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Grégoire, Jean-Pierre

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Grégoire

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Jean-Pierre

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Université Laval. Faculté de pharmacie

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  • PublicationRestreint
    Psychosocial factors associated with pharmacists’ antidepressant drug treatment monitoring.
    (American Pharmacists Association, 2020-03-12) Grégoire, Jean-Pierre; Guillaumie, Laurence; Humphries, Brittany; Lauzier, Sophie; Moisan, Jocelyne; Villeneuve, Denis
    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 ¼ 29.6%). Systematic ADT monitoring was not widely reported (mean score ¼ 2.0 out of 5.0), and intention was moderate (mean ¼ 3.2). Pharmacists’ intention was the sole psychosocial factor associated with reporting systematic ADT monitoring (P < 0.0001; R2 ¼ 0.370). All TPB constructs and professional identity were associated with intention (P < 0.0001; R2 ¼ 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.
  • PublicationAccès libre
    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.
    (Wolters Kluwer Health, 2015-07-01) Grégoire, Jean-Pierre; Dossa, Anara Richi; Lauzier, Sophie; Moisan, Jocelyne; Guénette, Line; Sirois, Caroline
    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.
  • PublicationRestreint
    Effectiveness and content analysis of interventions to enhance oral antidiabetic drug adherence in adults with type2 diabetes : systematic review and meta-analysis
    (Elsevier, 2015-05-23) Grégoire, Jean-Pierre; Bruin, Marijn de; Vézina-Im, Lydi-Anne; Guillaumie, Laurence; Pérez Herrera, Norma Maria; Zomahoun, Hervé Tchala Vignon; Moisan, Jocelyne; Guénette, Line
    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 I2). 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; I2 = 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; I2 = 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.
  • PublicationAccès libre
    Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents
    (2009-04-01) Grégoire, Jean-Pierre; Morin, Charles M.; Savard, Josée; Daley, Meagan; Baillargeon, Lucie; LeBlanc, Mélanie
    Background and purpose: To document and provide a micro analysis of the relationship between insomnia and health problems, health-care use, absenteeism, productivity and accidents. Participants and methods: A population-based sample of 953 French-speaking adults from Québec, Canada. Participants were categorized as having insomnia syndrome (SYND) or insomnia symptoms (SYMPT) or as good sleepers (GS). They completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences and reduced work productivity. Data were also obtained from the Québec-government-administered health insurance board on selected variables (e.g., consultations with health-care professionals, diagnoses). Results: There were significantly more individuals in the SYND group relative to the GS group reporting at least one chronic health problem (83% vs. 53%; OR: 2.78) and who had consulted a health-care professional in the past year (81% vs. 60%; OR: 2.8). There were also higher proportions of individuals in the SYND group than in the GS group who had used prescription medications (57% vs. 30.7%; OR: 2.8), most notably to treat insomnia, mood and anxiety disorders, or who had used over-the-counter products (75.6% vs. 62.0%; OR: 1.8) and alcohol as a sleep aid (17.8% vs. 3.9%; OR: 4.6). In terms of daytime function, 25.0% of the SYND had been absent from work relative to 17.1% of GS (OR: 1.7), 40.6% reported having experienced reduced productivity compared to 12.3% of GS (OR: 4.8) and non-motor-vehicle accidents occurred at higher rates in the SYND group (12.5% vs. 6.4% for GS; OR: 2.4). No differences were found for hospitalisations or motor-vehicle accidents. Most of the associations remained significant even after controlling for psychiatric comorbidity. Rates for the SYMPT group were situated between SYND and GS on all major dependent variables. Furthermore, insomnia and fatigue were perceived as contributing significantly to accidents, absences and decreased work productivity, regardless of insomnia status. Conclusions: This study indicates that insomnia is associated with significant morbidity in terms of health problems and health-care utilization, work absenteeism and reduced productivity, and risk of non-motor-vehicle accidents. Future studies should evaluate whether treating insomnia can reverse this morbidity.
  • PublicationRestreint
    Association between age and the initiation of antihypertensive, lipid Lowering, and antiplateletet medications in elderly individuals newly treated with antidiabetic drug.
    (London Baillière Tindall, 2009-09-16) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Couture, Julie; Sirois, Caroline
  • PublicationAccès libre
    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
    (M D P I AG, 2018-05-02) Grégoire, Jean-Pierre; Guillaumie, Laurence; Gagnon, Hélène; Villeneuve, Denis; Santina, Tania; Lauzier, Sophie; Moisan, Jocelyne
    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.
  • PublicationRestreint
    Persistence patterns with oral antidiabetes drug treatment in newly treated patients : a population-based study
    (Blackwell, 2011-05-18) Grégoire, Jean-Pierre; Blanc, Guillaume; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Objective: We assessed persistence patterns with oral antidiabetes drug (OAD) in patients newly dispensed with different OAD classes. Methods: We conducted a population-based cohort study using Quebec Health Insurance Board data. Patients aged 18 years or more newly dispensed an OAD between January 1, 1998 and December 31, 2003 were included in the study (n = 98,940). Persistence was defined as consistently refilling a prescription for the initial OAD within three times the days' supply of the preceding claim. For nonpersistent patients, a second course of therapy was defined as treatment initiation with any OAD after a first discontinuation. Patients were followed from treatment initiation up to December 31, 2004, ineligibility for the drug plan or death, whichever came first, and treatment discontinuation or second course of treatment. Cox regression models were used to compute adjusted hazards ratios (AHR) of persistence and initiation of second courses of therapy. Results: The probability of persisting with the initial OAD over a 12-month period was 65% and 56% for patients initiated on metformin and sylfonylurea, respectively. Compared to metformin, the likelihood of discontinuing the initial OAD over the study period was significantly higher for patients on sulphonylureas (AHR: 1.32; 95% CI 1.29–1.34). Patients started on sulphonylureas were also less likely to start a second course of therapy after a first treatment discontinuation (AHR: 0.91; 95% CI 0.89–0.93). Conclusions: Compared to diabetic patients initiated on metformin, those initiated on sulphonylureas displayed poorer persistence patterns.
  • PublicationAccès libre
    Association between interpersonal continuity of care and medication adherence in type 2 diabetes : an observational cohort study
    (Canadian Medical Association, 2017-05-08) Grégoire, Jean-Pierre; Dossa, Anara Richi; Lauzier, Sophie; Moisan, Jocelyne; Guénette, Line
    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.
  • PublicationAccès libre
    Difficulty adhering to antidiabetes treatment : factors associated with persistence and compliance.
    (Masson, 2013-03-21) Grégoire, Jean-Pierre; Moisan, Jocelyne; Breton, Marie-Claude; Guénette, Line; Sirois, Caroline
    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.
  • PublicationAccès libre
    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
    (Williams & Wilkins Co., 2016-04-01) Grégoire, Jean-Pierre; Guillaumie, Laurence; Zomahoun, Hervé Tchala Vignon; Lauzier, Sophie; Moisan, Jocelyne; Guénette, Line
    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.