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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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  • 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
  • PublicationRestreint
    Initiation of insulin therapy in elderly patients taking oral antidiabetes drugs
    (Canadian Medical Association, 2009-06-22) Pérez Herrera, Norma Maria; Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Background: We sought to estimate the rate of initiation of insulin therapy among elderly patients using oral antidiabetes drugs and to identify the factors associated with this initiation. Methods: We conducted a population-based cohort study involving people aged 66 or more years who were newly dispensed an oral antidiabetes drug. Individuals who had received acarbose or a thiazolidinedione were excluded. Therate of insulin initiation was calculated by use of the Kaplan–Meier method. Factors associated with insulin initiation were identified by multivariable Cox regression analyses. Results: In this cohort of 69 674 new users of oral antidiabetes drugs, insulin was initiated at rate of 9.7 cases per 1000 patient-years. Patients who had initially received an insulin secretagogue (rather than metformin), who were prescribed an oral antidiabetes drug by an endocrinologist or an internist, who received higher initial doses of an oral antidiabetes drug, who received oral corticosteroids, used glucometer strips, or were admitted to hospital in the year before initiation of oral antidiabetes therapy, or who received 16 or more medications were more likely than those without these characteristics to have insulin therapy initiated. In contrast, patients who received thiazides or who used up to 12 medications (v. none) were less likely to have insulin therapy initiated. Interpretation: Several factors related to drugs and health services are associated with the initiation of insulin therapy in elderly patients receiving oral antidiabetes drugs. It is unclear whether these factors predict secondary failure of oral antidiabetes drugs or instead reflect better management of type 2 diabetes.
  • PublicationRestreint
    Underuse of cardioprotective treatment by the elderly with type 2 diabetes
    (Masson, 2008-04-18) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Aims. – To assess whether elderly patients with type 2 diabetes use a comprehensive cardioprotective regimen (CCR) of antihypertensive, lipid-lowering and antiplatelet drugs in the year following oral antidiabetic drug initiation and, if so, to identify the determinants of such use. Methods. – Using the Quebec Diabetes Surveillance System administrative database, we carried out an inception cohort study of individuals aged 66 years and over who began oral antidiabetic therapy between 1998 and 2002. Those individuals with at least one claim in the year after starting antidiabetic treatment for an antihypertensive, a lipid-lowering and an antiplatelet drugs were deemed to be using a CCR. A multivariate logistic regression model was built to identify the characteristics associated with CCR use. Results. – Of the 48,505 individuals included in the study, 9912 (20.4%) used a CCR during the year following the first antidiabetic claim. Those more likely to use a CCR were men (odds ratio [OR]: 1.2; 99% confidence intervals [CI]: 1.1–1.3), those who had used an antihypertensive (1.6; 1.4–1.7), lipid-lowering (7.4; 6.8–8.0) or antiplatelet (7.3; 6.7–7.9) drug in the year before the first antidiabetic claim and those with a preexisting diagnosis of cardiovascular disease (1.9; 1.8–2.1). The odds of using a CCR increased every year. Conclusions. – CCR use by the elderly with type 2 diabetes in the year following antidiabetic initiation is low, and prior use of individual cardioprotective drugs is a strong predictor of its use. These findings suggest that the treatment of important modifiable risk factors for cardiovascular disease is suboptimal.
  • PublicationRestreint
    Suboptimal use of cardioprotective drugs in newly treated elderly individuals with type 2 diabetes.
    (American Diabetes Association, 2007-03-20) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Cardiovascular disease is the maincomplication experienced by el-derly individuals with diabetes (1).Despite randomized trials showing thebenefits of individual (2–4) or combined(5) pharmacological treatments of cardio-vascular risk factors in diabetes, observa-tional studies have shown suboptimal useof medications (6–8). However, little isknown about the use of cardioprotectivemedication among elderly individualswho were not already taking it before di-abetes treatment was undertaken. Wetherefore studied a population of elderlyindividuals with type 2 diabetes in theprovince of Quebec, Canada, who hadnot been treated with any antihyperten-sive, lipid-lowering, or antiplatelet drugsin the year before oral antidiabetes druginitiation. We assessed whether they useda comprehensive cardioprotective regi-men (CCR) of those three medications inthe year following oral antidiabetic initia-tion. We also identified the determinantsof a CCR use.
  • PublicationAccès libre
    The benefit of aspirin therapy in type 2 diabetes : what is the evidence?
    (Elsevier/North-Holland Biomedical Press, 2008-05-20) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Many clinical guidelines recommend aspirin therapy for the prevention of cardiovascular events in individuals with type 2 diabetes. However it is unclear whether the level of evidence in guidelines is derived from studies carried out among individuals with diabetes. Medline and Embase databases were searched to retrieve studies published since 1990, evaluating the effect of aspirin on cardiovascular outcomes in subjects with type 2 diabetes. Four studies corresponded to the inclusion criteria. The three clinical trials retrieved could not prove from a statistical point of view, the benefits of aspirin therapy for subjects with type 2 diabetes. Reduction in cardiac mortality was found only in one observational study. Consequently, these findings suggest that the clinical guidelines have based their recommendations upon the expected benefit previously observed in other high-risk populations. Given the lack of hard evidence and the different well-known platelet physiology encountered in patients with diabetes, use of aspirin as a standard treatment at the highest level of evidence in guidelines for subjects with type 2 diabetes should be revisited.
  • PublicationAccès libre
    The economic burden of insomnia : direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms and good sleepers
    (American Sleep Disorders Association and Sleep Research Society, 2009-01-01) Grégoire, Jean-Pierre; Morin, Charles M.; Savard, Josée; Daley, Meagan; LeBlanc, Mélanie
    Background and purpose: Insomnia is a highly prevalent problem that is associated with increased use of health care services and products, as well as functional impairments. This study estimated from a societal perspective the direct and indirect costs of insomnia. Participants and methods: A randomly selected sample of 948 adults (mean age = 43.7 years old; 60% female) from the province of Quebec, Canada completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences, and reduced productivity. Data were also obtained from the Quebec government administered health insurance board regarding consultations and hospitalizations. Participants were categorized as having insomnia syndrome, insomnia symptoms or as being good sleepers using a standard algorithm. Frequencies of target cost variables were obtained and multiplied by unit costs to generate estimates of total costs for the adult population of the province of Quebec. Results: The total annual cost of insomnia in the province of Quebec was estimated at $6.6 billion (Cdn$). This includes direct costs associated with insomnia-motivated health-care consultations ($191.2 million) and transportation for these consultations ($36.6 million), prescription medications ($16.5 million), over the-counter products ($1.8 million) and alcohol used as a sleep aid ($339.8 million). Annual indirect costs associated with insomnia-related absenteeism were estimated at $970.6 million, with insomnia-related productivity losses estimated at $5.0 billion. The average annual per-person costs (direct and indirect combined) were $5,010 for individuals with insomnia syndrome, $1431 for individuals presenting with symptoms, and $421 for good sleepers. Conclusions: This study suggests that the economic burden of insomnia is very high, with the largest proportion of all expenses (76%) attributable to insomnia-related work absences and reduced productivity. As the economic burden of untreated insomnia is much higher than that of treating insomnia, future clinical trials should evaluate the cost-benefits, cost-utility, and cost-effectiveness of insomnia therapies.
  • PublicationAccès libre
    The natural history of insomnia : a population-based 3-year longitudinal study
    (JAMA, 2009-03-09) Grégoire, Jean-Pierre; Mérette, Chantal; Morin, Charles M.; Bélanger, Lynda; Savard, Josée; Espie, Colin A.; Baillargeon, Lucie; LeBlanc, Mélanie; Ivers, Hans
    Background Despite its high prevalence, little information is available about the natural history of insomnia. The extent to which episodes of insomnia will persist or remit over time is difficult to predict. We examined the natural history of insomnia and describe the most common trajectories over 3 years. Methods Three hundred eighty-eight adults (mean [SD] age, 44.8 [13.9] years; 61% women) were selected from a larger population-based sample on the basis of the presence of insomnia at baseline. They completed standardized sleep/insomnia questionnaires at 3 annual follow-up assessments. For each follow-up assessment, participants were classified into 1 of 3 groups (individuals with an insomnia syndrome, individuals with insomnia symptoms, and individuals with good sleep) on the basis of algorithms using standard diagnostic criteria for insomnia. Rates of persistent insomnia, remission, and relapse were computed for each group. Results Of the study sample, 74% reported insomnia for at least 1 year (2 consecutive assessments) and 46% reported insomnia persisting over the entire 3-year study. The course of insomnia was more likely to be persistent in those with more severe insomnia at baseline (ie, insomnia syndrome) and in women and older adults. Remission rate was 54%; however, 27% of those with remission of insomnia eventually experienced relapse. Individuals with subsyndromal insomnia at baseline were 3 times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well. Conclusion These findings indicate that insomnia is often a persistent condition, in particular when it reaches the diagnostic threshold for an insomnia disorder.