Personne : Sirois, Caroline
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Université Laval. Faculté de pharmacie
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- PublicationAccès libreEconomic evaluations of interventions to optimize medication use in older adults with polypharmacy and multimorbidity : a systematic review(Dove Medical Press c, 2021-05-05) Gaudreault, Myriam; Bolduc, Carolann; Laberge, Maude; Lunghi, Carlotta; Nakamura, Yumiko; Sirois, Caroline; Laroche, Marie-LaurePurpose: To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy. Methods: We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs. Results: Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability. Conclusion: Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients.
- PublicationRestreintPharmacovigilance infirmière à l'urgence.(Ordre des infirmières et infirmiers du Québec, 2019-03-01) Carreau-Boudreau, Anne-Marie; Sirois, CarolineM. Tremblay, âgé de 80 ans, se présente aux urgences pour de multiples contusions après avoir chuté dans les escaliers le matin même. Son profl pharmacologique indique qu’il prend quotidiennement de l’amlodipine 5 mg pour une hypertension artérielle, du bisoprolol 1,25 mg pour stabiliser son rythme cardiaque, de l’acide acétylsalicylique (ASA) 80 mg, de la metformine 850 mg pour un diabète, de la rosuvastatine 10 mg pour une hypercholestérolémie, ainsi que du ramipril 10 mg et du furosémide 40 mg pour une insuffsance cardiaque légère. Son médecin a aussi instauré tout récemment du lorazépam régulier 1 mg au coucher afn de l’aider à dormir. Les premiers résultats biochimiques ne rapportent pas de décompensation de sa fonction cardiaque ou de son diabète.
- PublicationAccès libreStrategies aimed at preventing chronic opioid use in trauma and acute care surgery : a scoping review protocol.(BMJ Publishing, 2020-04-14) Lauzier, François; Tardif, Pier-Alexandre; Turgeon-Fournier, Alexis; Moore, Lynne; Bérubé, Mélanie; Perreault, Kadija; Pinard, Anne-Marie; Côté, Caroline; Bélanger, Carole; Sirois, CarolineIntroduction : Globally every year, millions of patients sustain traumatic injuries and require acute care surgeries. A high incidence of chronic opioid use (up to 58%) has been documented in these populations with significant negative individual and societal impacts. Despite the importance of this public health issue, optimal strategies to limit the chronic use of opioids after trauma and acute care surgery are not clear. We aim to identify existing strategies to prevent chronic opioid use in these populations. Methods and analysis : We will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify studies, reviews, recommendations and guidelines on strategies aimed at preventing chronic opioid use in patients after trauma and acute care surgery. We will search MEDLINE, EMBASE, PsycINFO, CINHAL, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest and websites of trauma and acute care surgery, pain, government and professional organisations. Databases will be searched for papers published from 1 January 2005 to a maximum of 6 months before submission of the final manuscript. Two reviewers will independently evaluate studies for eligibility and extract data from included studies using a standardised data abstraction form. Preventive strategies will be classified according to their types and targeted trauma populations and acute care surgery procedures. Ethics and dissemination : Research ethics approval is not required as this study is based on the secondary use of published data. This work will inform research and clinical stakeholders on the required next steps towards the uptake of effective strategies aimed at preventing chronic opioid use in trauma and acute care surgery patients.
- PublicationAccès librePharmacy record registration of acetyl salicylic acid (ASA) prescriptions in Quebec(Sagar Innovare Academic sciences, 2012-04-08) Guénette, Line; Sirois, CarolinePurpose: To determine the extent of which acetyl salicylic acid (ASA) use is included in patients' pharmacy records. Methods: During an in-home interview, people aged ≥ 65 years were asked to report all of the medications they had used at least once, including over-the-counter drugs, during the preceding month. Researchers recorded information on the drug name, reason for its use, and whether a physician prescribed it. From the pharmacy records, the drug names, prescription fill dates, quantities supplied, and the numbers of days' supply were recorded. The level of agreement for ASA use across data sources was assessed using proportions of agreement and kappa coefficients. Results: Of 193 individuals interviewed, 86 reported the use of ASA, including 76 ASA users (88.4%) who said it was prescribed by a physician. Pharmacy medication records indicated that there were 74 users of ASA. The proportion of agreement for ASA use was 93.8%, and kappa coefficient was 0.87 (95% confidence interval: 0.80-0.94). The sensitivity, specificity, and positive predictive value of the pharmacy data were all high. Conclusions: A large proportion of ASA use is documented in pharmacy records in Quebec. Thus, the information regarding ASA use in pharmacy records is reliable. This result may not be reproducible in other settings where pharmaceutical reimbursement rules are different.
- PublicationAccès libreQualité du traitement cardioprotecteur du diabète de type 2 chez les aînés québécois et son impact sur la morbidité cardiovasculaire(2010) Sirois, Caroline; Grégoire, Jean-Pierre; Moisan, JocelyneLe diabète de type 2 constitue une menace importante pour la santé publique, notamment parce qu'il engendre plusieurs complications cardiovasculaires. Les aînés sont particulièrement frappés par le diabète de type 2 et ses complications. Les médicaments cardioprotecteurs (antihypertenseurs, hypolipémiants et antiplaquettaires) peuvent réduire le fardeau des maladies cardiovasculaires, mais on connaît peu la façon dont ces médicaments sont utilisés par les aînés québécois et comment ils influencent leur santé. La thèse a pour objectif général de décrire l'usage de médicaments cardioprotecteurs dans le traitement du diabète de type 2 chez les aînés du Québec, et de déterminer l'impact des médicaments cardioprotecteurs sur la morbidité cardiovasculaire. Les bases de données administratives détenues ou gérées par la Régie de l'assurance maladie du Québec constituent les sources de données. La population à l'étude comprend les aînés de 66 ans et plus ayant débuté un antidiabétique oral entre le 1er janvier 1998 et le 31 décembre 2003. Trois études de cohorte ont été réalisées pour décrire l'usage des médicaments cardioprotecteurs dans l'année suivant l'initiation du traitement antidiabétique. Ensuite, une étude cas-témoins imbriquée dans la cohorte a été effectuée pour déterminer l'effet des médicaments cardioprotecteurs sur les infarctus du myocarde (IM) et les accidents vasculaires cérébraux (AVC). Deux autres études cas-témoins ont enfin été réalisées pour évaluer l'effet de l'aspirine sur les IM et les saignements gastrointestinaux. Le pourcentage d'individus utilisant les trois médicaments cardioprotecteurs s'élevait à 20,4%. Les plus forts prédicteurs de l'usage combiné de ces médicaments étaient l'usage antérieur d'antihypertenseurs [rapports de cotes (RC) = 1,6; LC. 95%: 1,4-1,7], d'hypolipémiants (7,4; 6,8-8,0) et d'antiplaquettaires (7,3; 6,7-7,9). Pour chaque période de 30 jours où les individus étaient exposés à une combinaison de médicaments cardioprotecteurs, le risque d'IM et d'AVC était diminué de 2% (RC : 0,98; 0,96-1,00). Toutefois, l'usage d'aspirine n'influençait pas le risque d'IM (1,16; 0,98-1,37), mais exposait à un risque accru de saignements gastro-intestinaux (1,94; 1,47-2,57).
- PublicationRestreintSuboptimal 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, CarolineCardiovascular 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.
- PublicationRestreintBenefits-risks and impacts on quality of life of medications used in multimorbid older adults : a Delphi study(SpringerLink, 2019-11-13) Berthelot, William; Frini, Anissa; Lunghi, Carlotta; Laroche, Marie‑Laure; Sirois, CarolineBackground: Multimorbidity and polypharmacy are common in older people. Despite the existence of quality criteria for medication use among this population, there is little guidance for managing the complex pharmacological arsenal in a multimorbidity context. Objective To establish consensus on benefits, risks and impacts on quality of life of medications used in an older adult with three chronic diseases that require complex pharmacotherapy. Setting International experts in pharmacology. Method: A panel of experts responded to three rounds of a Delphi survey. They assessed the benefits, risks and positive impacts on quality of life of 50 different medications or medication classes that could be used by a hypothetical multimorbid older patient aged 65–75 years, with type 2 diabetes, heart failure and chronic obstructive pulmonary disease. Each aspect was evaluated on a 5-level Likert scale. Main outcome measure: Percentage of agreement on each of the three aspects for all medication. Results: Consensus was reached on 95% of items (166/174). Only two medication classes were associated with both the highest category of benefits and positive impacts on quality of life, and the lowest risk category: long-acting anticholinergics and long-acting beta-2-agonists. Nine other medications/classes of medications were categorized within the highest benefits level (metformin, DPP-4-inhibitors, short-acting beta-2-agonists, ACE inhibitors, beta-blockers, warfarin, non-vitamin K oral anticoagulants, nitrates and acetaminophen). Fifteen medications were included in the highest level of risks, among which warfarin and Non-vitamin K oral anticoagulants. Conclusions: Medications recommended in clinical guidelines for individual diseases are generally considered positive for multimorbid older patients. Nevertheless, a non-negligible number of medications was deemed negative or very negative by our panelists. For multimorbid patients, individualizing treatment according to their preferences seems of utmost importance.
- PublicationRestreintUnderuse of cardioprotective treatment by the elderly with type 2 diabetes(Masson, 2008-04-18) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, CarolineAims. – 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.
- PublicationAccès libreAssociation between nutrition and the evolution of multimorbidity : the importance of fruits and vegetables and whole grain products(Churchill Livingstone, 2013-07-22) Ruel, Guillaume; Kröger, Edeltraut; Sirois, CarolineBackground & aims: Multimorbidity is a common health status. The impact of nutrition on the development of multimorbidity remains to be determined. The aim of this study is to determine the association between foods, macronutrients and micronutrients and the evolution of multimorbidity. Methods: Data from 1020 Chinese who participated in the Jiangsu longitudinal Nutrition Study (JIN) were collected in 2002 (baseline) and 2007 (follow-up). Three-day weighted food records and status for 11 chronic diseases was determined using biomedical measures (hypertension, diabetes, hypercholesterolemia and anemia) or self-reports (coronary heart disease, asthma, stroke, cancer, fracture, arthritis and hepatitis). Participants were divided in six categories of stage of evolution of multimorbidity. Association of foods, macronutrients and micronutrients at baseline with stages in the evolution of multimorbidity were determined. Data were adjusted for age, sex, BMI, marital status, sedentary lifestyle, smoking status, annual income, education and energy intake. Results: The prevalence of multimorbidity increased from 14% to 34%. A high consumption of fruit and vegetables (p < 0.05) and grain products other than rice and wheat (p < 0.001) were associated with healthier stages in the evolution of multimorbidity. The consumption of grain products other than rice and wheat was highly correlated with dietary fibers (r ¼ 0.77, p < 0.0001), iron (r ¼ 0.46, p < 0.0001), magnesium (r ¼ 0.49, p < 0.0001) and phosphorus (r ¼ 0.57, p < 0.0001) intake which were also associated with healthier stages. Conclusion: This study provides the first evidence of an association between nutrition and evolution towards multimorbidity. More precisely, greater consumption of fruits and vegetable and whole grain products consumption appear to lower the risk of multimorbidity.
- PublicationRestreintA linguistic multi-criteria classification approach for the evaluation of polypharmacy quality.(Newswood Limited, 2018-05-14) Frini, Anissa; Sirois, Caroline; Laroche, Marie-LaureWith the intensification of chronical disease within older people, concurrent use of different drugs (polypharmacy) is becoming increasingly frequent. However, there is no established manner to determine whether polypharmacy is appropriate or not. We propose an original method of classifying polypharmacy using multi-criteria decision-aid methods. To do this, we provided clinicians with a list of drugs that could be potentially prescribed to the typical elderly person suffering from three diseases (diabetes, chronic obstructive pulmonary disease, and heart failure). Clinicians expressed their opinion on a 5-point Likert scale, allowing for hesitation between two or more answers. They evaluated risks, benefits, and impacts of each drug on the patient’s quality of life. We then aggregated these evaluations in order to obtain, for each drug, a multi-criteria evaluation vector representing the collective opinion of the clinicians consulted. Subsequently, ELECTRE Tri-C and ELECTRE Tri multi-criteria methods were used to evaluate and assign the polypharmacy to one of the following three categories: appropriate, more or less appropriate, or inappropriate