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Berger Pelletier, Elyse

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Berger Pelletier

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Elyse

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Université Laval. Faculté de médecine

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ncf11885754

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L'utilisation de la solution de salin hypertonique dans le traitement des victimes de traumatisme craniocérébral grave à l'urgence

2013, Berger Pelletier, Elyse, Turgeon-Fournier, Alexis, Émond, Marcel

Le traumatisme craniocérébral grave (TCC grave) est une affection qui peut engendrer de graves séquelles aux victimes. Dans la dernière décennie, un nouveau traitement, la solution de salin hypertonique (SSH), a gagné en popularité. Toutefois, peu de données probantes appuient son utilisation. Nous présentons deux études sur l’utilisation de SSH. La première étude est une revue systématique avec méta-analyse d’études randomisées contrôlées. Les données des dix études incluses n’ont pas permis d’observer une amélioration de la survie. La deuxième étude est une enquête de pratique des médecins d’urgence québécois concernant l’utilisation des solutions hyperosmolaires dans la phase aiguë de réanimation des victimes de TCC grave. Cinquante-trois pour cent (53 %) des répondants ont répondu utiliser la SSH. Avec ces deux études, nous avons pu conclure que, malgré le manque de preuves suffisantes pour appuyer l’utilisation des SSH, les médecins québécois sont nombreux à l’utiliser.

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A value-based comparison of the management of ambulatory respiratory diseases in walk-in clinics, primary care practices, and emergency departments : protocol for a multicenter prospective cohort study

2021-02-22, Berger Pelletier, Elyse, Breton, Mylaine, Moore, Lynne, Guertin, Jason Robert, Mercier, Éric, Lachapelle, Philippe, Blouin, Danielle, Borgundvaag, Bjug, Vaillancourt, Samuel, Duhoux, Arnaud, Berthelot, Simon, Harvey Labbé, Laurie, Paquette, Jean-Sébastien, Laberge, Maude, Archambault, Patrick, Lapointe-shaw, Lauren, Simon, Mathieu, Mallet, Myriam, Lefebvre, Gabrielle, Layani, Géraldine, Matthews, Deborah, Talbot, Denis, McBrien, Kerry, Simonyan, David, McLeod, Shelley, Messier, Alexandre, Morris, Judy, Morris, Kathleen, Ovens, Howard, Pageau, Paul, Perry, Jeffrey, Schull, Michael J., Stelfox, Henry Thomas

Background: In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. Results: Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. Conclusions: The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative.