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Personne :
Sirois, Caroline

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Sirois

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Caroline

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Université Laval. Faculté de pharmacie

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ncf12082644

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  • PublicationAccès libre
    Polypharmacy and pharmacological treatment of diabetes in older individuals : a population-based study in Quebec, Canada
    (MDPI AG, 2019-12-01) Plante, Céline; Simard, Marc; Gagnon, Marie-Ève; Sirois, Caroline
    Our objectives were to describe the use of pharmacological treatments in older adults with diabetes and to identify the factors associated with the use of a combination of hypoglycemic, antihypertensive and lipid-lowering agents. Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study among individuals aged 66–75 years with diabetes in 2014-2015. We described the number of medications and the classes of medications used and calculated the proportion of individuals using at least one medication from each of these classes: hypoglycemics, antihypertensives and lipid-lowering agents. We identified the factors associated with the use of this combination of treatments by performing robust Poisson regressions. The 146,710 individuals used an average of 12 (SD 7) different medications, mostly cardiovascular (91.3% of users), hormones, including hypoglycemic agents (84.5%), and central nervous system medications (79.8%). The majority of individuals (59%) were exposed to the combination of treatments and the factor most strongly associated was the presence of cardiovascular comorbidities (RR: 1.29; 99% CI: 1.28-1.31). Older individuals with diabetes are exposed to a large number of medications. While the use of the combination of treatments is significant and could translate into cardiovascular benefits at the population level, the potential risk associated with polypharmacy needs to be documented.
  • PublicationAccès libre
    Quelle est la place des médicaments dans les troubles du spectre de l’autisme?
    (Association des pharmaciens détaillants de la province de Québec, 2013-08-02) Faubert, Mirella; Gagnon, Marie-Ève; Sirois, Caroline
  • PublicationAccès libre
    Utilisation des médicaments potentiellement inappropriés chez les aînés québécois présentant des maladies chroniques ou leurs signes précurseurs : portrait 2014-2015.
    (Institut national de santé publique, 2019-08-15) Simard, Marc; Gagnon, Marie-Ève; Sirois, Caroline
    On considère qu’un médicament est inapproprié si les risques sont supérieurs au bénéfice attendu, en particulier lorsque des alternatives thérapeutiques plus sûres existent pour la même indication. L’utilisation de médicaments potentiellement inappropriés est problématique au sein de la population âgée puisqu’elle est associée à la survenue d’effets indésirables et d’interactions médicamenteuses, et à une potentielle augmentation de la morbidité, du recours aux soins et de la mortalité. En 2014, près de la moitié (49 %) des aînés québécois présentant des maladies chroniques ou leurs signes précurseurs ont reçu au moins un médicament potentiellement inapproprié. Parmi les utilisateurs de ces médicaments, la proportion de nouveaux utilisateurs est de 16 %. Par conséquent, la vaste majorité des aînés exposés à ceux-ci l’étaient déjà l’année précédente.
  • PublicationRestreint
    One-year persistence of potentially inappropriate medication use in older adults: a population-based study
    (Macmillan Journals, 2020-01-09) Roux, Barbara; Gagnon, Marie-Ève; Simard, Marc; Sirois, Caroline
    Aims: To assess the 1-year persistence of potentially inappropriate medication (PIM) use and identify associated factors in community-dwelling older adults in Quebec, Canada. Methods: A population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System. Individuals insured by the public drug plan and aged ≥66 years who initiated a PIM between 1 April 2014 and 31 March 2015 were followed-up for 1 year. PIMs were identified using the 2015 Beers criteria. One-year persistence of PIM use was defined as continuous treatment with any PIM, without interruption for more than 60 days between prescriptions refills. Poisson regression models were performed to identify factors associated with 1-year persistence of any PIM. Results: In total, 25.1% of PIM initiators were persistent at 1 year. In non-persistent individuals, the median time to PIM discontinuation was 31 days (interquartile range 21-92). Individuals were more persistent at 1 year with antipsychotics (43.9%), longduration sulphonylureas (40.2%), antiarrhythmics/immediate-release nifedipine (36.5%) and proton pump inhibitors (36.0%). Factors significantly associated with persistence were an increased age, being a man and having a high number of medications and chronic diseases, especially dementia, diabetes and cardiovascular diseases. Conclusions: One-quarter of community-dwelling older adults are continuously exposed to PIMs. To optimize medication prescribing in the older population, further interventions are needed to limit the use of PIMs most likely to be continued, especially in individuals most at risk of being persistent and also particularly vulnerable to adverse events.
  • PublicationAccès libre
    Mixed bag “polypharmacy”: methodological pitfalls and challenges of this exposure definition
    (Springer International Publishing, 2019-07-22) Simard, Marc; Gagnon, Marie-Ève; Gosselin, Emmanuelle; Sirois, Caroline
    Purpose of Review The use of multiple medications is common in older adults but is associated with negative health outcomes. However, polypharmacy is not uniformly defined, and there is scant data on how the variety of definitions and their limitations hinder the development of sound scientific knowledge. The article intends to illustrate the challenges of this exposure definition. Recent Findings The array of thresholds for defining polypharmacy renders comparisons between results difficult. Few studies take into account the fact that polypharmacy is a changing exposure over time. In addition, although studies tend to recognize the confounding effect of multimorbidity, residual bias remains a concern. Summary Current studies in polypharmacy often ignore basic epidemiological principles for defining exposure. Future research should integrate time-varying exposure and methods to better control confounding bias. This will help determine the positive/negative impacts of polypharmacy and help establish if polypharmacy conveys information beyond being a marker of health status.
  • PublicationAccès libre
    Monitoring polypharmacy at the population level entails complex decisions : results of a survey of geriatric and pharmacotherapy experts.
    (Adis International Print, 2016-04-08) Gagnon, Marie-Ève; Milhomme, Daniel; Sirois, Caroline
    Aim The use of multiple medications is rising steadily among older individuals, but little is known about the impact of polypharmacy at a population level, both over time and across countries. Surveillance of polypharmacy is required to overcome these gaps. There currently exists no standard population indicator of polypharmacy. The objective of this survey was to query expert opinion on establishing a gold standard method for polypharmacy surveillance at the population level. Methodology We invited 71 experts in geriatrics, pharmacoepidemiology, pharmacology and surveillance to respond to an Internet-based survey. Participants were asked to rate their degree of agreement on statements related to the definition of polypharmacy, the goals of polypharmacy surveillance and knowledge transfer issues. Consensus was reached when 70 % of participants either strongly or moderately agreed with the statements. Qualitative content analysis was performed on optional comments provided by the participants. Results Thirty individuals (42 %) completed the survey. Consensus was reached on most items. However, there was no agreement on a quantitative indicator of polypharmacy. Participants resolved that the indicator include a quality component, and that levels of polypharmacy be created. Defining exposure also proved problematic: cumulative (e.g. total annual number) and/or simultaneous (concomitant) prescriptions could be considered. Conclusions A gold standard indicator of polypharmacy should include both quantity and quality. There is a need to better inform the relevant outcomes of polypharmacy, to identify the most appropriate threshold(s) and quality measure(s) of interest to decision makers.
  • PublicationRestreint
    Potentially inappropriate medication use in older adults : a population-based cohort study
    (Fampra, 2019-10-11) Roux, Barbara; Gagnon, Marie-Ève; Simard, Marc; Sirois, Caroline; Laroche, Marie-Laure
    Background: Non-optimal medication use among older adults is a public health concern. A concrete picture of potentially inappropriate medication (PIM) use is imperative to ensure optimal medication use. Objective: To assess the prevalence of PIMs in community-dwelling older adults and identify associated factors. Methods: A retrospective population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System (QICDSS). The QICDSS includes data on drug claims for community-dwelling older adults with chronic diseases or at risk of developing chronic diseases aged ≥65 years who are insured by the public drug insurance plan. Individuals aged ≥66 years who were continuously insured with the public drug plan between 1 April 2014 and 31 March 2016 were included. PIMs were defined using the 2015 Beers criteria. We conducted multivariate robust Poisson regression analyses to explore factors associated with PIM use. Results: A total of 1 105 295 individuals were included. Of these, 48.3% were prescribed at least one PIM. The most prevalent PIMs were benzodiazepines (25.7%), proton-pump inhibitors (21.3%), antipsychotics (5.6%), antidepressants (5.0%) and long-duration sulfonylureas (3.3%). Factors associated with PIM exposure included being a woman [rate ratio (RR): 1.20; 95% confidence interval (CI): 1.20-1.21], increased number of medications and having a high number of chronic diseases, especially mental disorders (RR: 1.50; 95% CI: 1.49-1.51). Conclusion: Almost one out of two community-dwelling older adults use a PIM. It is imperative to reduce the use of PIMs, by limiting their prescription and by promoting their deprescribing, which necessitates not only the active involvement of prescribers but also patients.
  • PublicationRestreint
    Optimiser le traitement pharmacologique de la clientèle âgée atteinte de diabète
    (Ordre des infirmières et infirmiers du Québec, 2020-01-10) Gagnon, Marie-Ève; Sirois, Caroline
    Le Québec est une société vieillissante. Dans 10 ans, un Québécois sur quatre sera âgé de 65 ans et plus. Dans 40 ans, une personne sur 10 aura plus de 80 ans (Institut de la statistique du Québec, 2014). Ce vieillissement occasionne l’émergence d’une panoplie de maladie chroniques où le diabète figure parmi les plus fréquentes. Près du quart de la population aînée québécoise souffre en effet de cette maladie (Plante, Sirois, Larocque et Simard, 2015), et cette proportion ne devrait que s’accroître avec les années. L’impact du diabète sur le système de santé est donc considérable.