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Gagné M, Têtu I, Grégoire JP, Moisan J. Adherence and sustained virologic response among vulnerable people initiating an hepatitis C treatment at a nurse-led clinic: A non-experimental prospective cohort study based on clinical records. International Journal of Nursing Studies Advances 2021. [DOI: 10.1016/j.ijnsa.2021.100029] [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: 01/18/2023] Open
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Lauzier S, Guillaumie L, Humphries B, Grégoire JP, Moisan J, Villeneuve D. Reprint of: Psychosocial factors associated with pharmacists' antidepressant drug treatment monitoring. J Am Pharm Assoc (2003) 2020; 60:S34-S43. [PMID: 32977929 DOI: 10.1016/j.japh.2020.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients undergoing antidepressant drug treatment (ADT) may face challenges regarding its adverse effects, adherence, and efficacy. Community pharmacists are well positioned to manage ADT-related problems. Little is known about the factors influencing pharmacists' ADT monitoring. This study aimed to identify the psychosocial factors associated with pharmacists' intention to perform systematic ADT monitoring and report on this monitoring. DESIGN Cross-sectional study based on the Theory of Planned Behavior (TPB). SETTING AND PARTICIPANTS Community pharmacists in the province of Quebec, Canada. OUTCOME MEASURES Pharmacists completed a questionnaire on their performance of ADT monitoring, TPB constructs (intention; attitude; subjective norm; perceived behavioral control; and attitudinal, normative, and control beliefs), and professional identity. Systematic ADT monitoring was defined as pharmacists' reporting 4 or more consultations with each patient during the first year of ADT to address adverse effects, adherence, and efficacy. Hierarchical linear regression models were used to identify the factors associated with the intention and reporting of systematic ADT monitoring and Poisson working models to identify the beliefs associated with intention. RESULTS A total of 1609 pharmacists completed the questionnaire (participation = 29.6%). Systematic ADT monitoring was not widely reported (mean score = 2.0 out of 5.0), and intention was moderate (mean = 3.2). Pharmacists' intention was the sole psychosocial factor associated with reporting systematic ADT monitoring (P < 0.0001; R2 = 0.370). All TPB constructs and professional identity were associated with intention (P < 0.0001; R2 = 0.611). Perceived behavioral control had the strongest association. CONCLUSION Interventions to promote systematic ADT monitoring should focus on developing a strong intention among pharmacists, which could, in turn, influence their practice. To influence intention, priority should be given to ensuring that pharmacists feel capable of performing this monitoring. The main barriers to overcome were the presence of only 1 pharmacist at work and limited time. Other factors identified offer complementary intervention targets.
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Lauzier S, Guillaumie L, Humphries B, Grégoire JP, Moisan J, Villeneuve D. Psychosocial factors associated with pharmacists' antidepressant drug treatment monitoring. J Am Pharm Assoc (2003) 2020; 60:548-558. [PMID: 32173335 DOI: 10.1016/j.japh.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patients undergoing antidepressant drug treatment (ADT) may face challenges regarding its adverse effects, adherence, and efficacy. Community pharmacists are well positioned to manage ADT-related problems. Little is known about the factors influencing pharmacists' ADT monitoring. This study aimed to identify the psychosocial factors associated with pharmacists' intention to perform systematic ADT monitoring and report on this monitoring. DESIGN Cross-sectional study based on the Theory of Planned Behavior (TPB). SETTING AND PARTICIPANTS Community pharmacists in the province of Quebec, Canada. OUTCOME MEASURES Pharmacists completed a questionnaire on their performance of ADT monitoring, TPB constructs (intention; attitude; subjective norm; perceived behavioral control; and attitudinal, normative, and control beliefs), and professional identity. Systematic ADT monitoring was defined as pharmacists' reporting 4 or more consultations with each patient during the first year of ADT to address adverse effects, adherence, and efficacy. Hierarchical linear regression models were used to identify the factors associated with the intention and reporting of systematic ADT monitoring and Poisson working models to identify the beliefs associated with intention. RESULTS A total of 1609 pharmacists completed the questionnaire (participation = 29.6%). Systematic ADT monitoring was not widely reported (mean score = 2.0 out of 5.0), and intention was moderate (mean = 3.2). Pharmacists' intention was the sole psychosocial factor associated with reporting systematic ADT monitoring (P < 0.0001; R2 = 0.370). All TPB constructs and professional identity were associated with intention (P < 0.0001; R2 = 0.611). Perceived behavioral control had the strongest association. CONCLUSION Interventions to promote systematic ADT monitoring should focus on developing a strong intention among pharmacists, which could, in turn, influence their practice. To influence intention, priority should be given to ensuring that pharmacists feel capable of performing this monitoring. The main barriers to overcome were the presence of only 1 pharmacist at work and limited time. Other factors identified offer complementary intervention targets.
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Mama Djima M, Ekouevi DK, Gregoire JP, Tchounga B, Coffie PA, Tran VT, Touré FY, Moisan J. Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d'Ivoire, West Africa: A cross-sectional study. PLoS One 2019; 14:e0221335. [PMID: 31525222 PMCID: PMC6746366 DOI: 10.1371/journal.pone.0221335] [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: 11/04/2018] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background In Côte d’Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d’Ivoire. Methods A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. Results A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. Conclusion Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.
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Affiliation(s)
- Mariam Mama Djima
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Institut Pasteur de Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- * E-mail:
| | - Didier Koumavi Ekouevi
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm U 1219, ISPED, Université Victor Segalen, Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Jean-Pierre Gregoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| | | | | | | | | | - Jocelyne Moisan
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
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Grégoire JP, Poirier P, Perez N, Demers E, Moisan J. TREATMENT COMPLETION AND IMPLEMENTATION BY PATIENTS INITIATING TICAGRELOR. J Popul Ther Clin Pharmacol 2019; 26:e56-e67. [PMID: 32722910 DOI: 10.22374/1710-6222.26.1.5] [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: 06/19/2018] [Accepted: 03/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In secondary prevention of adverse events and death following acute coronary syndrome, patients may benefit from adhering to a ticagrelor treatment. OBJECTIVES The authors assessed the proportion of new ticagrelor users who completed 12 months of treatment, explored the factors associated with treatment completion and, among the completers, evaluated the 12-month treatment implementation. METHODS A retrospective administrative health database inception cohort study was conducted in a population that included Quebec residents ≥18 years of age who initiated ticagrelor between January 1, 2012 and March 31, 2014. A patient still on ticagrelor at the end of the 12-month period after treatment initiation was considered to have completed the treatment. Factors associated with treatment completion were identified using log-binomial regression. Implementation was assessed using the proportion of days covered (PDC). RESULTS Of the 3,600 patients, 2,235 (62.1%) completed 12 months of treatment. The patients who were more likely to complete their treatment included those who had visited a general practitioner, had a percutaneous coronary intervention, used a statin or fibrate, and those who used an antihypertensive drug during the year preceding the ticagrelor treatment initiation. Older patients, those with atrial fibrillation, those who had ≥ 6 physician visits and those who used an anticoagulant were less likely to complete the 12-month treatment. The median PDC was 96.2%. CONCLUSION Treatment completion might be improved. Among patients who completed the treatment, implementation was high. The factors associated with completion could help to identify patients who might benefit from interventions that aim to optimize treatment completion.
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Affiliation(s)
- Jean-Pierre Grégoire
- Laval University Faculty of Pharmacy.,Population Health and Optimal Health Practices Unit, CHU de Qebec-Université Laval Research Center.
| | - Paul Poirier
- Laval University Faculty of Pharmacy.,Quebec Cardiology and Respiratory University Institute
| | - Norma Perez
- CHU de Quebec-Université Laval Research Center, Population Health and Optimal Health Practices Unit
| | - Eric Demers
- CHU de Quebec-Université Laval Research Center, Population Health and Optimal Health Practices Unit
| | - Jocelyne Moisan
- Laval University Faculty of Pharmacy.,Population Health and Optimal Health Practices Unit, CHU de Qebec-Université Laval Research Center
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Vignon Zomahoun HT, de Bruin M, Guillaumie L, Moisan J, Grégoire JP, Guénette L, Pérez N, Vézina-Im LA. Response to letter to the editor related to the retraction of a trial included in a meta-analysis of interventions to enhance oral medication adherence titled "Effectiveness and content analysis of interventions to enhance oral antidiabetic drug adherence in adults with type 2 diabetes: Systematic review and meta-analysis". Value Health 2019; 22:264-266. [PMID: 30711074 DOI: 10.1016/j.jval.2018.07.003] [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] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Quebec SPOR-SUPPORT Unit, Montreal, Centre de recherche sur les soins et les services de première ligne-Université Laval, Quebec City, Quebec, Canada
| | - Marijn de Bruin
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | | | - Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Norma Pérez
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Lydi-Anne Vézina-Im
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
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Gagné M, Boulet LP, Pérez N, Moisan J. Adherence stages measured by patient-reported outcome instruments in adults with asthma: a scoping review. J Asthma 2019; 57:179-187. [PMID: 30663908 DOI: 10.1080/02770903.2019.1565823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Individuals who are adherent to their asthma inhaled maintenance medication: (1) initiate their treatment (take the first dose); (2) implement it (take it as per prescribed dosing regimen); and persist with it (take it for the entire prescribing period). To avoid unnecessary hospitalizations and costs, patient adherence should be routinely assessed. To this end, we aimed to identify patient-reported outcome instruments (PROs) used for measurement of patient adherence to inhaled maintenance medication in asthmatic adults and to report on the adherence stage that these instruments measured. Data sources: We conducted a scoping review of six databases. Study selection: We searched for studies in which PROs were used to measure patient adherence to inhaled maintenance medication in asthmatic participants aged ≥18 years. We extracted and synthesized data in order to list the available PROs and to report the adherence stages that these instruments measured. Results: We included 186 studies (87 PROs). Among all 87 instruments, none were found to measure all three adherence stages. We found that 1 measured initiation, 2 evaluated initiation and implementation, 74 assessed implementation, 7 measured implementation and persistence. The most used instrument (n = 41 studies or 22%) was the Self-Reported Medication-Taking Scale, which was found to assess implementation only. Conclusion: Our results suggest that no single PRO exists to measure initiation, implementation and persistence with asthma inhaled maintenance medication. Results from this review could therefore guide the development or refinement of PROs that would aim to measure all three adherence stages.
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Affiliation(s)
- Myriam Gagné
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, Quebec, Canada.,Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Louis-Philippe Boulet
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, Quebec, Canada.,Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.,Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Norma Pérez
- CHU de Quebec - Laval University Research Center, Population Health and Optimal Health Practices Research Unit, Quebec City, Quebec, Canada
| | - Jocelyne Moisan
- CHU de Quebec - Laval University Research Center, Population Health and Optimal Health Practices Research Unit, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
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Gregoire JP, Poirier P, Pérez N, Demers É, Moisan J. Appropriateness of Ticagrelor Use at Initiation: A Population-Based Cohort Study. J Pharm Pharm Sci 2018; 21:409-412. [PMID: 30384882 DOI: 10.18433/jpps29913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Ticagrelor is recommended following an acute coronary syndrome if used appropriately. Its use has not yet been well described in the context of ambulatory clinical practice. The objective of this study was to assess the proportion of ticagrelor new users who initiated this medication appropriately and explore associated factors. METHODS A retrospective population-based inception cohort study was conducted using Quebec administrative databases. The study population included all Quebec residents aged ≥18 years who had a first ticagrelor prescription claim between 1 January, 2012, and 31 March, 2015, and had been continuously eligible in the Quebec public drug plan during the 365 days preceding the first ticagrelor claim. The initial ticagrelor prescription was considered appropriate if:1) it met the indication for use criterion, 2) the prescribed daily dose was 90 mg twice a day, and 3) there was a concomitant use of acetylsalicylic acid (ASA) 80-81 mg daily. Factors potentially associated with the ticagrelor appropriateness of use were included in a logistic log-binomial regression model. RESULTS A total of 7,073 patients were included in the study, 6,013 (85.0%) had an appropriate indication, 6,895 (97.5%) were prescribed ticagrelor 90 mg twice a day, and 6,385 (90.3%) had a concomitant prescription of ASA. A total of 5,371 (75.9%) patients were prescribed ticagrelor in accordance with all criteria. Twelve factors were associated with prescription appropriateness. CONCLUSIONS A large majority of patients initiated ticagrelor appropriately. Further improvement in appropriateness may come at targeting indication for use.
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Affiliation(s)
- Jean-Pierre Gregoire
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada. Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, 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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Zongo A, Grégoire JP, Moisan J, Guénette L. Measuring adherence to oral antidiabetic multi-drug treatment: Comparative validity of prescription claims-based adherence measures against hospitalization. Res Social Adm Pharm 2018; 15:738-743. [PMID: 30253976 DOI: 10.1016/j.sapharm.2018.09.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of prescription claims data to measure adherence to diabetes treatment is very common in research. However, there is no clear evidence regarding the accuracy of the methods used to assess adherence to multi-drug treatments for the many patients using multiple antidiabetic drugs. PURPOSE To assess the validity of prescription claims-based adherence measures in the context of multiple oral antidiabetic drug treatment. METHODS A cohort of patients who began their antidiabetic drug treatment with at least two oral antidiabetic drugs (new users) was created using Quebec medico-administrative data. Four different prescription claims-based adherence measures were assessed: proportion of days covered (PDC) by at least one class of drugs, mean PDC, PDC by all classes and daily polypharmacy possession ratio (DPPR). All-cause and diabetes-related hospitalizations were the validation criteria. To assess the validity of the measures, receiver operating characteristic (ROC) curves were plotted for each measure and each criterion. RESULTS A total of 5982 individuals were included. The areas under the ROC curves for the PDC by at least one class of drugs, the mean PDC, the PDC by all classes of drugs and the DPPR were respectively 0.54 (95% CI: 0.52-0.56), 0.51 (0.49-0.53), 0.50 (0.48-0.52) and 0.51 (0.49-0.53) with all-cause hospitalization as criterion and 0.55 (0.53-0.57), 0.53 (0.51-0.55), 0.51 (0.49-0.53) and 0.53 (0.51-0.55) using diabetes-related hospitalization as criterion. CONCLUSIONS The results suggest that all measures have poor validity in predicting hospitalizations thus raising concerns about their utility in the assessment of adherence to multi-drug treatment. Future research should assess the capacity of these measures to predict other outcomes more closely related to medication adherence.
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Affiliation(s)
- Arsène Zongo
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada.
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Gagné M, Boulet L, Pérez N, Moisan J. Patient-reported outcome instruments that evaluate adherence behaviours in adults with asthma: a systematic review of measurement properties. Br J Clin Pharmacol 2018; 84:1928-1940. [PMID: 29710423 PMCID: PMC6089817 DOI: 10.1111/bcp.13623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/29/2018] [Accepted: 04/23/2018] [Indexed: 11/27/2022] Open
Abstract
AIM The aim of the present study was to identify systematically the measurement properties of patient-reported outcome instruments (PROs) that evaluate adherence to inhaled maintenance medication in adults with asthma. METHODS We conducted a systematic review of six databases. Two reviewers independently included studies on the measurement properties of PROs that evaluated adherence in asthmatic participants aged ≥18 years. Based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), the reviewers: (i) extracted data on internal consistency, reliability, measurement error, content validity, structural validity, hypotheses testing, cross-cultural validity, criterion validity and responsiveness; (ii) assessed the methodological quality of the included studies; (iii) assessed the quality of the measurement properties (positive or negative); and (iv) summarized the level of evidence (limited, moderate or strong). RESULTS We screened 6068 records and included 15 studies (14 PROs). No studies evaluated measurement error or responsiveness. Based on methodological and measurement property quality assessments, we found limited positive evidence of: (i) internal consistency of the Adherence Questionnaire, Refined Medication Adherence Reason (MAR) scale, Medication Adherence Report Scale for Asthma (MARS-A) and Test of the Adherence to Inhalers (TAI); (ii) reliability of the TAI; and (iii) structural validity of the adherence questionnaire, MAR scale, MARS-A and TAI. We also found limited negative evidence of: (i) hypotheses testing of the Adherence Questionnaire; (ii) reliability of the MARS-A; and (iii) criterion validity of the MARS-A and TAI. CONCLUSIONS Our results highlighted the need to conduct further high-quality studies to evaluate the reliability, validity and responsiveness of the available PROs.
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Affiliation(s)
- Myriam Gagné
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular HealthLaval UniversityQuebec CityQCCanada
- Quebec Heart and Lung Institute–Laval UniversityQuebec CityQCCanada
| | - Louis‐Philippe Boulet
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular HealthLaval UniversityQuebec CityQCCanada
- Quebec Heart and Lung Institute–Laval UniversityQuebec CityQCCanada
- Faculty of MedicineLaval UniversityQuebec CityQCCanada
| | - Norma Pérez
- CHU de Quebec–Laval University Research Center, Population Health and Optimal Health Practices Research UnitQuebec CityQCCanada
| | - Jocelyne Moisan
- CHU de Quebec–Laval University Research Center, Population Health and Optimal Health Practices Research UnitQuebec CityQCCanada
- Faculty of PharmacyLaval UniversityQuebec CityQCCanada
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Tran VT, Mama Djima M, Messou E, Moisan J, Grégoire JP, Ekouevi DK. Avoidable workload of care for patients living with HIV infection in Abidjan, Côte d'Ivoire: A cross-sectional study. PLoS One 2018; 13:e0202911. [PMID: 30142165 PMCID: PMC6108500 DOI: 10.1371/journal.pone.0202911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/26/2018] [Accepted: 08/10/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE People living with HIV infection (PLWHIV) in Sub-Saharan Africa cope with an increasing workload of care (doctor visits, lab tests, medication management, refills, etc.) in a context of poor health service organization. We aimed to describe the workload of care for PLWHIV in Sub-Saharan Africa and assess to what extent simple adjustments in care organization could reduce this workload of care. METHODS Adult PLWHIV under antiretroviral treatment for at least 1 year were recruited in three centers (two public, one private) in Abidjan, Côte d'Ivoire. Using methods inspired from sociology, we precisely described all health-related activities (HRAs) performed by patients, in 1 month, in terms of time, money and opportunity costs. Then, we assessed the theoretical avoidable workload of care if patients' visits and tests had been grouped on the same days. RESULTS We enrolled 476 PLWHIV in the study. Patients devoted 6.7 hours (SD = 6.3), on average, in HRAs per month and spent 5% (SD = 11) of their monthly revenue, on average, on health activities. However, we found great inter-patient heterogeneity in the mixture of activities performed (managing medications; dietary recommendations; visits, tests, support groups; administrative tasks; etc.) and their time allocation, temporal dispersion and opportunity costs (personal, familial, social or professional costs). For 22% of patients, grouping activities on the same days could reduce both time and cost requirements by 20%. CONCLUSION PLWHIV in Côte d'Ivoire have a heavy workload of care. Grouping visits and tests on the same days may be a simple and feasible way to reduce patients' investment of time and money in their care.
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Affiliation(s)
- Viet-Thi Tran
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- METHODS Team, Centre de recherche en Epidémiologie et Statistiques Sorbonne Paris Cité (CRESS, UMR1153), Paris, France
- * E-mail:
| | - Mariam Mama Djima
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- Institut Pasteur, Abidjan, Côte d’Ivoire
- Faculty of Pharmacy of Laval University, Québec, Canada
| | | | | | | | - Didier K. Ekouevi
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- Bordeaux Population Health (UMR1219), Bordeaux, France
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13
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Gagné M, Moisan J, Lauzier S, Hamel C, Côté P, Bourbeau J, Boulet LP. Comparative impact of two continuing education activities targeted at COPD educators on educational outcomes: protocol for a non-randomized controlled study using mixed methods. BMC Health Serv Res 2018; 18:460. [PMID: 29914484 PMCID: PMC6006567 DOI: 10.1186/s12913-018-3284-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
Background Therapeutic patient education (TPE) improves quality of life and reduces health care utilization among patients with chronic obstructive pulmonary disease (COPD). However, benefits from TPE might depend on the performance of the educators and training is needed to ensure the effective delivery of TPE interventions. Based on the framework by Moore et al. (J Contin Educ Health Prof 29:1-15, 2009), we will compare the impact of two continuing education (CE) activities on TPE in regard to the following educational outcomes: (1) learning, (2) self-report of competence, (3) performance of the educators, and (4) outcomes of COPD patients who will meet the newly trained educators for TPE. Methods We will conduct a non-randomized controlled study using mixed methods. Educators will first participate in a CE activity on TPE that will include a role-playing simulation (experimental group) or in a lecture on TPE (comparison group) and then will perform TPE in COPD patients. Among educators, we will assess: (1) learning, by measuring knowledge about TPE, and (2) self-report of competence using self-administered questionnaires before and after the activity. Then, after the CE activity, we will assess (3) educators’ performance levels in delivering TPE by rating a videotaped TPE intervention. In COPD patients who will meet the newly trained educators for TPE after either CE activity, we will assess (4) quality of life and resource utilization using interviewer-administered questionnaires, before and after TPE. Statistical analyses will compare the experimental group against the comparison group using multivariate models. Using a semi-structured interview guide, we will conduct interviews with educators and perform content analysis. Results will be integrated in order that qualitative results further explain the quantitative ones. Discussion To the best of our knowledge, this is the first controlled mixed methods study to compare the impact of two CE activities on TPE in regard to four educational outcomes. We believe this study will serve as a model for evaluating CE activities on TPE. Results from this study could increase educators’ performance levels in delivering effective TPE interventions, and, in turn, COPD patient outcomes. Trial registration The study was registered on https://clinicaltrials.gov/ (NCT02870998) on March 15, 2016. Electronic supplementary material The online version of this article (10.1186/s12913-018-3284-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Myriam Gagné
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada.,Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Population Health and Optimal Health Practices Research Unit, CHU de Quebec Research Center, Quebec City, QC, Canada.,Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
| | - Sophie Lauzier
- Population Health and Optimal Health Practices Research Unit, CHU de Quebec Research Center, Quebec City, QC, Canada.,Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
| | - Christine Hamel
- Faculty of Education, Laval University, Quebec City, QC, Canada
| | - Patricia Côté
- Quebec Respiratory Health Education Network, Quebec City, QC, Canada
| | - Jean Bourbeau
- Quebec Respiratory Health Education Network, Quebec City, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Louis-Philippe Boulet
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada. .,Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada. .,Quebec Respiratory Health Education Network, Quebec City, QC, Canada. .,Faculty of Medicine, Laval University, Quebec City, QC, Canada.
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14
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Santina T, Lauzier S, Gagnon H, Villeneuve D, Moisan J, Grégoire JP, Guillaumie L. The Development of a Community Pharmacy-Based Intervention to Optimize Patients' Use of and Experience with Antidepressants: A Step-by-Step Demonstration of the Intervention Mapping Process. Pharmacy (Basel) 2018; 6:pharmacy6020039. [PMID: 30720782 PMCID: PMC6025435 DOI: 10.3390/pharmacy6020039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: To describe the development of a community pharmacy-based intervention aimed at optimizing experience and use of antidepressants (ADs) for patients with mood and anxiety disorders. Methods: Intervention Mapping (IM) was used for conducting needs assessment, formulating intervention objectives, selecting change methods and practical applications, designing the intervention, and planning intervention implementation. IM is based on a qualitative participatory approach and each step of the intervention development process was conducted through consultations with a pharmacists' committee. Results: A needs assessment was informed by qualitative and quantitative studies conducted with leaders, pharmacists, and patients. Intervention objectives and change methods were selected to target factors influencing patients' experience with and use of ADs. The intervention includes four brief consultations between the pharmacist and the patient: (1) provision of information (first AD claim); (2) management of side effects (15 days after first claim); (3) monitoring treatment efficacy (30-day renewal); (4) assessment of treatment persistence (2-month renewal, repeated every 6 months). A detailed implementation plan was also developed. Conclusion: IM provided a systematic and rigorous approach to the development of an intervention directly tied to empirical data on patients' and pharmacists' experiences and recommendations. The thorough description of this intervention may facilitate the development of new pharmacy-based interventions or the adaptation of this intervention to other illnesses and settings.
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Affiliation(s)
- Tania Santina
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Sophie Lauzier
- Faculty of Pharmacy and Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | | | | | - Jocelyne Moisan
- Faculty of Pharmacy and Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy and Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Laurence Guillaumie
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada.
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15
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Zomahoun HTV, Guénette L, Grégoire JP, Lauzier S, Lawani AM, Ferdynus C, Huiart L, Moisan J. Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. Int J Epidemiol 2018; 46:589-602. [PMID: 27864410 DOI: 10.1093/ije/dyw273] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 11/14/2022] Open
Abstract
Background Medication adherence is frequently suboptimal in adults with chronic diseases, resulting in negative consequences. Motivational interviewing (MI) is a collaborative conversational style for strengthening a person's motivation and commitment to change. We aimed to assess whether MI interventions are effective to enhance medication adherence in adults with chronic diseases and to explore the effect of individual MI intervention characteristics. Methods We searched electronic databases and reference lists of relevant articles to find randomized controlled trials (RCTs) that assessed MI intervention effectiveness on medication adherence in adults with chronic diseases. A random-effects model was used to estimate a pooled MI intervention effect size and its heterogeneity (I 2 ). We also explored the effects of individual MI characteristics on MI intervention effect size using a meta-regression with linear mixed model. Results : Nineteen RCTs were identified, and 16 were included in the meta-analysis. The pooled MI intervention effect size was 0.12 [95% confidence interval (CI) = (0.05, 0.20), I 2 = 1%]. Interventions that were based on MI only [β = 0.183, 95% CI = (0.004, 0.362)] or those in which interventionists were coached during intervention implementation [β = 0.465, 95% CI = (0.028, 0.902)] were the most effective. MI interventions that were delivered solely face to face were more effective than those that were delivered solely by phone [β = 0.270, 95% CI = (0.041, 0.498)]. Conclusions This synthesis of RCTs suggests that MI interventions might be effective at enhancing of medication adherence in adults treated for chronic diseases. Further research is however warranted, as the observed intervention effect size was small.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Laval University Faculty of Pharmacy, Québec, QC, Canada.,Research Unit, Laval University Chair on Adherence to Treatments.,Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - Line Guénette
- Laval University Faculty of Pharmacy, Québec, QC, Canada.,Research Unit, Laval University Chair on Adherence to Treatments.,Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Laval University Faculty of Pharmacy, Québec, QC, Canada.,Research Unit, Laval University Chair on Adherence to Treatments.,Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - Sophie Lauzier
- Laval University Faculty of Pharmacy, Québec, QC, Canada.,Research Unit, Laval University Chair on Adherence to Treatments.,Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | | | - Cyril Ferdynus
- CHU La Réunion, Unité de Soutien Méthodologique, F-97400, Saint-Denis, La Réunion, France and.,INSERM, CIC 1410, F-97410, Saint Pierre, La Réunion, France
| | - Laetitia Huiart
- CHU La Réunion, Unité de Soutien Méthodologique, F-97400, Saint-Denis, La Réunion, France and.,INSERM, CIC 1410, F-97410, Saint Pierre, La Réunion, France
| | - Jocelyne Moisan
- Laval University Faculty of Pharmacy, Québec, QC, Canada.,Research Unit, Laval University Chair on Adherence to Treatments.,Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Québec, QC, Canada
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16
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Guillaumie L, Ndayizigiye A, Beaucage C, Moisan J, Grégoire JP, Villeneuve D, Lauzier S. Patient perspectives on the role of community pharmacists for antidepressant treatment: A qualitative study. Can Pharm J (Ott) 2018. [PMID: 29531632 DOI: 10.1177/1715163518755814] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Patients prescribed antidepressant drug treatment (ADT) for major depression report several needs in relation to their treatment, and a large proportion of these patients will end ADT prematurely. Community pharmacists may play an important role in monitoring ADT and supporting these patients. However, little is known about patient experiences of the services provided in community pharmacies. The objectives of this study were to 1) explore patients' experiences with the services community pharmacists provide for ADT and 2) identify potential avenues for improvement of pharmacists' services within the context of ADT. Methods A qualitative descriptive exploratory study was conducted among individuals diagnosed with major depression who had initiated ADT at some point in the 12 months prior to their participation in the study. A total of 14 persons recruited in a local health centre and a community-based organization participated in individual interviews. A thematic analysis of the interview transcripts was conducted. Results Pharmacists tend to concentrate their involvement in treatment at initiation and at the first refill when questions, uncertainties and side effects are major issues. Patients felt that the pharmacists' contributions consisted of providing information and reassurance; in these respects, their needs were met. Participants had few ideas as to what additional services pharmacists could implement to improve patients' experience with ADT. Patients' sole expectations were that pharmacists extend this information role to the whole length of the treatment and enhance the confidentiality of discussions in pharmacy. Conclusion Pharmacists should provide counselling throughout the entire treatment rather than passively waiting for patients to ask their questions. However, facilitation of open discussions may not be achieved unless confidentiality at pharmacies is secured.
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Affiliation(s)
- Laurence Guillaumie
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Alice Ndayizigiye
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Clément Beaucage
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Jocelyne Moisan
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Jean-Pierre Grégoire
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Denis Villeneuve
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Sophie Lauzier
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
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17
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Kayibanda JF, Girouard C, Grégoire JP, Demers E, Moisan J. Adherence to the evidence-based heart failure drug treatment: Are there sex-specific differences among new users? Res Social Adm Pharm 2017; 14:915-920. [PMID: 29089274 DOI: 10.1016/j.sapharm.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/04/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The evidence-based heart failure (HF) drug treatment is made of a β-blocker and an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker, or hydralazine + isosorbide dinitrate. Little is known about sex-based difference in adherence to the evidence-based HF drug treatment. OBJECTIVES To assess among new users of the evidence-based HF drug treatment, the association between sex and 1) persistence with the treatment 1 year after its initiation, 2) implementation of the treatment among those who persisted, and 3) overall adherence to treatment in the year following its initiation. METHODS A cohort study was conducted among new users of this treatment using Quebec medico-administrative data. Patients still on the evidence-based HF drug treatment one year after initiation were considered persistent. Among persistent users, those with ≥88% of days covered by the treatment were deemed to have adequately implemented it. Persistent patients who have adequately implemented the treatment were considered adherent. To measure the association between, on one hand sex, and on the other persistence, implementation and adherence, adjusted proportion ratios (APR) with their 95% confidence intervals (CI) were calculated. RESULTS Among 13,453 women, 72.1% were persistent, 72.2% adequately implemented the treatment, and 52.8% were adherent. Among the 14,614 men, these proportions were 73.6%, 67.9% and 50.1%, respectively. Men were less likely than women to be adherent to their treatment (APR: 0.96, 95% CI: 0.94-0.99). CONCLUSION Among individuals initiating an evidence-based multi-drug treatment for HF, men are less likely than women to be adherent to this treatment.
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Affiliation(s)
- J F Kayibanda
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.
| | - C Girouard
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - J-P Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - E Demers
- Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - J Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
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18
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. The impact of incident depression on medication adherence in patients with type 2 diabetes. Diabetes Metab 2017; 43:521-528. [PMID: 28822618 DOI: 10.1016/j.diabet.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/09/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression has been correlated with suboptimal adherence to antidiabetic drugs (ADs). Most studies on this topic were cross-sectional; thus, the directionality of this relationship could not be established. The objective of this study was to measure the association between incident depression and AD nonadherence among newly treated patients with diabetes. METHODS We performed a population-based cohort study among new AD users using the Quebec public health insurance data. To avoid immortal time bias, we carried out depression diagnosis-time distribution matching by assigning a date of depression diagnosis to individuals without depression. Nonadherence (i.e.,<90% of days covered by≥1 AD) during the year following depression diagnosis (real or assigned date) was the outcome. Multivariate logistic regression analyses that adjusted for baseline adherence and other confounders were used to estimate the adjusted effect of depression on AD nonadherence. RESULTS Between 2000 and 2006, we identified 3,106 new AD users with a subsequent diagnosis of depression and 70,633 without depression, of which 52% and 49% became non-adherent to AD treatment, respectively. Among patients with depression, 52.0% were considered AD non-adherent in the year after depression diagnosis compared with 49.0% of matched patients without depression. Depression was associated with AD nonadherence after accounting for baseline adherence and other confounders with an adjusted odds ratio of 1.24 (95% confidence interval: 1.13-1.37). CONCLUSIONS The results suggest that depression is an independent risk factor for AD nonadherence. Patients with type 2 diabetes and depression might benefit from adherence-enhancing interventions.
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Affiliation(s)
- C Lunghi
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - A Zongo
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - J Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - J-P Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - L Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada.
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. Factors associated with antidiabetic medication non-adherence in patients with incident comorbid depression. J Diabetes Complications 2017; 31:1200-1206. [PMID: 28325698 DOI: 10.1016/j.jdiacomp.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
AIM To identify factors associated with antidiabetic drug (AD) non-adherence among patients with type 2 diabetes and depression. STUDY DESIGN AND SETTINGS We conducted a population-based retrospective cohort study among new AD users with a diagnosis of depression following AD initiation. We used public health insurance data from Quebec. The dependent variable was non-adherence (i.e., <90% of days covered by ≥1AD) in the year after a depression diagnosis. Different sociodemographic, clinical and medication-related variables were assessed as potential factors of non-adherence to AD treatment. We performed univariate and multivariate logistic regressions. RESULTS We identified 3106 new users of ADs with a diagnosis of depression between 2000 and 2006. Of these individuals, 52% were considered non-adherent to their ADs. Baseline non-adherence, younger age, the addition of another AD to the initial treatment, <4 drug claims, visits with several different physicians, high socioeconomic status, and a small number of diabetes complications were associated with AD non-adherence. CONCLUSIONS The factors identified in the present study may help clinicians recognize patients with type 2 diabetes and incident depression at increased risk for non-adherence. In these patients, close follow-up and targeted interventions could help improve adherence to AD treatment, improve glycemic control and reduce complications.
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Affiliation(s)
- Carlotta Lunghi
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada.
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Lunghi C, Moisan J, Grégoire JP, Guénette L. The Association between Depression and Medication Nonpersistence in New Users of Antidiabetic Drugs. Value Health 2017; 20:728-735. [PMID: 28577689 DOI: 10.1016/j.jval.2016.09.2399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 03/18/2016] [Revised: 07/25/2016] [Accepted: 09/10/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the association between depression and nonpersistence with antidiabetic drugs (ADs) among new users of oral ADs and to estimate factors associated with nonpersistence among these new users with depression. METHODS We used administrative claims data to identify an adult cohort (≥18 years) of new oral AD users who were free of depression. We followed the patients from AD initiation until either discontinuation, ineligibility for the public drug plan, death, or the end of the study. A proportional hazard Cox regression model with depression as a time-dependent variable was used to compute the adjusted hazard ratio of nonpersistence. A proportional hazard Cox regression model was also used to identify factors associated with nonpersistence in the subcohort of patients with depression. RESULTS We identified 114,366 new oral AD users, of whom 4,808 were diagnosed with depression during the follow-up. A greater proportion (55.4%) of patients with depression (vs. 42.5% without depression) discontinued their treatment during the follow-up. The adjusted hazard ratio of nonpersistence with ADs was 1.52 (95% confidence interval 1.41-1.63). Among patients with depression, independent factors associated with nonpersistence included younger age at oral AD initiation (<45 years) and starting treatment with drugs other than metformin (especially polytherapy with insulin). CONCLUSIONS Patients with depression are more likely to discontinue their treatment. Health care professionals should pay attention to patients on AD therapy who also suffer from depression, especially if the patients are young or are using insulin because these patients are at an increased risk of nonpersistence.
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Affiliation(s)
- Carlotta Lunghi
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada.
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Adouni Lawani M, Zongo F, Breton MC, Moisan J, Grégoire JP, Dorval E, Boulet LP, Jobin MS, Guénette L. Factors associated with adherence to asthma treatment with inhaled corticosteroids: A cross-sectional exploratory study. J Asthma 2017; 55:318-329. [PMID: 28471286 DOI: 10.1080/02770903.2017.1326131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Understanding factors at the patient, provider or organizational level associated with inhaled corticosteroids (ICSs) adherence is important when planning adherence-enhancing interventions. OBJECTIVE To explore factors associated with adherence to ICS among patients with asthma aged 12-45 years. METHODS A cross-sectional study was conducted among patients with asthma reporting ICS prescription during the baseline interview of an intervention study. Three methods were used to measure ICS adherence: a 4-item self-report questionnaire, a single question (SQ) measuring past 7-day exposure to ICS and a medication possession ratio (MPR, i.e., the sum of ICS days of supply/365). We assessed 46 potential factors of ICS adherence derived from the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Their association with ICS adherence was measured using multivariate logistic regressions. RESULTS Among the 319 participants included, 16.0% were deemed adherent according to the 4-item questionnaire. This proportion was 43.0% and 9.1% for the SQ and the MPR method, respectively. Ten factors were associated with good ICS adherence. Among these factors, four were associated with adherence through one of the measuring methods: a low family income level, a high number of asthma drugs used, a good knowledge of asthma pathophysiology and the perception that following the ICS prescription was easy. Two factors emerged through more than one measure: perceiving asthma severity as moderate to very severe and perceiving a high risk of death if ICSs are not taken as prescribed. CONCLUSION ICS adherence was poor in those individuals with asthma. Future adherence-enhancing interventions could target the identified modifiable risk factors. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02093013.
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Affiliation(s)
- Moulikatou Adouni Lawani
- a Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec - Université Laval Research Center , Quebec City , Quebec , Canada
| | - Frank Zongo
- a Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec - Université Laval Research Center , Quebec City , Quebec , Canada
| | - Marie-Claude Breton
- a Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec - Université Laval Research Center , Quebec City , Quebec , Canada
| | - Jocelyne Moisan
- a Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec - Université Laval Research Center , Quebec City , Quebec , Canada
| | - Jean-Pierre Grégoire
- a Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec - Université Laval Research Center , Quebec City , Quebec , Canada
| | - Eileen Dorval
- d Accès Pharma A. Malkhassian & T. Sastre , Dorval , Quebec , Canada
| | | | - Marie-Sophie Jobin
- c PMPRB (Regulatory Affairs and Outreach, Patented Medicine Prices Review Board) , Ottawa , Ontario , Canada
| | - Line Guénette
- a Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada.,b Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec - Université Laval Research Center , Quebec City , Quebec , Canada
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Guénette L, Zongo A, Guillaumie L, Lauzier S, Blais L, Grégoire JP, Moisan J. Psychosocial determinants of non-adherence to antidiabetic drug treatment: A prospective cohort study. Diabetes Metab 2017; 43:368-372. [PMID: 28483291 DOI: 10.1016/j.diabet.2017.03.005] [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] [Received: 03/06/2017] [Revised: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- L Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada.
| | - A Zongo
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - L Guillaumie
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - S Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - L Blais
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada; Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - J-P Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - J Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
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Dossa AR, Moisan J, Guénette L, Lauzier S, Grégoire JP. Association between interpersonal continuity of care and medication adherence in type 2 diabetes: an observational cohort study. CMAJ Open 2017; 5:E359-E364. [PMID: 28483785 PMCID: PMC5498180 DOI: 10.9778/cmajo.20160063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prior studies have shown that, compared to patients with a low level of interpersonal continuity of care, patients with a high level of continuity of care have a lower likelihood of hospital admission and emergency department visits, and a higher likelihood of patient satisfaction. We sought to determine whether higher levels of continuity of care are associated with medication persistence and compliance among new users of oral antidiabetic treatment. METHODS We conducted a medicoadministrative cohort study of new users of oral antidiabetics aged 18 years or more among people covered by the Quebec public drug plan. We excluded people with fewer than 730 days of treatment and those who had been in hospital for 275 days or more in the first or second year after initiation of antidiabetic treatment. We categorized continuity of care observed in the first year after treatment initiation as low, intermediate or high. The association between continuity of care and medication persistence and compliance was assessed using generalized linear models. RESULTS In this cohort of 60 924 new users of oral antidiabetic treatment, compared to patients with a high level of continuity of care, those with an intermediate and a low level of continuity of care were less likely to be persistent (adjusted prevalence ratio 0.97 [95% confidence interval (CI) 0.96-0.98] and 0.96 [95% CI 0.95-0.97], respectively) and compliant (adjusted prevalence ratio 0.98 [95% CI 0.97-0.99] and 0.95 [0.94-0.97], respectively) with their antidiabetic treatment. INTERPRETATION A higher level of interpersonal continuity of care was associated with a higher likelihood of drug persistence and compliance. Since the strength of this association was weak, further research is required to determine whether continuity of care plays a role in medication adherence.
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Affiliation(s)
- Anara Richi Dossa
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Jocelyne Moisan
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Line Guénette
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Sophie Lauzier
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Jean-Pierre Grégoire
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
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Girouard C, Grégoire JP, Poirier P, Moisan J. Effect of contraindicated drugs for heart failure on hospitalization among seniors with heart failure: A nested case-control study. Medicine (Baltimore) 2017; 96:e6239. [PMID: 28248890 PMCID: PMC5340463 DOI: 10.1097/md.0000000000006239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Little is known about the effect of nonsteroidal anti-inflammatory drugs (NSAIDs), thiazolidinediones (TZDs), nifedipine and nondihydropyridine calcium channel blockers (CCBs) usage on the risk of all-cause hospitalization among seniors with heart failure (HF). We assessed the risk of all-cause hospitalization associated with exposure to each of these drug classes, in a population of seniors with HF.Using the Quebec provincial databases, we conducted a nested case-control study in a population of individuals aged ≥65 with a first HF diagnosis between 2000 and 2009. Patients were considered users of a potentially inappropriate drug class if their date of hospital admission occurred in the interval between the date of the last drug claim and the end date of its days' supply. The risks of hospitalization were estimated using multivariate conditional logistic regression.Of the 128,853 individuals included in the study population, 101,273 (78.6%) were hospitalized. When compared to nonusers, users of NSAIDs (adjusted odds ratio: 1.16; 95% confidence interval: 1.13-1.20), TZD (1.09; 1.04-1.14), and CCBs (1.03; 1.01-1.05) had an increased risk of all-cause hospitalization, but not the users of nifedipine (1.00; 0.97-1.03).Seniors with HF exposed to a potentially inappropriate drug class are at increased risk of worse health outcomes. Treatment alternatives should be considered, as they are available.
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Affiliation(s)
- Catherine Girouard
- Chair on Adherence to Treatments
- Faculté de Pharmacie, Université Laval
- Axe Santé des populations et pratiques optimales en santé Centre de recherche du CHU de Québec
| | - Jean-Pierre Grégoire
- Chair on Adherence to Treatments
- Faculté de Pharmacie, Université Laval
- Axe Santé des populations et pratiques optimales en santé Centre de recherche du CHU de Québec
| | - Paul Poirier
- Faculté de Pharmacie, Université Laval
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Chair on Adherence to Treatments
- Faculté de Pharmacie, Université Laval
- Axe Santé des populations et pratiques optimales en santé Centre de recherche du CHU de Québec
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Gagné ME, Légaré F, Moisan J, Boulet LP. Impact of Adding a Decision Aid to Patient Education in Adults with Asthma: A Randomized Clinical Trial. PLoS One 2017; 12:e0170055. [PMID: 28107540 PMCID: PMC5249233 DOI: 10.1371/journal.pone.0170055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 09/10/2016] [Accepted: 12/25/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Not providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma. METHODS A parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education + DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score -37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models. RESULTS Fifty-one participants (response rate: 53%; age: 44 ± 13 years; women: n = 32) were randomized either to the education + DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean [95% CI] knowledge scores increased from 21.5 [19.9-23.2] to 25.1 [23.1-27.0] in the education + DA group (P = 0.0002) and from 24.0 [22.3-25.7] to 26.0 [24.0-28.0] in the education group (P = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups. CONCLUSIONS Education improved knowledge, decisional conflict, and asthma control whether the DA was added or not.
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Affiliation(s)
- Myriam E. Gagné
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada
- Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
| | - France Légaré
- Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Laval University, Quebec City, QC, Canada
- CHU de Quebec Research Center, Population Health and Optimal Health Practices Research Unit, Quebec City, QC, Canada
| | - Jocelyne Moisan
- CHU de Quebec Research Center, Population Health and Optimal Health Practices Research Unit, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
| | - Louis-Philippe Boulet
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada
- Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
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Zongo FE, Moisan J, Grégoire JP, Lesage A, Dossa AR, Lauzier S. Association between community pharmacy loyalty and persistence and implementation of antipsychotic treatment among individuals with schizophrenia. Res Social Adm Pharm 2016; 14:53-61. [PMID: 28077240 DOI: 10.1016/j.sapharm.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 06/01/2016] [Revised: 12/08/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non-adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy. OBJECTIVE To assess the association between the level of community pharmacy loyalty and persistence with and implementation of antipsychotic drug treatment among individuals with schizophrenia. METHODS A cohort study using databases from the Quebec health insurance board (Canada) was conducted among new antipsychotic users insured by Quebec's public drug plan. Level of community pharmacy loyalty was assessed as the number of pharmacies visited in the year after antipsychotics initiation. Persistence was defined as having an antipsychotic supply in the user's possession on the 730th day after its initiation and implementation as having antipsychotics in the user's possession for ≥80% of the days in the second year after antipsychotics initiation (among persistent only). Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). RESULTS 6,251 individuals were included in the cohort and 54.1% had their drug prescriptions filled in >1 pharmacy. When compared to those who had their prescriptions filled in a single pharmacy, those who had their prescriptions filled in ≥4 different pharmacies were 22% more likely to be non-persistent (aPR = 1.22; 95%CI = 1.10-1.37) and 49% more likely to have an antipsychotic for <80% of the days (aPR = 1.49; 95%IC = 1.28-1.74). CONCLUSION This first exploration of community pharmacy loyalty in the context of severe mental illness indicates that this healthcare organisation factor might be associated with antipsychotics persistence and implementation. Identification of individuals with low community pharmacy loyalty and initiatives to optimize community pharmacy loyalty could contribute to enhanced persistence and implementation.
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Affiliation(s)
- Frank E Zongo
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Jocelyne Moisan
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Alain Lesage
- Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Unité 218, 7331 Rue Hochelaga, Montréal, QC, Canada
| | - Anara Richi Dossa
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Sophie Lauzier
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada.
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Zongo A, Guénette L, Moisan J, Guillaumie L, Lauzier S, Grégoire JP. Revisiting the internal consistency and factorial validity of the 8-item Morisky Medication Adherence Scale. SAGE Open Med 2016; 4:2050312116674850. [PMID: 27895914 PMCID: PMC5117245 DOI: 10.1177/2050312116674850] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/06/2016] [Indexed: 12/20/2022] Open
Abstract
Objective: To assess the internal consistency and factorial validity of the adapted French 8-item Morisky Medication Adherence Scale in assessing adherence to noninsulin antidiabetic drug treatment. Study Design and Setting: In a cross-sectional web survey of individuals with type 2 diabetes of the Canadian province of Quebec, self-reported adherence to the antidiabetes drug treatment was measured using the Morisky Medication Adherence Scale-8. We assessed the internal consistency of the Morisky Medication Adherence Scale-8 with Cronbach’s alpha, and factorial validity was assessed by identifying the underlying factors using exploratory factor analyses. Results: A total of 901 individuals completed the survey. Cronbach’s alpha was 0.60. Two factors were identified. One factor comprised five items: stopping medication when diabetes is under control, stopping when feeling worse, feeling hassled about sticking to the prescription, reasons other than forgetting and a cross-loading item (i.e. taking drugs the day before). The second factor comprised three other items that were all related to forgetfulness in addition to the cross-loading item. Conclusion: Cronbach’s alpha of the adapted French Morisky Medication Adherence Scale-8 was below the acceptable value of 0.70. This observed low internal consistency of the scale is probably related to the causal nature of the items of the scale but not necessarily a lack of reliability. The results suggest that the adapted French Morisky Medication Adherence Scale-8 is a two-factor scale assessing intentional (first factor) and unintentional (second factor) non-adherence to the noninsulin antidiabetes drug treatment. The scale could be used to separately identify these outcomes using scores obtained on each of the sub-scales.
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Affiliation(s)
- Arsène Zongo
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments, Laval University, Quebec City, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments, Laval University, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments, Laval University, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments, Laval University, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments, Laval University, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments, Laval University, Quebec City, QC, Canada
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Guénette L, Zongo A, Guillaumie L, Lauzier S, Blais L, Grégoire JP, Moisan J. Determinants of Non-Adherence to Antidiabetic Drug Treatments: A Study Using the Theory of Planned Behaviour and Pharmacy-Based Adherence Measures. Can J Diabetes 2016. [DOI: 10.1016/j.jcjd.2016.08.066] [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: 10/20/2022]
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. The Association Between Depression and Medication Non-Adherence in Type 2 Diabetes: A Population-Based Cohort Study. Can J Diabetes 2016. [DOI: 10.1016/j.jcjd.2016.08.193] [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: 10/20/2022]
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Girouard C, Grégoire JP, Poirier P, Moisan J. Factors associated with β-blocker initiation and discontinuation in a population-based cohort of seniors newly diagnosed with heart failure. Patient Prefer Adherence 2016; 10:1811-1821. [PMID: 27695300 PMCID: PMC5029844 DOI: 10.2147/ppa.s109054] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE β-Blockers (bisoprolol, carvedilol, and metoprolol) are the cornerstone of heart failure (HF) management. The incidence rate of β-blocker initiation and discontinuation and their associated factors among seniors with a first HF diagnosis were assessed. METHODS A population-based inception cohort study that included all individuals aged ≥65 years with a first HF diagnosis in Quebec was conducted. β-Blockers initiation among 91,131 patients who were not using β-blockers at the time of HF diagnosis and discontinuation among those who initiated a β-blocker after HF diagnosis were assessed. Stepwise Cox regression analyses were used to calculate hazard ratios (HR) and to identify factors associated with β-blocker initiation and discontinuation. RESULTS After HF diagnosis, 32,989 (36.2%) individuals initiated a β-blocker. Of these, 15,408 (46.7%) discontinued their β-blocker during the follow-up. Individuals more likely to initiate a β-blocker were those diagnosed in a recent calendar year (2009: HR, 2.11; 95% confidence interval [CI], 2.00-2.23) and diagnosed by a cardiologist (HR, 1.38; 95% CI, 1.34-1.42). Individuals less likely to initiate were those aged ≥90 years (HR, 0.65; 95% CI, 0.61-0.68) and those with chronic obstructive pulmonary disease (HR, 0.66; 95% CI, 0.64-0.68). Individuals more likely to discontinue were those with more than nine medical consultations (HR, 1.14; 95% CI, 1.10-1.18) and those with dementia (HR, 1.13; 95% CI, 1.01-1.27). Individuals less likely to discontinue were those diagnosed in a recent calendar year (2009: HR 0.74; 95% CI, 0.65-0.82) and those exposed to another β-blocker before HF diagnosis (HR, 0.88; 95% CI, 0.85-0.91). CONCLUSION Quebec seniors seem to be underexposed to β-blocker following HF diagnosis. Among those who initiate β-blocker use, discontinuation is high. Better understanding of the underlying causes is needed to help target interventions to improve the management of HF.
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Affiliation(s)
- Catherine Girouard
- Chair on Adherence to Treatments, Université Laval
- Faculty of Pharmacy, Université Laval
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center
| | - Jean-Pierre Grégoire
- Chair on Adherence to Treatments, Université Laval
- Faculty of Pharmacy, Université Laval
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center
| | - Paul Poirier
- Faculty of Pharmacy, Université Laval
- Quebec Heart and Lung Institute-Université Laval, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Chair on Adherence to Treatments, Université Laval
- Faculty of Pharmacy, Université Laval
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center
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Lunghi C, Moisan J, Grégoire JP, Guénette L. Incidence of Depression and Associated Factors in Patients With Type 2 Diabetes in Quebec, Canada: A Population-Based Cohort Study. Medicine (Baltimore) 2016; 95:e3514. [PMID: 27227919 PMCID: PMC4902343 DOI: 10.1097/md.0000000000003514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
It has been reported that the risk of depression is higher among people with type 2 diabetes compared with a nondiabetic population. Among diabetic patients, depression has been associated with worse self-care behaviors, poor glycemic control, and an increased risk of diabetes complications. Identifying factors associated with the occurrence of depression may help physicians identify earlier diabetic patients at a high risk of developing depression, improve prevention, and accelerate proper treatment. To our knowledge, very few population-based studies have reported on the incidence of clinically diagnosed depression as a consequence of type 2 diabetes over a long follow-up period. The objective of this study was to estimate the incidence of clinically diagnosed depression among type 2 diabetic patients newly treated with oral antidiabetic drugs (ADs) and to identify factors associated with the occurrence of depression.Administrative claims data from the public health insurance plan were used to identify a cohort of new oral AD users aged ≥18 years between 2000 and 2006. Patients were followed from oral AD treatment initiation until the diagnosis of depression, ineligibility for the public drug plan, death, or the end of the study, whichever came first. Incidence rates were determined using person-time analysis. Factors associated with depression were identified using multivariable Cox regression analysis.We identified 114,366 new oral AD users, of which 4808 had a diagnosis of depression. The overall incidence rate of depression was 9.47/1000 person-years (PYs) (10.72/1000 PYs for women and 8.27/1000 PYs for men). The incidence of depression was higher during the year after oral AD treatment initiation. Independent factors associated with depression included having had mental disorders other than depression, hospitalization, a higher number of different drugs taken and of physicians visited during the year before oral AD initiation. Moreover, we observed a statistically significant age-by-socioeconomic status interaction.The incidence of diagnosed depression is higher during the first year after oral AD treatment initiation. Clinicians could pay particular attention to women, patients starting an AD at a young age, those with a low socioeconomic status, and especially those with a history of anxiety or dementia.
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Affiliation(s)
- Carlotta Lunghi
- From the Faculty of Pharmacy (CL, JM, J-PG, LG); Chair on Adherence to Treatments (CL, JM, J-PG, LG), Laval University; and Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre (CL, JM, J-PG, LG), Quebec, QC, Canada
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Abstract
BACKGROUND Patient decision aids (PDAs) are used in shared decision making to improve practitioner-patient communication and help patients decide about treatment options. To develop a PDA for adults with asthma considering inhaled corticosteroids, with or without long-acting beta2-agonists, to optimize asthma control. METHODS The PDA was developed based on the International Patient Decision Aid Standards. Step 1: PDA was drafted. Step 2: PDA acceptability was assessed among target users, certified asthma educators (CAEs) and adults with asthma, following an iterative process. a) Participants read the PDA, b) rated its presentation, length, balance, and perceived usefulness, indicated what they liked/disliked about it, and made suggestions for improvement. c) Based on results from (b), PDA was refined. This process was repeated with new participants until no suggestions were made. Step 3: The PDA was field tested with target users. Interviews with CAEs were conducted to identify areas of improvement. Step 4: Final PDA version was written. RESULTS A color-printed, 4-page, letter-sized PDA was drafted. Acceptability testing involved 11 CAEs (women, n = 10) and 20 adults with asthma (women, n = 13; age 22-61 years). Five successive refined versions were produced. Major changes were made to PDA terminology, instructions, paper size, and visual presentation. Two CAEs (women, n = 2) and 26 adults with asthma (women, n = 19; age 20-65 years) field tested PDA. Minor changes were made to language and instructions to ensure usability. The final version was a color-printed, 12-page, A3-sized booklet. CONCLUSION Our newly developed PDA was found acceptable and usable in target users.
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Affiliation(s)
- Myriam E Gagné
- a Knowledge Translation , Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University , Quebec City , Quebec , Canada.,b Quebec Heart and Lung Institute , Quebec City , Quebec , Canada
| | - France Légaré
- c Canada Research Chair in Implementation of Shared Decision Making in Primary Care , Laval University , Quebec City , Quebec , Canada.,d CHU de Québec Research Center , Population Health and Optimal Health Practices Research Unit , Quebec City , Quebec , Canada.,e Faculty of Medicine , Laval University , Quebec City , Quebec , Canada
| | - Jocelyne Moisan
- d CHU de Québec Research Center , Population Health and Optimal Health Practices Research Unit , Quebec City , Quebec , Canada.,f Chair on Adherence to Treatments , Laval University , Quebec City , Quebec , Canada.,g Faculty of Pharmacy , Laval University , Quebec City , Quebec , Canada
| | - Louis-Philippe Boulet
- a Knowledge Translation , Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University , Quebec City , Quebec , Canada.,b Quebec Heart and Lung Institute , Quebec City , Quebec , Canada.,e Faculty of Medicine , Laval University , Quebec City , Quebec , Canada
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Zomahoun HTV, Moisan J, Lauzier S, Guillaumie L, Grégoire JP, Guénette L. Predicting Noninsulin Antidiabetic Drug Adherence Using a Theoretical Framework Based on the Theory of Planned Behavior in Adults With Type 2 Diabetes: A Prospective Study. Medicine (Baltimore) 2016; 95:e2954. [PMID: 27082543 PMCID: PMC4839786 DOI: 10.1097/md.0000000000002954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Understanding the process behind noninsulin antidiabetic drug (NIAD) nonadherence is necessary for designing effective interventions to resolve this problem. This study aimed to explore the ability of the theory of planned behavior (TPB), which is known as a good predictor of behaviors, to predict the future NIAD adherence in adults with type 2 diabetes. We conducted a prospective study of adults with type 2 diabetes. They completed a questionnaire on TPB variables and external variables. Linear regression was used to explore the TPB's ability to predict future NIAD adherence, which was prospectively measured as the proportion of days covered by at least 1 NIAD using pharmacy claims data. The interaction between past NIAD adherence and intention was tested. The sample included 340 people. There was an interaction between past NIAD adherence and intention to adhere to the NIAD (P = 0.032). Intention did not predict future NIAD adherence in the past adherers and nonadherers groups, but its association measure was high among past nonadherers (β = 5.686, 95% confidence interval [CI] -10.174, 21.546). In contrast, intention was mainly predicted by perceived behavioral control both in the past adherers (β = 0.900, 95% CI 0.796, 1.004) and nonadherers groups (β = 0.760, 95% CI 0.555, 0.966). The present study suggests that TPB is a good tool to predict intention to adhere and future NIAD adherence. However, there was a gap between intention to adhere and actual adherence to the NIAD, which is partly explained by the past adherence level in adults with type 2 diabetes.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- From the Faculty of Pharmacy, Laval University, Quebec, QC, Canada (HTVZ, JM, SL, J-PG, Line Guénette); Chair on Adherence to Treatments (HTVZ, JM, SL, Line Guénette, J-PG, Laurence Guillaumie); Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre (HTVZ, JM, SL, , Line Guénette, J-PG, Laurence Guillaumie); and Faculty of Nursing, Laval University, Quebec, QC, Canada (Laurence Guillaumie)
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Guénette L, Breton MC, Guillaumie L, Lauzier S, Grégoire JP, Moisan J. Psychosocial factors associated with adherence to non-insulin antidiabetes treatments. J Diabetes Complications 2016; 30:335-42. [PMID: 26615905 DOI: 10.1016/j.jdiacomp.2015.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/08/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
AIMS To discern psychosocial factors of non-insulin antidiabetes drug (NIAD) adherence. METHODS A cross-sectional study based on the theory of planned behavior (TPB). Adults with type 2 diabetes (T2D) who were members of Diabète Québec, a provincial association of persons with diabetes, and were prescribed at least one NIAD were invited to complete a web-based questionnaire. We measured variables ascertaining TPB constructs and other factors potentially associated with NIAD adherence (e.g., habit, social support, and mental health). NIAD adherence was assessed using the 8-item Morisky Medication Adherence Scale. Factors were identified using a multivariate logistic regression model. RESULTS In our study, 901 participants (373 women; 515 retired; mean age: 62.7 years) with T2D for a mean of 10 years, completed the questionnaire. Participants exhibited a high intention to adhere to their NIAD treatment (mean score=5.8/6), positive attitudes toward adherence (mean score=5.5/6), and elevated perceived behavioral control in taking their medication (mean score=5.7/6). Only 405 (45%) participants reported high adherence (score=8/8). Perceived behavioral control, habit, older age, no perceived side effects, a longer period since T2D diagnosis and a lower number of NIAD daily doses were significantly associated with adherence (p<0.05). CONCLUSION We identified several factors that may be modified for NIAD adherence and thereby provided insight into future adherence-enhancing intervention targets.
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Affiliation(s)
- Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada.
| | - Marie-Claude Breton
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
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Girouard C, Gregoire JP, Kayibanda JF, Poirier P, Demers E, Moisan J. Underexposure of Seniors to Heart Failure Drug Therapy. J Popul Ther Clin Pharmacol 2016; 23:e13-e25. [PMID: 26949982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Little is known about exposure to heart failure (HF) treatment among seniors with ischemic heart disease. OBJECTIVES In a population of seniors, we: 1) estimated the association between age and exposure to HF drug therapy at 6, 12, 36 and 60 month intervals after HF diagnosis, and 2) determined the influence of the passage of time on exposure to drug therapy. METHODS Using the Quebec provincial administrative databases, we conducted a population-based inception cohort study that included all individuals aged ≥ 65 with a first HF diagnosis between 2000 and 2009 and an ischemic heart disease diagnosis in the year before HF diagnosis. We assessed exposure to HF drug therapy and to drug therapy at target doses at 6, 12, 36 and 60 month intervals after HF diagnosis. Adjusted prevalence ratios (aPR) between age at diagnosis and exposure to drug therapy and the influence of time (6-month periods) were assessed using multivariate modified Poisson regressions. RESULTS Among the 86,428 seniors, those who were older were less likely to be exposed to both HF drug therapy and drug therapy at target doses at each time point, than were the younger ones (aged 65-69). The aPRs for exposure to drug therapy for the 90+ age group were 0.64, 0.64, 0.56 and 0.53 at the 6, 12, 36 and 60 month intervals, respectively. After HF diagnosis, exposure increased by a maximum of 8% per 6-month period. CONCLUSION Increasing age is associated with a decrease in exposure to drug therapy, with only slight improvement in exposure after HF diagnosis.
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Truong VT, Moisan J, Kröger E, Langlois S, Grégoire JP. Persistence and compliance with newly initiated antihypertensive drug treatment in patients with chronic kidney disease. Patient Prefer Adherence 2016; 10:1121-9. [PMID: 27382260 PMCID: PMC4922779 DOI: 10.2147/ppa.s108757] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease initiating an antihypertensive drug (AH) treatment must persist and comply with it to slow disease progression and benefit from the reduction of cardiovascular morbidity and mortality. OBJECTIVES This study evaluates the persistence and compliance with AH treatment and identifies the associated factors among chronic kidney disease patients who initiated AH treatment. METHODS A population-based cohort study using Quebec administrative data was conducted. Patients who still take any AH 1 year after initiation were considered persistent. Of these patients, those who had ≥80% of days covered with an AH in the year after initiation were considered compliant. Factors associated with persistence and compliance were identified using a modified Poisson regression. RESULTS Of the 7,119 eligible patients, 78.8% were persistent, 87.7% of whom were compliant with their AH treatment. Compared with patients on diuretic monotherapy, those who initially used angiotensin-converting enzyme inhibitor monotherapy, angiotensin II receptor blocker monotherapy, calcium channel blocker monotherapy, β-blocker monotherapy, or multidrug therapy were more likely to be persistent. In contrast, individuals who visited their physicians ≥17 times were less likely to be persistent than those who visited between 0 and 8 times. The patients who were more likely to be compliant had initially used an angiotensin-converting enzyme inhibitor, β-blocker, calcium channel blocker, or multitherapy as opposed to a diuretic. CONCLUSION A year after initiating AH treatment, nearly a third of chronic kidney disease patients were either not taking an AH or had not been compliant. Factors associated with persistence and compliance could help identify patients who need help in managing their AH treatment.
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Affiliation(s)
- Viet Thanh Truong
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
| | - Edeltraut Kröger
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
- Center of Excellence on Aging of Québec
| | | | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
- Correspondence: Jean-Pierre Grégoire, Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center, 1050 Chemin Sainte-Foy, Québec, Canada G1S 4L8, Tel +1 418 682 7511 ext 84664, Fax +1 418 682 7949, Email
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Guénette L, Breton MC, Grégoire JP, Jobin MS, Bolduc Y, Boulet LP, Dorval E, Moisan J. Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids. J Asthma 2015; 52:638-45. [PMID: 25539138 DOI: 10.3109/02770903.2014.999084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To measure the effectiveness of an integrated care program for individuals with asthma aged 12-45 years, on asthma control and adherence to inhaled corticosteroids (ICS). METHODS Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. RESULTS Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (p = 0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (p = 0.02). CONCLUSION An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.
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Affiliation(s)
- Line Guénette
- a Faculty of Pharmacy , Laval University , Quebec City , Québec , Canada
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Dossa AR, Grégoire JP, Lauzier S, Guénette L, Sirois C, Moisan J. Association Between Loyalty to Community Pharmacy and Medication Persistence and Compliance, and the Use of Guidelines-Recommended Drugs in Type 2 Diabetes: A Cohort Study. Medicine (Baltimore) 2015; 94:e1082. [PMID: 26166087 PMCID: PMC4504647 DOI: 10.1097/md.0000000000001082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/31/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022] Open
Abstract
Pharmacists record data on all drugs claimed and may build a personal relationship with their clients. We hypothesized that loyalty to a single pharmacy could be associated with a better quality of drug use.To assess the association between pharmacy loyalty and quality of drug use among individuals treated with oral antidiabetes drugs (OADs).This is a cohort study using Quebec Health Insurance Board data. Associations were assessed using multivariable logistic regression.New OAD users, aged ≥18 years.Individuals who filled all their prescription drugs in the same pharmacy during the first year of treatment were considered loyal. During year 2 of treatment we assessed 4 quality indicators of drug use: persistence with antidiabetes treatment, compliance with antidiabetes treatment among those considered persistent, use of an angiotensin-converting enzyme inhibitor or of an angiotensin II receptor blocker (ACEi/ARB), and use of a lipid-lowering drug.Of 124,009 individuals, 59.75% were identified as loyal. Nonloyal individuals were less likely to persist with their antidiabetes treatment (adjusted odds ratio = 0.89; 95% CI: 0.86-0.91), to comply with their antidiabetes treatment (0.82; 0.79-0.84), to use an ACEi/ARB (0.85; 0.83-0.88) and to use a lipid-lowering drug (0.83; 0.80-0.85). Quality of drug use decreased as the number of different pharmacies increased (linear contrast tests <0.001).Results underscore the important role pharmacists could play in helping their clients with chronic diseases to better manage their drug treatments. Further research is needed to determine to what extent the positive effects associated with pharmacy loyalty are specifically due to pharmacists.
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Affiliation(s)
- Anara Richi Dossa
- From the Faculty of Pharmacy, Laval University (ARD, J-PG, SL, LG, JM); Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre (ARD, J-PG, SL, LG, JM); and Department of Nursing, UQAR, Campus Lévis, Lévis, Québec, Canada (CS)
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Vignon Zomahoun HT, de Bruin M, Guillaumie L, Moisan J, Grégoire JP, Pérez N, Vézina-Im LA, Guénette L. Effectiveness and Content Analysis of Interventions to Enhance Oral Antidiabetic Drug Adherence in Adults with Type 2 Diabetes: Systematic Review and Meta-Analysis. Value Health 2015; 18:530-540. [PMID: 26091607 DOI: 10.1016/j.jval.2015.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 08/29/2014] [Revised: 12/22/2014] [Accepted: 02/08/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To estimate the pooled effect size of oral antidiabetic drug (OAD) adherence-enhancing interventions and to explore which of the behavior change techniques (BCTs) applied in the intervention groups modified this pooled intervention effect size. METHODS We searched relevant studies published until September 3, 2013, on MEDLINE, Embase, PsycInfo, the Cochrane Library, CINAHL, Current Contents Connect, and Web of Science. Selected studies were qualitatively synthesized, and those of at least medium quality were included in the meta-analysis. A random-effects model was used to pool effectiveness (Hedges's g) and to examine heterogeneity (Higgins I(2)). We also explored the influence on the pooled effectiveness of unique intervention BCTs (those delivered to the intervention groups but not control groups in a trial) by estimating their modifying effects. RESULTS Fourteen studies were selected for the qualitative synthesis and 10 were included in the meta-analysis. The pooled effectiveness of the interventions was 0.21 (95% confidence interval -0.05 to 0.47; I(2) = 82%). Eight unique BCTs were analyzed. "Cope with side effects" (P = 0.003) and "general intention formation" (P = 0.006) had a modifying effect on the pooled effectiveness. The pooled effectiveness of the interventions in which "cope with side effects" was applied was moderate (0.64; 95% confidence interval 0.31-0.96; I(2) = 56%). CONCLUSIONS The overall effectiveness of OAD adherence-enhancing interventions that have been tested is small. Helping patients cope with side effects or formulate desired treatment outcomes could have an impact on the effectiveness of OAD adherence-enhancing interventions. Only those interventions that include helping patients to cope with side effects appear to be particularly effective in improving OAD adherence.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada; CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada
| | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Scotland
| | - Laurence Guillaumie
- CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada; Faculty of Nursing, Laval University, Québec City, Québec, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada; CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada; CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada
| | - Norma Pérez
- CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada
| | - Lydi-Anne Vézina-Im
- CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada; Faculty of Nursing, Laval University, Québec City, Québec, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada; CHU de Québec Research Center Population Health and Optimal Practices Research Unit and Chair on adherence to treatments, Québec City, Québec, Canada.
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Guénette L, Lauzier S, Guillaumie L, Giguère G, Grégoire JP, Moisan J. Patients' beliefs about adherence to oral antidiabetic treatment: a qualitative study. Patient Prefer Adherence 2015; 9:413-20. [PMID: 25792814 PMCID: PMC4362977 DOI: 10.2147/ppa.s78628] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to elicit patients' beliefs about taking their oral antidiabetic drugs (OADs) as prescribed to inform the development of sound adherence-enhancing interventions. METHODS A qualitative study was performed. Adults with type 2 diabetes who had been taking an OAD for >3 months were solicited to participate in one of six focus groups. Discussions were facilitated using a structured guide designed to gather beliefs related to important constructs of the theory of planned behavior. Four coders using this theory as the theoretical framework analyzed the videotaped discussions. RESULTS Forty-five adults participated. The most frequently mentioned advantages for OAD-taking as prescribed were to avoid long-term complications and to control glycemia. Family members were perceived as positively influential. Carrying the OAD at all times, having the OAD in sight, and having a routine were important facilitating factors. Being away from home, not accepting the disease, and not having confidence in the physician's prescription were major barriers to OAD-taking. CONCLUSION This study elicited several beliefs regarding OAD-taking behavior. Awareness of these beliefs may help clinicians adjust their interventions in view of their patients' beliefs. Moreover, this knowledge is crucial to the planning, development, and evaluation of interventions that aim to improve medication adherence.
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Affiliation(s)
- Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
- Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Gabriel Giguère
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
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Sirois C, Moisan J, Poirier P, Grégoire JP. Comparative effectiveness of cardioprotective drugs in elderly individuals with type 2 diabetes. Int J Clin Pract 2015; 69:305-12. [PMID: 25359240 DOI: 10.1111/ijcp.12503] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 06/18/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS Although many elderly individuals suffer from type 2 diabetes, the effectiveness of cardioprotective drugs in primary prevention of cardiovascular events in clinical practice in this population has rarely been evaluated. We aimed to assess the effectiveness of, (i) angiotensin converting enzyme inhibitors or angiotensin receptor blockers, (ii) statins, (iii) antiplatelet drugs and (iv) the combination of these three drugs, in the prevention of myocardial infarction (MI) and stroke in elderly individuals with type 2 diabetes. METHODS Using Quebec administrative databases, we conducted nested case-control analyses among a cohort of 17,384 individuals without a history of cardiovascular disease. Individuals were aged ≥ 66 years, newly treated with oral antidiabetes drugs and had not used any of the three above classes of cardioprotective drugs in the year before cohort entry. For each case (MI/stroke during follow-up), five controls were matched for age, year of cohort entry and sex. Use of each drug and of their combination was defined as current, past or no use. We calculated adjusted odds ratios (AOR) of MI/stroke. RESULTS We observed no reduction in the MI/stroke risk for users of ACEI/ARB nor for users of the three drugs combination. Longer exposure to statins was associated with a lower risk (AOR for every 30 days of therapy: 0.97; 95% CI: 0.96-0.99). By contrast, current use of antiplatelet drugs was associated with an increased risk of MI/stroke (1.40; 1.12-1.75). CONCLUSION The benefit of cardioprotective drugs in primary prevention was not clear in this cohort of elderly individuals with type 2 diabetes. A short duration of exposure to these drugs might explain the lack of benefit.
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Affiliation(s)
- C Sirois
- Département des sciences infirmières, Université du Québec à Rimouski, Lévis, QC, Canada; Faculté de Pharmacie, Université Laval, Québec, QC, Canada
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Htv Z, de Bruin M, Guillaumie L, Moisan J, Gregoire JP, Perez N, Vézina-Im LA, Guenette L. Content Analysis And Effectiveness Of Interventions To Enhance Oral Antidiabetic Drug (Oad) Adherence In Adults With Type 2 Diabetes: A Systematic Review And Meta-Analysis. Value Health 2014; 17:A748. [PMID: 27202708 DOI: 10.1016/j.jval.2014.08.181] [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: 06/05/2023]
Affiliation(s)
- Zomahoun Htv
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | | | | | - J Moisan
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - J P Gregoire
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - N Perez
- Laval University, Québec, QC, Canada
| | | | - L Guenette
- Laval University Faculty of Pharmacy, Québec, QC, Canada
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Dossa R, Gregoire JP, Lauzier S, Guenette L, Sirois C, Moisan J. Loyalty To A Pharmacy Is Associated With A Better Quality Of Antidiabetes Drug Use. Value Health 2014; 17:A748. [PMID: 27202707 DOI: 10.1016/j.jval.2014.08.180] [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: 06/05/2023]
Affiliation(s)
- R Dossa
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - J P Gregoire
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - S Lauzier
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - L Guenette
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - C Sirois
- Université du Québec à Rimouski, Lévis, QC, Canada
| | - J Moisan
- Laval University Faculty of Pharmacy, Québec, QC, Canada
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Zongo A, Guenette L, Moisan J, Gregoire JP. HBA1C Control Predictive Validity of Four Self-Reported Measures of Antidiabetes Medication Adherence. Value Health 2014; 17:A730. [PMID: 27202609 DOI: 10.1016/j.jval.2014.08.079] [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: 06/05/2023]
Affiliation(s)
- A Zongo
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - L Guenette
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - J Moisan
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - J P Gregoire
- Laval University Faculty of Pharmacy, Québec, QC, Canada
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Ngamini-Ngui A, Fleury MJ, Moisan J, Grégoire JP, Lesage A, Vanasse A. High users of emergency departments in Quebec among patients with both schizophrenia and a substance use disorder. Psychiatr Serv 2014; 65:1389-91. [PMID: 25124150 DOI: 10.1176/appi.ps.201300474] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study assessed factors associated over time with high use of emergency departments by patients in Quebec who had schizophrenia and a co-occurring substance use disorder. METHODS The cohort study included 2,921 patients who received a diagnosis of schizophrenia in 2006 and had at least one emergency department visit during fiscal year 2006-2007. Generalized estimating equations were used to estimate predictors of high use of emergency departments over time. RESULTS After adjustment for all covariates, predictors of high use over time were as follows: living in either a university medical region (OR=2.10) or a peripheral medical region (OR=2.10), frequent hospitalization (OR=1.16), and greater number of psychiatric (OR=1.64) or physical comorbidities (OR=1.23). CONCLUSIONS Because high use of emergency departments is a strong indicator of poor care continuity, identified associated factors could help develop and offer new programs to be deployed in the community to better support these patients with greater needs.
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Affiliation(s)
- André Ngamini-Ngui
- Dr. Ngamini-Ngui and Dr. Fleury are with the Centre de Réadaptation en Dépendance de Montréal, Institut Universitaire, Montreal, Quebec, Canada (e-mail: ). Dr. Ngamini-Ngui is also with the Centre de Recherche CSSS Champlain-Charles-Le Moyne, Longueuil, Quebec. Dr. Fleury is also with the Douglas Mental Health University Institute, McGill University, Montreal. Dr. Moisan and Dr. Grégoire are with the Faculté de Pharmacie, Université Laval, and with the Centre de Recherche du Centre Hospitalier Universitaire de Québec. Dr. Lesage is with the Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Montreal, Quebec. Dr. Vanasse is with the Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec
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Ngamini Ngui A, Apparicio P, Fleury MJ, Grégoire JP, Moisan J, Lesage A, Vanasse A. Disentangling the influence of neighborhood and individual characteristics on early residential mobility among newly diagnosed patients with schizophrenia: a multilevel analysis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1569-78. [PMID: 24789455 DOI: 10.1007/s00127-014-0883-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Early residential mobility of schizophrenic patients may relate to discontinuity of treatment and adverse outcome. However, factors influencing early residential mobility of these patients are still poorly examined. The aim of this study was to disentangle the influence of individual and neighborhood characteristics on early residential mobility of schizophrenic patients. METHODS The study used administrative data of 13, 400 individuals newly diagnosed with schizophrenia in Quebec between 2001 and 2002. These individuals were nested in 163 different health territories. Multilevel analyses were used to assess the contribution of individual and neighborhood characteristics on early residential mobility. RESULTS The final model indicates that at the individual level, being men, wonder patients and physical comorbidity increased the likelihood of early residential mobility whereas older patients were less likely to migrate earlier. The health territory level explains about 7 % of the variation of early residential mobility and variables influencing residential mobility at this level are the fourth and the third quartiles of the population density. CONCLUSIONS Factors influencing early residential mobility of schizophrenic patients are located at both individual and neighborhood levels. This suggests that policies targeting only one-level factors are unlikely to significantly delays early residential mobility.
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Affiliation(s)
- André Ngamini Ngui
- Centre de réadaptation en dépendance de Montréal, Institut Universitaire, Montreal, Canada,
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Breton MC, Guillaumie L, Lauzier S, Grégoire JP, Moisan J, Guénette L. Psychosocial Determinants of Adherence to Non-Insulin Antidiabetes Treatment. Can J Diabetes 2014. [DOI: 10.1016/j.jcjd.2014.07.096] [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: 10/24/2022]
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Dossa R, Grégoire JP, Lauzier S, Guénette L, Moisan J. Effect of Continuity of Care on Antidiabetes Drug Adherence and Use of Guidelines-Recommended Drugs. Can J Diabetes 2014. [DOI: 10.1016/j.jcjd.2014.07.060] [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: 10/24/2022]
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Sirois C, Moisan J, Poirier P, Grégoire JP. Myocardial infarction and gastro-intestinal bleeding risks associated with aspirin use among elderly individuals with type 2 diabetes. Ann Med 2014; 46:335-40. [PMID: 24785356 DOI: 10.3109/07853890.2014.902636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/09/2023] Open
Abstract
INTRODUCTION The benefit of aspirin in primary prevention of myocardial infarction and the associated gastro-intestinal bleeding risks have not been well established in the elderly population with diabetes. METHODS Using Quebec administrative databases, we conducted two nested case-control analyses within a cohort of individuals aged ≥ 66 years newly treated with an oral antidiabetes drug between 1998 and 2003. The 28,067 individuals had no cardiovascular disease recorded in the database in the year prior cohort entry. They had not used prescribed aspirin, antiplatelet, or anticoagulant drugs, and were not hospitalized for gastro-intestinal bleeding in the year prior cohort entry. The odds of myocardial infarction and gastro-intestinal bleedings were compared between individuals who were current, past, or non-users of aspirin. RESULTS There were 1101 (3.9%) cases of myocardial infarction. Compared to non-users, neither aspirin users (OR 0.89; 95% CI 0.71-1.13) nor aspirin past users (0.81; 0.62-1.06) showed a statistically significant lower risk of myocardial infarction. There were 373 (1.3%) cases of gastro-intestinal bleeding. Current users of aspirin had about a 2-fold greater risk of gastro-intestinal bleeding compared to non-users (2.19; 1.53-3.13). CONCLUSIONS Our results suggest that individual assessment of bleeding risk and cardiovascular risk is mandatory among elderly people with diabetes before introducing aspirin therapy.
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Kayibanda JF, Bitera R, Demers E, Moisan J, Alary M. Sexual Risk Factors Associated with Intimate Partner Violence Against Women in Rwanda: A Couples-Based Analysis. Women Health 2014; 54:301-16. [DOI: 10.1080/03630242.2014.896444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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