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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
    Strategies 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, Caroline
    Introduction : 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 libre
    Portrait de la polypharmacie chez les aînés québécois entre 2000 et 2016
    (Institut national de santé publique du Québec, 2020-10-26) Gosselin, Emmanuelle; Simard, Marc; Dubé, Marjolaine; Sirois, Caroline
    En 2016-2017, 45,0 % des Québécois de plus de 65 ans avaient au moins deux maladies chroniques et 27,8 % en avaient trois et plus. Le traitement des maladies chroniques implique souvent l’usage d’un ou plusieurs médicaments. De ce fait, on constate que de plus en plus d’aînés reçoivent de multiples traitements pharmacologiques concomitants. Cet usage simultané de médicaments est nommé polypharmacie. Il n’existe pas de consensus sur la définition de polypharmacie, mais la consommation de cinq ou de dix médicaments sert souvent de seuil pour la caractériser. La polypharmacie peut s’avérer nécessaire pour traiter adéquatement les problèmes de santé de plusieurs aînés. Elle peut également entraîner des problèmes potentiels. En effet, l’usage de plusieurs médicaments augmente le risque d’effets indésirables, d’interactions médicamenteuses et d’interactions médicaments-maladie. Cet usage accroît aussi le risque de cascades médicamenteuses, où l’effet indésirable d’un premier médicament est interprété comme la manifestation d’une nouvelle condition pour laquelle on prescrit un second médicament. La polypharmacie a été associée à de nombreux impacts négatifs sur la santé, comme les hospitalisations accrues, un risque de mortalité plus élevé, les chutes et la fragilité. Il convient ainsi d’effectuer une surveillance de cette condition dans la population. Au Québec, à ce jour, il n’existe pas de résultats permettant de suivre l’évolution de la polypharmacie. Ce feuillet vise à dresser un premier portrait de la polypharmacie chez les aînés au Québec. Spécifiquement, il a pour objectifs : 1) d’estimer la prévalence de la polypharmacie (définie par l’usage de 5, 10 et 15 médicaments et plus) entre 2000 et 2016; 2) de caractériser les disparités liées à l’âge, au sexe, au statut socioéconomique, à la région de résidence et en fonction des maladies chroniques pour l’année financière 2016-2017.
  • PublicationAccès libre
    Portrait de la polypharmacie chez les aînés québécois atteints de la maladie pulmonaire obstructive chronique entre 2000 et 2015
    (Institut national de santé publique du Québec, 2021-02-09) Ouali, Amina; Simard, Marc; Sirois, Caroline
  • PublicationRestreint
    Cross-cultural adaptation and psychometric validation of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire in French language
    (ScienceDirect, 2020-11-10) Roux, Barbara; Ouellet, Nicole; Sirois, Caroline; Anne, Niquille; Spinewine, Anne; Pétein, Catherine; Sibille, François-Xavier; Csajka, Chantal; Reeve, Emily; Villeneuve, Claire; Marie-Laure, Laroche
    Background: The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire allows capture of the beliefs and attitudes of older adults and caregivers towards deprescribing. Objectives: To translate and validate the rPATD questionnaire into French. Methods: The French rPATD was translated using forward-backward translation. Psychometric properties were evaluated in both older adults ≥65 years living in the community or in institutions and who were taking at least one chronic medication and in caregivers of older adults with similar characteristics. Participants were recruited in four French-speaking countries (Belgium, Canada, France and Switzerland). Face and content validity were assessed during the translation process. Construct validity (exploratory factor analysis (EFA)) and internal consistency (Cronbach's alpha) were investigated in questionnaires without missing data. Test-retest reliability was evaluated using intra-class correlation coefficient (ICC) in a sample of participants. Results: In total, 320 questionnaires from older adults and 215 questionnaires from caregivers were included to evaluate construct validity and internal consistency. EFA extracted four factors in the older adults' and caregivers' versions of the questionnaire consistent with the English rPATD. The extracted factors related to the perceived burden of medication taking, the beliefs in appropriateness of medications, concerns about stopping medications and the level of involvement in making decisions and of knowledge of medications. Internal consistency was satisfactory for three factors for both versions (Cronbach's alpha >0.70), with lower internal consistency in the concerns about stopping factor. Test-retest reliability was overall good for all factors in the caregivers' version (ICC > 0.75) while for the older adults' version, moderate (ICC range: 0.75-0.50) to good ICC values were found. Conclusions: The French rPATD presents globally good psychometric properties and can be used to explore attitudes towards deprescribing in French-speaking older adults and caregivers.
  • PublicationRestreint
    Pharmacist-led transitions of care for older adults at risk of drug-related problems : a feasibility study
    (ScienceDirect, 2020-09-25) Cossette, Benoit; Sirois, Caroline; Ricard, Geneviève; Poirier, Rolande; Gosselin, Suzanne; Langlois, Marie-France; Breton, Mylaine; Rodrigue, Claudie; Lessard-Beaudoin, Mélissa; Teasdale, Julie; Piché, Benjamin; Khalilipalandi, Sara; Trottier, Lise; Mallet, Louise
    Background: Transitions of care (TOC) is one of three key action areas identified in the World Health Organization (WHO)’s third Global Patient Safety Challenge, Medication Without Harm, released in 2017. Systematic reviews have shown that TOC interventions can improve health outcomes, although few studies have evaluated the role of the community pharmacist. Objective: To evaluate the feasibility of a pharmacist-led TOC intervention for older adults at risk of drug-related problems. Methods: Pragmatic feasibility study conducted in hospital and community pharmacies in a health region of Quebec, Canada. The interventions consisted of a pharmaceutical care plan developed by the hospital pharmacist and transferred at hospital discharge to the patients’ community pharmacist, who completed patient consultations in the week following discharge and monthly for six months thereafter. Feasibility evaluations included recruitment, retention, time required, types of interventions, and modified classes of medications, based on clinical data entered in an electronic health record accessible to clinicians in all settings. Results: Of the 90 recruited patients, 76 were discharged with a pharmaceutical care plan. The mean age of these 76 subjects was 79.5 years, and 52.6% were female. The most frequent inclusion criteria were 15 or more medications (57.9%), two or more emergency department visits (past three months), or one or more hospitalization (past twelve months) (42.1%). The hospital pharmacist interventions took a mean time of 222 min. The community pharmacist interventions took a mean time of 52 min and 32 min for the first and subsequent visits, respectively. Therapeutic goals were documented for 60.5% of patients. Conclusions: This study shows the feasibility of implementing a pharmacist-led TOC intervention in the Canadian context. Development of the TOC model in three health regions is currently being pursued along with the inclusion of primary care clinics who recently added pharmacists to their interdisciplinary teams.
  • PublicationAccès libre
    L’effet combiné de la multimorbidité et des troubles mentaux sur les admissions fréquentes à l’urgence chez les adultes québécois
    (Institut national de santé publique du Québec, 2020-04-03) Candas, Bernard; Simard, Marc; Mbuya-Bienge, Cynthia; Gaulin, Myles; Sirois, Caroline
    Les travaux présentés dans ce feuillet visent à déterminer si la multimorbidité physique et les troubles mentaux agissent en synergie pour augmenter le risque d’admissions fréquentes à l’urgence. Les objectifs spécifiques sont de : 1) estimer la prévalence des troubles mentaux selon le nombre de maladies chroniques physiques; 2) quantifier l’effet des maladies chroniques physiques et des troubles mentaux sur les admissions fréquentes à l’urgence. La prévalence des troubles mentaux est de 11,6 % en absence de maladie chronique physique et augmente à 31,4 % en présence de quatre maladies chroniques physiques ou plus. La présence de troubles mentaux et la multimorbidité physique sont toutes deux associées à une augmentation des admissions fréquentes à l’urgence. Chez les individus avec trouble mental sévère, lorsque le nombre de maladies chroniques physiques varie d’aucune à quatre ou plus, la proportion d’utilisateurs fréquents de l’urgence passe de 9,2 % à 25,4 % (soit une augmentation de 16,2 points de pourcentage). Cette augmentation est moindre (11,4 points de pourcentage) chez les individus sans trouble mental. Notre étude populationnelle démontre l’importance primordiale de la santé mentale comme contributeur aux admissions fréquentes à l’urgence, un problème majeur dans le contexte québécois et ailleurs dans le monde. Tant pour les individus que pour le système de santé, les troubles mentaux augmentent le risque d’admissions fréquentes de manière significative. Une amélioration dans la prise en charge des individus avec des troubles mentaux pourrait avoir un double impact (par l’effet direct des troubles mentaux et de leur synergie avec les maladies chroniques physiques) sur la réduction des admissions fréquentes à l’urgence. Une meilleure compréhension des causes sous-jacentes de cette synergie serait utile dans la planification des soins, par exemple pour cibler des personnes à risque pour des programmes de suivi et des soins intégrés qui prendraient en compte les besoins particuliers des patients multimorbides avec des troubles mentaux.
  • 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
    Does socio-economic status influence the effect of multimorbidity on the frequent use of ambulatory care services in a universal healthcare system? A population-based cohort study
    (BioMed Central, 2021-03-06) Candas, Bernard; Simard, Marc; Mbuya-Bienge, Cynthia; Gaulin, Myles; Sirois, Caroline
    Background Frequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire population covered by a universal health system. Methods Using a linkage of administrative databases, we conducted a population-based cohort study of all adults in Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in the total population during the 2014–15 fiscal year. We used ajusted logistic regressions to model the association between frequent use of health services and multimorbidity, depending on socioeconomic status. Results Frequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency departments and general practitioners. Socioeconomic status modified the association between multimorbidity and frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general practitioner. Conclusion Even in a universal healthcare system, the gap between socioeconomic groups widens as a function of multimorbidity with regard to visits to the specialist physicians. Further studies are needed to better understand the differential use of specialized care by the most deprived individuals.
  • PublicationRestreint
    Chronic respiratory diseases should be considered when interpreting indicators of community antimicrobial use in people aged over 65 years old.
    (Canadian Public Health Association, 2020-01-14) Fortin, Élise; Jean, Sonia; Dionne, Marc; Simard, Marc; Sirois, Caroline
    Objectives Chronic respiratory diseases (CRD) put patients at increased risk of respiratory infection and antimicrobial use, but surveillance results on community antimicrobial use are generally not adjusted for this risk factor. The objective of this study was to demonstrate the importance of accounting for CRD when interpreting indicators of community antimicrobial use in people over 65 years old, in Québec, Canada. Methods Retrospective cohort study of antimicrobial use according to CRD status in individuals over 65 years old covered by Québec’s public drug insurance plan between 2010 and 2015. Defined daily doses per 1000 person-days (DID) were computed per antimicrobial class and were further stratified according to chronic disease group, fiscal year, gender and age group. Results Antimicrobial use was 2.3 times higher in the CRD group (29.7 DID) compared with the other chronic disease group (13.1 DID) and 3.1 times higher than in the no chronic disease group (9.6 DID). The same gradient was reflected as well in use per antimicrobial class, per age group, per gender, and in time. Antimicrobial use increased throughout the study period and was higher in older age groups and in women. Conclusions Interpretation of results of antimicrobial use surveillance should consider the prevalence of CRD in populations. In order to identify opportunities for adapted interventions targeting inappropriate use, finer analyses are necessary.
  • PublicationRestreint
    A hybrid Delphi multi-criteria sorting approach for polypharmacy evaluations
    (Springer Nature, 2020-01-01) Frini, Anissa; Sirois, Caroline; Laroche, Marie-Laure
    With 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 a Delphi survey results and 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 opinions 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 TriC and ELECTRE Tri multi-criteria sorting methods were used to evaluate and assign the polypharmacy to one of the following three categories: appropriate, more or less appropriate, or not appropriate. The proposed approach is innovative and enables the integration of a variety of conflicting criteria in the evaluation of polypharmacy quality. It also allows clinicians to express their opinion, and their hesitation where relevant, linguistically.