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14. Difficulty adhering to antidiabetes treatment : factors associated with persistence and compliance.

Author

Grégoire, Jean-Pierre, Moisan, Jocelyne, Breton, Marie-Claude, Guénette, Line, Sirois, Caroline, Grégoire, Jean-Pierre, Moisan, Jocelyne, Breton, Marie-Claude, Guénette, Line, and Sirois, Caroline

Abstract

Aims. – This study aimed to assess the 1-year treatment persistence and compliance of new oral antidiabetic drug (OAD) users with their treatment, and to identify the factors associated with both persistence and compliance. Methods. – This population-based cohort study of new OAD users aged 18 years or above used the Quebec health insurance board databases. Those having a prescription filled for antidiabetic treatment during the period leading up to the 1-year anniversary of their first claim were considered to be persistent with their antidiabetic treatment. Of these patients, individuals with a medication possession ratio (MPR) greater or equal to 80% for OAD or insulin were deemed compliant. Also identified were the characteristics associated with both outcomes, using a multivariate logistic regression model. Results. – Our cohort consisted of 151,173 individuals, 119,832 (79.3%) of whom were considered persistent. Of these, 93,418 (78.0%) were also deemed compliant. Persistence and compliance were associated with older ages, living in a rural region, low socioeconomic status, having the first OAD prescribed by a general practitioner and a history of using five different drugs or more. People were less likely to be persistent and compliant if their initial OAD was a secretagogue and if they had consulted a physician eight times or more during the year prior to starting treatment. Conclusion. – One year after OAD treatment initiation, 21% had discontinued their treatment and 22% of those still being treated were non-compliant. These results could help to tailor interventions aimed at optimizing the use of OAD treatments., La difficulté à adhérer à un traitement antidiabétique : les facteurs associés à la persistance et à l’observance. Buts. – Déterminer la persistance au traitement chez les nouveaux utilisateurs d’antidiabétique oral (ADO) un an après l’initiation du traitement. Parmi les persistants, évaluer leur observance du traitement et, enfin, identifier les facteurs associés à la persistance et à l’observance. Méthodes. – Nous avons effectué une étude de cohorte populationnelle de nouveaux utilisateurs d’ADO âgés de 18 ans ou plus en utilisant les banques de données de la Régie de l’assurance maladie du Québec. Les personnes qui ont acquis une ordonnance pour un traitement antidiabétique dans la période précédant le premier anniversaire de leur première acquisition ont été considérées persistantes à prendre leur traitement antidiabétique. Parmi ces personnes, celles pour qui plus de 80 % des jours étaient couverts par un ADO ou de l’insuline ont été considérées observantes. Nous avons identifié les caractéristiques associées à la persistance et à l’observance en utilisant un modèle de régression logistique multivariée. Résultats. – Notre cohorte était composée de 151 173 individus dont 119 832 (79,3 %) étaient considérés persistants. De ces individus, 93 418 (78,0 %) ont été jugés observants. La persistance et l’observance étaient associées à l’augmentation de l’âge, au fait de vivre dans une région rurale, à un statut socioéconomique bas, au fait que le premier ADO prescrit l’ait été par un médecin généraliste et au fait d’avoir utilisé cinq médicaments différents ou plus dans l’année précédente. Les individus étaient moins susceptibles d’être persistants et observants si le premier ADO prescrit était une sulfonylurée et s’ils avaient consulté un médecin huit fois ou plus dans l’année précédant l’initiation de leur ADO. Conclusions. – Un an après l’initiation d’un traitement ADO, 21 % des individus avaient cessé leur traitement et 22 % de ceux toujours traités n’étaient pas o

Published
2021

19. 2. Futile or Fertile? Lessons Learned from a Novel Geriatric Rehabilitation Curriculum

Author

Sider, Cody, Lee, Ben, Taneja, Karishma, Morgenstern, Jason, Evans, Alison, Naqvi, Raza, Brymer, Chris, Perrella, Andrew, Chau, Vicky, Cuperfain, Ari, Marshall, Cecelia, Tsokas, Mario, Chiu, Karen, Zhao, Qiannan, Sheng, Dade, Iaboni, Andrea, Radcliffe, Sarah, Giangregorio, Aidan, Ioannidis, George, Kennedy, Courtney, Lamarche, Larkin, Oliver, Doug, Dolovich, Lisa, Haney, Erin, Papioann, Alexandra, Franco, Bryan, Heckman, George, Dupuis, Sherry, Loiselle, Lisa, Boscart, Veronique, Lee, Linda, Sivarajah, Lavan, Borhan, ASM, Negm, Ahmed, Marr, Sharon, Patterson, Christopher, Misiaszek, Brian, Woo, Tricia, Papaioannou, Alexandra, Norman, Richard, Sinha, Samir, Cheung, Evelyn, Costa, Andrew, Osborne, Alyson, Kane, Sheri-Lynn, Burrell, Alishya, Chahine, Saad, Diachun, Laura, Goldlist, Kady, Ehrlich, April, Cioltan, Hannah Stocker, Wendel, Christopher, Pang, Rui Wen, Evans, Kevin, Mohler, Jane, Fain, Mindy, Bastron, Robert, Stanton, Mark, Reich, Krista, Tang, Andrew, Paget, Michael, McLaughlin, Kevin, Kwan, Emily, Chabot, Julia, Beauchet, Oliver, Fung, Shek, Peretz, Isabelle, Haque, Nihal, Dasgupta, Monidipa, von Maltzahn, Maia, Alston, Jillian, Stall, Nathan, Habeeb, Yaser, Gandell, Dov, Norris, Mireille, Liu, Barbara, Searle, Samuel, Rodger, Alison, Walsh, Steve, Nemiroff, Leah, Haroon, Babar, Rockwood, Kenneth, Klair, Amandeep Kiddy, Haddad, Taleen, Huang, Allen, Tharmalingam, Surenthar, Takaoka, Alyson, Shears, Melissa, Millen, Tina, Holding, Amanda, Clarke, France, Sean, Bagshaw, Li, Guowei, Cook, Deborah, Pieruccini-Faria, Frederico, Muir-Hunter, Susan, Fischer, Hadas, Fung, Kinwah, Bronskill, Susan, Austin, Peter, Matlow, Jeremy, Quinn, Kieran, Mitchell, Susan, Bell, Chaim, Rochon, Paula, Turner, Justin, Tannenbaum, Cara, Sathiyamoorthy, Thrmiga, Ali, Amanda, Kloseck, Marita, Lee, Justin, Muratov, Sergei, Tarride, Jean-Eric, Paterson, Michael, Gomes, Tara, Mbuagbaw, Lawrence, Thavorn, Kednapa, Khuu, Wayne, Holbrook, Anne, Nicholson, Kathryn, Terry, Amanda, Fortin, Martin, Williamson, Tyler, Thind, Amardeep, De Jesus, Marcos Barrera, Bhullar, Ashley, Tate, Robert, St. John, Philip, Torbiak, Lindsay, Tyas, Suzanne, Menec, Verena, Griffith, Lauren, St. John, Phillip, Watt, Jennifer, Crilly, Richard, Wong-Pack, Matthew, Ringer, Thom, Miller, Patricia, Sztramko, Richard, Vastis, Peter, Abu-Ghazaleh, Nadine, Abyad, Abdulrazak, Alibhai, Shabbir M. H., Loucks, Allison, Jin, Rana, Puts, Martine, Alsaad, Saad Mohammad, Brignardello-Petersen, Romina, Thabane, Lehana, Veroniki, Areti-Angeliki, Adachi, Rick, Richardson, Julie, Cameron, Ian, Bakouni, Hamzah, Vasiliadis, Helen-Maria, Basu, Monisha, Borrie, Michael, Morais, Jose, Hogan, David, Molnar, Frank, Fruetel, Karen, Beauchet, Olivier, Launay, Cyrille, Allali, Gilles, Chen, Szu-Yu Tina, Kushner-Kow, Janet, Yu, Sung-Hsun, Chu, Karen, Seifer, Colette, Chuen, Victoria, Prashad, Rashmi, Beker, Lyndsay, Schlegel, Kimberly, Coulter, Corinne, Davies, Jasmine, Whitlock, Jennifer, Gutmanis, Iris, Park, Grace, Garm, Antonina (Annette), Song, Xiaowei, Hammami, Sonia, Hajem, Said, Hammami, Mohamed, Yaich, Amine, Kechida, Malek, Klii, Rym, Kochtali, Ines, Peel, Alexandrea, Harkness, Karen, Berry, Elizabeth, Smith, Stuart, Ross, Heather, Haslam-Larmer, Lynn, Convery, Catherine, Crawford, Lindsay, Hubble, Gerry, Valleau, Ellen, Hewston, Patricia, Deshpande, Nandini, Ho, Joanne, Carayannopoulos, Kallirroi Laiya, Bukhari, Rida, Cameron, Colleen, Nagge, Jeff, Jantzi, Micaela, Hirdes, John, Giangregorio, Lora, Pickard, Laura, Adachi, Jonathan D., Dobbs, Bonnie, Charles, Lesley, Chan, Karenn, Jamieson, Jeffrey, Tian, Peter, Slayter, Jeremy, McGibbon, Chris, McCollum, Alexander, Yetman, Linda, Oakley, Heather, Gionet, Sharron, McCloskey, Rose, Jarrett, Pamela, Mumbere-Bamusemba, David, Morais, José, Breton, Marie Claude, Farrell, Barbara, Giguère, Anik, Laurin, Danielle, Morin, Michèle, Sirois, Caroline, Tourigny, André, Marcotte, Martine, Kröger, Edeltraut, Sirois, Marie-Josée, Carmichael, Pierre-Hugues, Reeve, Emily, Kouladjian, Lisa, Veillette, Nathalie, Émond, Marcel, Dionne, Clermont, Aubin, Michèle, Bélanger, Richard, Foldes-Busque, Guillaume, Guillaumie, Laurence, Pluye, Pierre, Ware, Mark, Kueper, Jacqueline K., Montero-Odasso, Manuel, Speechley, Mark, Lanoue, Derek, Byszewski, Anna, Parsons, Robert, Lee, Jennifer, Chen, Andrea, Locklin, Jason, Patel, Tejal, Slonim, Karen, Hillier, Loretta M., Donaldson, Lindsay, Linda, Linda, Hillier, Loretta, McDermott, Miranda, Legere, Laura, McNeill, Susan, Blain, Julie, Lam, Robert, Rey, Michelle, Lemay, Geneviève, Leblond, Sara, Antoun, Thérèse, Carreau, Louise, Bouattane, El Moustafa, Joanisse, John, Lessard, Linda, Filion, Mélanie, Lesley, Charles, Parmar, Jasneet, Bremault-Phillips, Suzette, Lori, Sacry, Bryan, Slugett, Lew, Brendan, Keller, Denise, Ho, Joanne M.W., Parker, Shelley, Zeh, Wendy, Wong, Ken, Tsang, Ada, Contreras, Jesika, Ryan, David, Schwartz, Rhonda, Straus, Sharon, Liu, Barbara A., Jackson, Linda, Scarfone, Valerie, Madden, Kenneth, Cuff, Darcye, Meneilly, Graydon, Mah, Jasmine, Rhee, Glara Gaeun, Peel, Jacinta, Rocker, Adam, Weiss, Daniel, Tsang, Phillip, Mah, Greta, Chu, Patrick, Chan, Gabriel, Mandas, Roula, Olanubi, Timmy, Lum, Marlene, Heitner, Renee, Dellaposta, Felina, McGeachie, Mary Ellen, Chu, Dominic, Chang, Feng, McCormack, Norma, Woollard, Susan, McMillan, Jacqueline, Gill, John, Krentz, Hartmut, Mehta, Nishila, Rodrigues, Craig, Lamba, Manpreet, Wu, Wei, Herrmann, Nathan, Gill, Sudeep, Chan, An Wen, Mason, Robin, Day, Suzanne, Milan, Raymond, Berbich, Djamal, Naglie, Gary, Sanford, Sarah, Bédard, Michel, Tuokko, Holly, Mazer, Barbara, Porter, Michelle, Moorhouse, Paige, Polgar, Jan, Rapoport, Mark J., Naqvi, Syed, Dawood, Ryhana, O’Neill, Meagan, Mina, Daniel Santa, Sabiston, Catherine, Tomlinson, George, O’Donnell, Denis, Hazzan, Afeez A., Navare, Hrishi, Broadhurst, Daphne, Simpson, Diane, Loeb, Mark, Bon, Trevor, Plotnikov, Galina, Gorelic, Oleg, Bracha, Lior, Tishler, Moshe, Izhakian, Shimon, Prorok, Jeanette, McMillan, Colleen, Oremus, Mark, Stolee, Paul, Rosario, Carla, Jang, Raymond, Bezjak, Andrea, Yokom, Daniel, Alibhai, Shabbir M.H., Rozanski, Gabriela, Tang, Ada, Gourlay, Julie, Jack, Kelsey, Nowak, Christina, Sattar, Schroder, Spoelstra, Sandra, Bethell, Jennifer, Andrew, Melissa, Ayala, Ana Patricia, Ploeg, Jenny, Deangelis, Carlo, Elliott, Jacobi, Frank, Chris, Sidani, Souraya, McGilton, Katherine, Schuck, Sheena, Truter, Karen, Peters, Kayleen, Scotchmer, Emma, Sekhon, Harmehr, Skrastins, Emily, Ishigami, Yoko, Kirkland, Susan, Barhoumi, Amel, Robert, Tate, Lauren, Griffith, Thébeau, Annette, Tessier, Daniel, Trottier, Lise, Tran, Hang, Pereira, José, Teeple, Lori, Downer, Kathryn, Varughese, Jobin, Marcella, Jill, David, Henderson, Mary-Lou, Kelley, Robert, Benoît, Drake, Colleen, Grossman, Daphna, Vasudev, Akshya, Forchuk, Cheryl, Burhan, Amer, Booth, Richard, Hoch, Jeff, Isaranuwatchai, Wanrudee, Rudnick, Abraham, Seth, Puneet, Flint, Alistair, Rej, Soham, Reiss, Jeffrey, Von Maltzahn, Maia, Wong, Camilla, Tanzini, Rosa Maria, Gulasingam, Pauline, Cheng, Susanna, Haq, Rashida, Yang, Samantha, Johnson, Keia, Sheiban, Linda, Yu, Maggie Yongci, Jeffs, Lianne, Yung, Donald, Ewa, Vivian, and Turley, Nathan

Subjects
Abstracts, Geriatrics and Gerontology, Gerontology
Published
2017
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27. Number of patients needed to prescribe statins in primary cardiovascular prevention: mirage and reality.

Author

Rossignol, Michel, Labrecque, Michel, Cauchon, Michel, Breton, Marie-Claude, and Poirier, Paul

Subjects
CARDIOVASCULAR disease treatment, PHYSICIAN-patient relations, CORONARY disease, PRIMARY care, FAMILY medicine, CORONARY heart disease prevention, ANTILIPEMIC agents, PREVENTIVE health services
Abstract

Background: Number of patients needed to treat (NNT) with a statin in primary prevention of coronary heart disease (CHD) is often misinterpreted because this single statistic averages results from heterogeneous studies.Objective: To provide estimates of the number of individuals needed to be prescribed a statin to prevent one CHD event accounting for their level of CHD risk and for persistence to treatment.Methods: A post hoc analysis was conducted based on a Cochrane review on statins for the primary prevention of cardiovascular diseases. Five-year NNTs were calculated separately from randomized clinical trials (RCTs), including 'lower' and 'higher' risk populations (CHD mean event rates of 3.7 and 14.4 per 1000 person-years, respectively). NNTs were adjusted for 5-year persistence to treatment using a value of 65%.Results: Persistence-adjusted 5-year NNTs to prevent one CHD for the lower and higher CHD risk categories were 146 [95% confidence interval (CI): 117-211] and 53 (95% CI: 39-88) respectively, values 25% and 15% higher than their unadjusted counterpart (117, 95% CI: 94-167 and 46, 95% CI: 34-78).Conclusions: Five-year NNTs for statins to prevent a first CHD is almost three times higher in those at lower versus higher risk populations. Reporting combined results from RCTs including subjects at different cardiovascular risks should be avoided. Individualizing the risk of CHD should orient family physicians and their patients in their choice of preventive approaches and generate more realistic expectations about compliance and outcomes. [ABSTRACT FROM AUTHOR]

Published
2018
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28. Factors associated with adherence to asthma treatment with inhaled corticosteroids: A cross-sectional exploratory study.

Author

Adouni Lawani, Moulikatou, Zongo, Frank, Breton, Marie-Claude, Moisan, Jocelyne, Grégoire, Jean-Pierre, Dorval, Eileen, Boulet, Louis-Philippe, Jobin, Marie-Sophie, and Guénette, Line

Subjects
ASTHMATICS, ASTHMA treatment, CORTICOSTEROIDS, PATHOLOGICAL physiology, PATIENT compliance
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 [ABSTRACT FROM AUTHOR]

Published
2018
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29. Le risque de mortalité périnatale associé à l’asthme et à l’utilisation de corticostéroïdes inhalés pendant la grossesse

Author

Breton, Marie-Claude and Blais, Lucie

Subjects
administrative databases of Quebec, mortalité périnatale, corticostéroïde inhalés, deux niveaux d’échantillonnage, cohort, asthma, two-stage sampling, grossesse, asthme, bases de données administratives du Québec, perinatal mortality, cohorte, épidémiologie, epidemiology, pregnancy, medical chart, inhaled corticosteroids, dossier médical
Abstract

L’asthme maternel complique environ 3,4% à 12,4% des grossesses dans les pays développés ce qui en fait une des maladies chroniques les plus fréquentes pouvant engendrer de sérieux problèmes médicaux chez la mère et le fœtus. D’autre part, un taux relativement important de femmes enceintes, soit 4 à 7%, utilisent des médicaments anti-asthmatiques. La mortinaissance, la mortalité néonatale et/ou la mortalité périnatale sont les issues de grossesses les plus dramatiques pour l’enfant et la famille. Toutefois, l’effet de l’asthme et de l’utilisation des corticostéroïdes inhalés (CSI) pendant la grossesse sur ces complications a été inadéquatement évalué. La majorité des études qui ont évalué ces associations souffraient d’un manque de puissance statistique et/ou d’une absence ou d’un ajustement inadéquat pour les variables potentiellement confondantes. Les travaux présentés dans cette thèse ont donc pour objectif d’évaluer le risque de mortalité périnatale chez les femmes asthmatiques comparativement aux femmes non- asthmatiques. Cette thèse vise également à évaluer si les femmes asthmatiques exposées aux CSI courent plus de risque de mortalité périnatale que les femmes asthmatiques non exposées et si le risque de mortalité périnatale varie en fonction de la dose quotidienne de CSI utilisée par la mère pendant la grossesse. À l’aide du croisement de trois bases de données administratives du Québec, une large cohorte de femmes asthmatiques et non-asthmatiques qui ont eu au moins une grossesse entre 1990 et 2002 a été construite (n=41 142). À partir de cette cohorte, deux cohortes de grossesses ont été constituées. Les deux premières études présentées dans cette thèse sont basées sur toute la cohorte alors que la dernière étude est basée uniquement sur les grossesses de femmes asthmatiques. Une étude de cohorte a d’abord été réalisée afin d’évaluer l’effet de l’asthme maternel sur le risque de mortalité périnatale permettant l’ajustement pour les variables provenant des bases de données administratives. Afin de mieux estimer le risque de mortalité périnatale chez les femmes asthmatiques une étude de cohorte comprenant deux phases d’échantillonnage a ensuite été réalisée à l’aide d’informations additionnelles sur le tabagisme, l’utilisation de drogue illicite et l’histoire de mortinaissances, colligées à partir du dossier médical de la mère. Finalement, le risque de mortalité périnatale chez les femmes asthmatiques qui ont utilisé des CSI pendant la grossesse et le risque de mortalité périnatale en fonction de la dose moyenne quotidienne de CSI consommée par la mère pendant la grossesse ont été investigués à l’aide d’une étude de cohorte à deux phases d’échantillonnage chez les femmes asthmatiques uniquement. Nous avons premièrement observé que l’asthme pendant la grossesse pourrait augmenter le risque de mortalité périnatale due à l’augmentation du risque de bébés de petits poids et de bébés prématurés chez les femmes asthmatiques (OR=1,30; IC 95%: 1,05-1,57). Toutefois, après avoir ajusté pour le tabagisme pendant la grossesse, le risque relatif de mortalité périnatale a diminué à 12% et l’association n’est pas demeurée statistiquement significative (OR= 1,12; IC 95%: 0,87-1,45). Finalement, l’utilisation de CSI pendant la grossesse, lorsque la dose n’a pas été considérée, n’a pas été associé à une augmentation significative du risque de mortalité périnatale (OR= 1,07; IC 95% : 0,70-1,61) et un effet protecteur non-significatif de l’utilisation de doses de CSI de 250 ug ou moins par jour a été observé (OR=0,89; IC 95%: 0,55 -1,44). Toutefois, les femmes qui ont pris des doses >250 ug/jour avaient un risque accru de mortalité périnatale de 52%, mais cette association n’était pas statistiquement significative (OR=1,52; IC 95%: 0,62-3,76). Cette augmentation du risque pourrait toutefois résulter d’un ajustement imparfait pour la sévérité et le contrôle de l’asthme (les femmes asthmatiques qui ont utlisé >250 ug/jour sont susceptibles d’avoir un asthme plus sévère ou inadéquatement maîtrisé). Les conclusions de nos travaux qui sont plutôt rassurantes pourront contribuer à une meilleure prise en charge des femmes enceintes asthmatiques, à aider les médecins dans la prescription de CSI pendant la grossesse et à rassurer les femmes enceintes souffrant d’asthme et les femmes enceintes qui doivent utiliser des CSI. Toutefois, des études supplémentaires sont nécessaires afin de pouvoir conclure que l’utilisation de doses plus élevées de CSI (>250 ug/jour) pendant la grossesse sont sécuritaires., Maternal asthma is one of the most common medical conditions in developed contries that can cause serious problems for the mother and the foetus with 3.4% to 12.4% of pregnancies complicated by asthma. On the other hand, a relatively important rate of of pregnant women, 4% to 7%, uses anti-asthmatic drugs. Stillbirth, neonatal mortality and/or perinatal mortality are the most dramatic perinatal pregnancy outcomes for children and families. However, the effect of asthma and the use of inhaled corticosteroids (ICS) during pregnancy on these perinatal outcomes have been inadequately evaluated. Most studies that have evaluated these associations suffer from a lack of statistical power and/or a lack or an inadequate adjustment for potential confounding variables. The objectives of this thesis were to evaluate the risk of perinatal mortality among asthmatic women compared to non-asthmatic women. This thesis also aims at evaluating whether or not asthmatic women exposed to ICS during pregnancy are more at risk of perinatal mortality than asthmatic women who are not exposed to ICS as well as estimating the risk of perinatal mortality as a function of the daily dose of ICS taken by the mother during pregnancy. From the linkage of three of Quebec’s administrative databases, a large cohort was created including asthmatics and non-asthmatic women who had at least one pregnancy between 1990 and 2002 (n=41 142). From this cohort, two cohorts of pregnancies were constructed. The first two studies presented in this thesis were based on the entire cohort, whereas the third study was based only on the pregnancies of asthmatic women. A cohort study was first conducted to evaluate the effect of maternal asthma on the risk of perinatal mortality while adjusting for confounding variables derived from the administrative databases. To better quantify the association between maternal asthma and the risk of perinatal mortality, a two-stage sampling cohort design was conducted using additional information on smoking, illicit drug use and history of stillbirths, which were gathered from the medical charts of a sampling of mothers. Finally, the risk of perinatal mortality among asthmatic women exposed to ICS during pregnancy and the risk of perinatal mortality according to the daily dose of ICS taken during pregnancy were evaluated with a two-stage sampling cohort design among asthmatics women only. Firstly, we observed that asthma during pregnancy may increase the risk of perinatal mortality due to an increased risk of low birth weight and premature delivery among asthmatic women (OR=1.30; 95%CI: 1.05-1.57). However, after adjusting for cigarette smoking, the relative risk of perinatal mortality decreased to 12% and did not remain statistically significant. Finally, no significant increased risk of perinatal mortality among asthmatic women exposed to ICS during pregnancy (any doses) as compared to asthmatic women who were not exposed to ICS during pregnancy was observed (OR=1.07 (95% CI: 0.70 -1.61)) and a non-significant protective effect was observed among women who used 250 ug or less of ICS per day (OR=0.89; 95% CI: 0.55 -1.44)). However, the use of more than 250 ug/day of ICS was associated with a 52% increased risk of perinatal mortality, but the association was not significant (OR=1.52; 95% CI: 0.62-3.76). This increased risk may be explain by an inadequate adjustment for asthma severity and control (asthmatic women who used more than 250 ug/day of ICS may have more severe and uncontrolled asthma). The conclusions of our work which is rather reassuring can contribute to a better management of asthma during pregnancy, assist physicians in prescribing ICS during pregnancy and reassure pregnant women with asthma and pregnant women who should use ICS. However, additional studies are needed before we can conclude that higher doses of ICS (> 250 ug/day) are safe during pregnancy.

Published
2011

32. Difficulty adhering to antidiabetes treatment : factors associated with persistence and compliance.

Author

Guénette, Line, Moisan, Jocelyne, Breton, Marie-Claude, Sirois, Caroline, Grégoire, Jean-Pierre, Guénette, Line, Moisan, Jocelyne, Breton, Marie-Claude, Sirois, Caroline, and Grégoire, Jean-Pierre

Abstract

Aims. – This study aimed to assess the 1-year treatment persistence and compliance of new oral antidiabetic drug (OAD) users with their treatment, and to identify the factors associated with both persistence and compliance. Methods. – This population-based cohort study of new OAD users aged 18 years or above used the Quebec health insurance board databases. Those having a prescription filled for antidiabetic treatment during the period leading up to the 1-year anniversary of their first claim were considered to be persistent with their antidiabetic treatment. Of these patients, individuals with a medication possession ratio (MPR) greater or equal to 80% for OAD or insulin were deemed compliant. Also identified were the characteristics associated with both outcomes, using a multivariate logistic regression model. Results. – Our cohort consisted of 151,173 individuals, 119,832 (79.3%) of whom were considered persistent. Of these, 93,418 (78.0%) were also deemed compliant. Persistence and compliance were associated with older ages, living in a rural region, low socioeconomic status, having the first OAD prescribed by a general practitioner and a history of using five different drugs or more. People were less likely to be persistent and compliant if their initial OAD was a secretagogue and if they had consulted a physician eight times or more during the year prior to starting treatment. Conclusion. – One year after OAD treatment initiation, 21% had discontinued their treatment and 22% of those still being treated were non-compliant. These results could help to tailor interventions aimed at optimizing the use of OAD treatments., La difficulté à adhérer à un traitement antidiabétique : les facteurs associés à la persistance et à l’observance. Buts. – Déterminer la persistance au traitement chez les nouveaux utilisateurs d’antidiabétique oral (ADO) un an après l’initiation du traitement. Parmi les persistants, évaluer leur observance du traitement et, enfin, identifier les facteurs associés à la persistance et à l’observance. Méthodes. – Nous avons effectué une étude de cohorte populationnelle de nouveaux utilisateurs d’ADO âgés de 18 ans ou plus en utilisant les banques de données de la Régie de l’assurance maladie du Québec. Les personnes qui ont acquis une ordonnance pour un traitement antidiabétique dans la période précédant le premier anniversaire de leur première acquisition ont été considérées persistantes à prendre leur traitement antidiabétique. Parmi ces personnes, celles pour qui plus de 80 % des jours étaient couverts par un ADO ou de l’insuline ont été considérées observantes. Nous avons identifié les caractéristiques associées à la persistance et à l’observance en utilisant un modèle de régression logistique multivariée. Résultats. – Notre cohorte était composée de 151 173 individus dont 119 832 (79,3 %) étaient considérés persistants. De ces individus, 93 418 (78,0 %) ont été jugés observants. La persistance et l’observance étaient associées à l’augmentation de l’âge, au fait de vivre dans une région rurale, à un statut socioéconomique bas, au fait que le premier ADO prescrit l’ait été par un médecin généraliste et au fait d’avoir utilisé cinq médicaments différents ou plus dans l’année précédente. Les individus étaient moins susceptibles d’être persistants et observants si le premier ADO prescrit était une sulfonylurée et s’ils avaient consulté un médecin huit fois ou plus dans l’année précédant l’initiation de leur ADO. Conclusions. – Un an après l’initiation d’un traitement ADO, 21 % des individus avaient cessé leur traitement et 22 % de ceux toujours traités n’étaient pas o

Published
2013

36. The Drug Utilization Review Network of Quebec

Author

Breton, Marie-Claude, Bourbeau, Kateri, Cusson, Jean R., Grégoire, Jean-Pierre, Guévremont, Chantai, Labranche, Sylvie, Milot, Alain, Robert, Sylvie, and St-Laurent, Maurice

Abstract

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebec's Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The network's main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the network's efforts.

Published
1996
Full Text
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37. A pharmacoeconomic evaluation of the myocardial ischemia reduction with aggressive cholesterol lowering (MIRACL) study in Canada.

Author

Casciano R, Tarride JE, Breton MC, Stern L, and Langer A

Subjects
Anticholesteremic Agents therapeutic use, Canada epidemiology, Cost-Benefit Analysis standards, Humans, Hypercholesterolemia drug therapy, Hypercholesterolemia epidemiology, Myocardial Ischemia drug therapy, Myocardial Ischemia epidemiology, Anticholesteremic Agents economics, Economics, Pharmaceutical standards, Hypercholesterolemia economics, Myocardial Ischemia economics
Abstract

Objective: To determine a 16-week total healthcare cost and the cost-effectiveness of short-term, lipid-lowering therapy with atorvastatin 80 mg following acute coronary syndrome (ACS) in Canada., Methods: The expected costs per patient on atorvastatin 80 mg per day and placebo were compared using clinical outcome data from the MIRACL study and cost data from the Ontario Case Costing Project and the Ontario Schedule of Benefits. The cost per event avoided was also assessed. The clinical outcomes measured included: death, cardiac arrest, non-fatal myocardial infarction (MI), fatal MI, angina pectoris, stroke, congestive heart failure, and surgical or percutaneous coronary revascularizations. All direct medical costs from the perspective of the Canadian health care system were taken into account., Results: The total expected cost per patient was 2,590 dollars in the placebo group and 2,639 dollars in the atorvastatin group. The incremental cost of atorvastatin treatment (49.26 dollars per patient) corresponded to a cost of 1,285 dollars per event avoided. The cost savings obtained through the reduction in events offset 86% of the cost of atorvastatin treatment. Budget impact analysis revealed that increased rates of atorvastatin usage following ACS were associated with large numbers of events avoided at a small additional cost when projected to the Canadian population., Conclusions: In Canada, the clinical benefits of intensive short-term atorvastatin treatment administered within 96 hours after ACS were associated with a favorable cost-effectiveness ratio. The incremental cost of atorvastatin is mostly offset by savings due to the reduction in events in patients treated with atorvastatin.

Published
2004

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