pulmonary Disease: An Eight-Variable Assessment Score Tool. COPD 2017; 14:490-497. [PMID: 28745528 DOI: 10.1080/15412555.2017.1343814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several authors have studied predictors of outcomes following a hospitalization for chronic obstructive pulmonary disease (COPD); however, few have reported outcomes following a first hospitalization for COPD. The objective is to develop a predictive mortality risk model in patients surviving a first hospitalization for COPD. This is a retrospective cohort study using linked administrative and clinical data. The cohort included 1129 patients of 40-84 years, discharged alive from a hospitalization for COPD in a regional hospital (Sherbrooke, Canada) between 04/2006 and 03/2013 and to whom were prescribed at least two COPD drugs during their hospitalization. One-year mortality was analysed using logistic regression on a derivation sample and validated on a testing sample. In total, 141 (12.5%) patients died within one year from discharge of their first hospitalization for COPD. Predictors were: older age (OR (95% CI): 1.055 (1.026-1.085)), male sex (OR (95% CI): 1.474 (0.921-2.358)), having a severe COPD exacerbation (OR (95% CI): 2.548 (1.571-4.132)), higher hospital length of stay (OR (95% CI): 1.024 (0.996-1.053)), higher Charlson co-morbidity index (OR (95% CI): 1.262 (1.099-1.449)), being diagnosed of cancer (OR (95% CI): 2.928 (1.456-5.885)), the number of prior all-cause hospitalizations (OR (95% CI): 1.323 (1.097-1.595)), and a COPD duration exceeding 3 years (OR (95% CI): 1.710 (1.058-2.763)). A simple clinical prognosis tool is proposed and shows good discrimination in both the derivation and validation cohorts (c-statistic >0.78). One over eight patients discharged alive from a first COPD hospitalization will die the following year. It is thus important to identify higher-risk patients in order to plan and manage appropriate treatment.
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Affiliation(s)
- Alain Vanasse
- a Département de médecine de famille et de médecine d'urgence , Université de Sherbrooke , Sherbrooke , Canada.,b PRIMUS Group, Centre de recherche du CHUS , Université de Sherbrooke , Sherbrooke , Canada
| | - Josiane Courteau
- b PRIMUS Group, Centre de recherche du CHUS , Université de Sherbrooke , Sherbrooke , Canada
| | - Simon Couillard
- c Service de pneumologie du Département de Médecine, Faculté de médecine et des sciences de la santé , Université de Sherbrooke , Sherbrooke , Canada
| | - Marie-France Beauchesne
- d Faculté de Pharmacie , Université de Montréal , Montréal , Canada.,e Département de Pharmacie , Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke , Canada
| | - Pierre Larivée
- c Service de pneumologie du Département de Médecine, Faculté de médecine et des sciences de la santé , Université de Sherbrooke , Sherbrooke , Canada
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48
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Carrier JD, Blais L, Cohen A, Courteau J, Roberge P, Larouche A, Grignon S, Fleury MJ, Lesage A, Demers MF, Roy MA, Delorme A, Vanasse A. Amorcer un traitement antipsychotique en schizophrénie : la situation au Québec de 1998 à 2006. smq 2017. [DOI: 10.7202/1040245ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contexte Cet article vise à décrire les facteurs associés à la prescription d’antipsychotiques par un psychiatre plutôt qu’un omnipraticien, la prescription d’un antipsychotique de seconde plutôt que de première génération, la prescription d’une multithérapie d’antipsychotiques et le non-renouvellement de la prescription initiale.
Méthodologie Il s’agit d’une étude pharmacoépidémiologique observationnelle avec analyses secondaires d’une banque de données médicoadministratives (RAMQ). Les données disponibles portaient sur un échantillon exhaustif des personnes adultes ayant reçu un diagnostic de schizophrénie et ayant obtenu un antipsychotique couvert par le régime public d’assurance médicaments de 1998 à 2006. Les résultats de régression logistique multiple sont rapportés.
Résultats Parmi les 16 225 personnes éligibles, 46,2 % étaient des femmes et 70 % étaient bénéficiaires d’une aide financière. La clientèle des psychiatres était plus jeune et plus atteinte au niveau de la santé mentale. La multithérapie était associée aux hospitalisations pour psychose, au faible statut socio-économique et à un âge entre 35 et 64 ans. Les antipsychotiques de seconde génération ont pris une place importante au cours de la période à l’étude. Le non-renouvellement était associé à l’abus de substances et était moins fréquent suite à une hospitalisation pour trouble mental.
Conclusions Malgré les limites liées à l’utilisation de données administratives, l’utilisation d’une banque de données exhaustive provenant autant de médecine générale que de spécialité permet à cette étude de brosser un portrait populationnel pertinent pour connaître la situation réelle du traitement incident de la schizophrénie au Québec de 1998 à 2006, une période caractérisée par l’introduction des antipsychotiques de seconde génération.
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Affiliation(s)
- Jean-Daniel Carrier
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Québec, Canada
- Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Chaire pharmaceutique AstraZeneca en santé respiratoire, Montréal, Québec, Canada
| | - Alan Cohen
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Pasquale Roberge
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Annie Larouche
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
| | - Sylvain Grignon
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Marie-Josée Fleury
- Université McGill, Montréal, Québec, Canada
- Institut universitaire en santé mentale Douglas, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Québec, Canada
| | | | - Marc-André Roy
- Département de psychiatrie et de neurosciences, Université Laval, Québec, Canada
- Centre de recherche CERVO, Québec, Canada
| | - André Delorme
- Département de psychiatrie, Université de Montréal – Direction de la santé mentale, ministère de la Santé et des Services sociaux du Québec, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
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Hylands M, Godbout MP, Mayer SK, Fraser WD, Vanasse A, Leclair MA, Turgeon AF, Lauzier F, Charbonney E, Trottier V, Razek TS, Roy A, D’Aragon F, Belley-Côté E, Day AG, Le Guillan S, Sabbagh R, Lamontagne F. Vasopressor use following traumatic injury - A single center retrospective study. PLoS One 2017; 12:e0176587. [PMID: 28448605 PMCID: PMC5407798 DOI: 10.1371/journal.pone.0176587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/13/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives Vasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers. Methods We conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included. A systolic blood pressure <90 mmHg, a mean arterial pressure <60 mmHg, the use of vasopressors or ≥2 L of intravenous fluids defined hemodynamic instability. Main outcome measures were use of intravenous fluids and vasopressors prior to surgical or endovascular management. Results Of 111 eligible patients, 63 met our criteria for hemodynamic instability. Of these, 60 (95%) had sustained blunt injury and 22 (35%) had concomitant severe traumatic brain injury. The subgroup of patients referred from a primary or secondary hospital (20 of 63, 32%) had significantly longer transport times (243 vs. 61 min, p<0.01). Vasopressors, used in 26 patients (41%), were independently associated with severe traumatic brain injury (odds ratio 10.2, 95% CI 2.7–38.5). Conclusions In this cohort, most trauma patients had suffered multiple blunt injuries. Patients were likely to receive vasopressors during the early phase of trauma care, particularly if they exhibited signs of neurologic injury. While these results may be context-specific, determining the risk-benefit trade-offs of fluid resuscitation, vasopressors and permissive hypotension in specific patients subgroups constitutes a priority for trauma research going forwards.
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Affiliation(s)
- Mathieu Hylands
- Division of General Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Pier Godbout
- Division of General Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sandeep K. Mayer
- Division of General Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - William D. Fraser
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Alain Vanasse
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marc-André Leclair
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Alexis F. Turgeon
- Department of Anesthesiology and Critical Care, Université Laval, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Québec, Québec, Canada
| | - François Lauzier
- Centre de recherche du Centre hospitalier universitaire de Québec, Québec, Québec, Canada
- Department of Medicine, Université Laval, Québec, Québec, Canada
| | - Emmanuel Charbonney
- Department of Critical Care, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Vincent Trottier
- Centre de recherche du Centre hospitalier universitaire de Québec, Québec, Québec, Canada
- Department of General Surgery, Université Laval, Québec, Québec, Canada
| | - Tarek S. Razek
- Department of General Surgery/Trauma Surgery, MUHC Montreal General Hospital, Montreal, Quebec, Canada
| | - André Roy
- Department of Physiatry, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - Frédérick D’Aragon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Emilie Belley-Côté
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Andrew G. Day
- Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | - Soazig Le Guillan
- Division of Traumatology/General Surgery, Sacré-Coeur Hospital of Montreal, Montreal, Canada
| | - Robert Sabbagh
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Urology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - François Lamontagne
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- * E-mail:
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50
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Carrier JD, Blais L, Cohen A, Courteau J, Roberge P, Larouche A, Grignon S, Fleury MJ, Lesage A, Demers MF, Roy MA, Delorme A, Vanasse A. [Initiating an antipsychotic drug treatment for schizophrenia: the situation in Quebec, Canada, from 1998 to 2006]. Sante Ment Que 2017; 42:85-103. [PMID: 28792563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectives To describe factors associated with the following characteristics of the first prescription of an antipsychotic drug treatment (ADT): 1) prescribing physician type (psychiatrist vs. general practitioner); 2) second-generation vs. first-generation antipsychotic drug; 3) in conjunction with at least one additional antipsychotic drug (multitherapy); 4) never renewed by the patient.Methods This is a pharmacoepidemiologic study using administrative data from the Régie de l'assurance maladie du Québec (RAMQ), the public healthcare insurer in Quebec, Canada. Available data sample was exhaustive for adults with a diagnosis of schizophrenia who received an ADT under RAMQ drug coverage from 1998 to 2006. We report multiple logistic regression results.Results Among 16,225 patients who met inclusion criteria 46.2% were women and 70% were beneficiaries of governmental financial assistance. Patients who had their ADT prescribed by psychiatrists tended to be younger and were more burdened by their mental illness. Multitherapy was associated with hospitalization with a psychotic disorder as main diagnosis, lower socioeconomic status, and age between 35 and 64. Second-generation antipsychotic use became progressively more prominent during the period under study. Antipsychotic non renewal was correlated with substance use disorders and was less likely to happen following hospitalization with a psychiatric main diagnosis. Conclusions Although this study is subject to the intrinsic limitations of secondary analysis of administrative data, the database available for study was exhaustive within the Quebec healthcare system and included data from both general practice and specialized care, which allowed us to draw a relevant picture of how ADT were initiated for schizophrenia in Quebec, Canada, from 1998 to 2006. This timeframe is especially relevant since the 1990s were marked by the introduction of second-generation antipsychotics in Canada.
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Affiliation(s)
- Jean-Daniel Carrier
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada ; Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Québec, Canada ; Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Québec, Canada ; Chaire pharmaceutique AstraZeneca en santé respiratoire, Montréal, Québec, Canada
| | - Alan Cohen
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada ; Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada ; Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
| | - Pasquale Roberge
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada ; Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
| | - Annie Larouche
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada
| | - Sylvain Grignon
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Marie-Josée Fleury
- Université McGill, Montréal, Québec, Canada ; Institut universitaire en santé mentale Douglas, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
| | | | - Marc-André Roy
- Département de psychiatrie et de neurosciences, Université Laval, Québec, Canada ; Centre de recherche CERVO, Québec, Canada
| | - André Delorme
- Département de psychiatrie, Université de Montréal - Direction de la santé mentale, ministère de la Santé et des Services sociaux du Québec, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada ; Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada
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