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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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  • 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
    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
    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
    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.
  • 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.
  • PublicationAccès libre
    Comparative effectiveness of cardioprotective drugs in elderly individuals with type 2 diabetes.
    (Wiley-Blackwell, 2014-10-31) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Aims: Although many elderly individuals suffer from type 2 diabetes, the effectiveness of cardioprotective drugs in primary prevention of cardiovascular events in clinical practice in this population has rarely been evaluated. We aimed to assess the effectiveness of, (i) angiotensin converting enzyme inhibitors or angiotensin receptor blockers, (ii) statins, (iii) antiplatelet drugs and (iv) the combination of these three drugs, in the prevention of myocardial infarction (MI) and stroke in elderly individuals with type 2 diabetes. Methods: Using Quebec administrative databases, we conducted nested case-control analyses among a cohort of 17,384 individuals without a history of cardiovascular disease. Individuals were aged ≥ 66 years, newly treated with oral antidiabetes drugs and had not used any of the three above classes of cardioprotective drugs in the year before cohort entry. For each case (MI/stroke during follow-up), five controls were matched for age, year of cohort entry and sex. Use of each drug and of their combination was defined as current, past or no use. We calculated adjusted odds ratios (AOR) of MI/stroke. Results: We observed no reduction in the MI/stroke risk for users of ACEI/ARB nor for users of the three drugs combination. Longer exposure to statins was associated with a lower risk (AOR for every 30 days of therapy: 0.97; 95% CI: 0.96–0.99). By contrast, current use of antiplatelet drugs was associated with an increased risk of MI/stroke (1.40; 1.12–1.75). Conclusion: The benefit of cardioprotective drugs in primary prevention was not clear in this cohort of elderly individuals with type 2 diabetes. A short duration of exposure to these drugs might explain the lack of benefit.
  • 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.
  • PublicationRestreint
    Myocardial infarction and gastro-intestinal bleeding risks associated with aspirin use among elderly individuals with type 2 diabetes
    (Finnish Medical Society Duodecim, 2014-05-02) Grégoire, Jean-Pierre; Poirier, Paul; Moisan, Jocelyne; Sirois, Caroline
    Introduction. The benefi t of aspirin in primary prevention of myocardial infarction and the associated gastro-intestinal bleeding risks have not been well established in the elderly population with diabetes. Methods. Using Quebec administrative databases, we conducted two nested case-control analyses within a cohort of individuals aged 66 years newly treated with an oral antidiabetes drug between 1998 and 2003. The 28,067 individuals had no cardiovascular disease recorded in the database in the year prior cohort entry. They had not used prescribed aspirin, antiplatelet, or anticoagulant drugs, and were not hospitalized for gastro-intestinal bleeding in the year prior cohort entry. The odds of myocardial infarction and gastro-intestinal bleedings were compared between individuals who were current, past, or non-users of aspirin. Results. There were 1101 (3.9%) cases of myocardial infarction. Compared to non-users, neither aspirin users (OR 0.89; 95% CI 0.71 – 1.13) nor aspirin past users (0.81; 0.62 – 1.06) showed a statistically signifi cant lower risk of myocardial infarction. There were 373 (1.3%) cases of gastro-intestinal bleeding. Current users of aspirin had about a 2-fold greater risk of gastro-intestinal bleeding compared to non-users (2.19; 1.53 – 3.13). Conclusions. Our results suggest that individual assessment of bleeding risk and cardiovascular risk is mandatory among elderly people with diabetes before introducing aspirin therapy.