Claudine Laurier

Use of alternative and complementary therapies in children with cancer

The use of complementary and alternative medicines (CAM) is becoming increasingly popular. Although considered beneficial by users, the potential for interaction or substitution with conventional treatment should not be overlooked by health care professionals. It is therefore important to gain insight into the prevalence and the factors related to the use of CAM. To establish the prevalence of use of CAM among children with cancer treated in a large pediatric hospital, describe the profile of use and factors related with use. As a secondary objective we aimed at measuring quality of life of the children aged 5 or more and compare the scores between users and non‐users.

Alzheimer's disease: a review of the disease, its epidemiology and economic impact

This article consists of a critical review of Canadian, American and European studies published between 1976 and 1997 on the subject of Alzheimers disease (AD), and its epidemiology, patterns of care, prognostic factors, and economic impact. As the population ages in North America and Europe, significant increases in the prevalence of AD over the next decades have been projected. The elderly population represents the largest consumer group of health care resources and the management of common diseases occurring in this population will have major medical, social, and economic implications. As a result, researchers will need to integrate the ever-increasing knowledge on AD when addressing governmental and societal concerns regarding its impact. Described herein is the study findings, limitations, and differences observed following the review of the diagnostic criteria, prevalence rates, incidence rates and risk factors. Highlighted are the areas where data is lacking. To refine current models of disease progression, and better address where health care resources and new therapies would be most beneficial, the review of predictors of institutionalization and predictive models of disease progression and survival, was performed. New research questions are indicated.

Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial.

Background  Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs).

Correlates of Potentially Inappropriate Prescriptions of Benzodiazepines among Older Adults: Results from the ESA Study

Les données de l’étude ESA ont été appariées aux données d’utilisation des services médicaux et pharmaceutiques de la Régie d’assurance maladie du Québec pour documenter la prescription potentiellement non appropriée de benzodiazépines chez les personnes âgées. Nos résultats indiquent que 32% des répondants ont pris une dose journalière moyenne de 6.1 mg de l’équivalent diazépam pour une durée moyenne de 205 jours par année. Nos résultats indiquent aussi que presque la moitié, 48% des utilisateurs de benzodiazépines, ont reçu au moins une prescription de benzodiazépine potentiellement non appropriée pendant les 12 mois qui précédaient l’étude. Près de 23% des consommateurs ont reçu au moins une prescription concomitante de Bzs et d’un autre médicament pouvant résulter en une interaction sérieuse. De plus, les personnes âgées de 75 ans et plus avaient plus de chances de recevoir une Bz pour une longue période de temps que les personnes âgées de 65–74 ans. Cette étude a montré que la durée d’utilisation des benzodiazépines augmentait avec le nombre de prescripteurs et avec le nombre de pharmacies consultées pendant l’année. Le nombre de pharmacies utilisées a aussi été associé avec la présence d’une ordonnance non appropriée de benzodiazépines pendant la même année. Nos résultats plaident en faveur d’un système de santé plus intégré, incluant une révision régulière des médicaments pris par les personnes âgées. ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65–74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults’ drug regimens.

Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids

Oral candidiasis (OC) is a frequent side effect of inhaled corticosteroids (iCSTs). This study estimated occurrence and significance of risk factors of OC treated with antifungals in users of iCSTs under conditions of normal use. This retrospective analysis used data drawn from drug insurance plan records in Quebec, Canada. The sample contained 27,000 seniors using anti-asthma medications during 1990. Three years of data (1989-1991) were searched for use of oral antifungals concurrent with exposure to iCSTs. A case-control study examined factors leading to increased probability of first incidence of OC in new users of iCSTs. Three-year occurrence for OC was 7%. Increased risk for a first occurrence of OC was significantly associated with higher doses of iCST, increased length of iCST exposure, use of antibiotics, use of oral steroids, having three or more prescribers, a history of use of both high and low strengths of iCST, and concurrent use of oral steroids and diabetes medications. The occurrence of OC is relatively high. Knowledge of factors leading to increased risk could facilitate the targetting of patients who need timely intervention, under conditions of normal use.

Feasibility of a randomised trial of a continuing medical education program in shared decision-making on the use of antibiotics for acute respiratory infections in primary care: the DECISION+ pilot trial

BackgroundThe misuse and limited effectiveness of antibiotics for acute respiratory infections (ARIs) are well documented, and current approaches targeting physicians or patients to improve appropriate use have had limited effect. Shared decision-making could be a promising strategy to improve appropriate antibiotic use for ARIs, but very little is known about its implementation processes and outcomes in clinical settings. In this matter, pilot studies have played a key role in health science research over the past years in providing information for the planning, justification, and/or refinement of larger studies. The objective of our study was to assess the feasibility and acceptability of the study design, procedures, and intervention of the DECISION+ program, a continuing medical education program in shared decision-making among family physicians and their patients on the optimal use of antibiotics for treating ARIs in primary care.MethodsA pilot clustered randomised trial was conducted. Family medicine groups (FMGs) were randomly assigned, to either the DECISION+ program, which included three 3-hour workshops over a four- to six-month period, or a control group that had a delayed exposure to the program.ResultsAmong 21 FMGs contacted, 5 (24%) agreed to participate in the pilot study. A total of 39 family physicians (18 in the two experimental and 21 in the three control FMGs) and their 544 patients consulting for an ARI were recruited. The proportion of recruited family physicians who participated in all three workshops was 46% (50% for the experimental group and 43% for the control group), and the overall mean level of satisfaction regarding the workshops was 94%.ConclusionsThis trial, while aiming to demonstrate the feasibility and acceptability of conducting a larger study, has identified important opportunities for improving the design of a definitive trial. This pilot trial is informative for researchers and clinicians interested in designing and/or conducting studies with FMGs regarding training of physicians in shared decision-making.Trial RegistrationClinicaltrials.Gov NCT00354315

Communication of Verbal Information by Community Pharmacists

Communication of verbal information on prescribed drugs is recognized as an important function of the pharmacist. This article describes and analyzes the communication behavior adopted by community pharmacists in the province of Quebec. Data were collected by means of two questionnaires mailed to a random sample of 634 community pharmacists. Percentage of prescriptions for new medications on which the pharmacists indicated they provide verbal information averaged 68.9 (SD 24.2). A majority of respondents indicated that they include information on the indication and mode of administration in more than 75 percent of their counseling episodes. However, on average, rare but serious adverse effects were less frequently discussed. The frequency of verbal communication was analyzed according to the pharmacists gender, number of years since licensure, employment status, work setting, and perceptions of both professional and commercial dimensions of the pharmacists role. Regression showed that perception of the professional dimension of the role, gender, workload, and floor surface of the pharmacy were related to provision of verbal information on new prescribed medications.

Health Survey Data on Potentially Inappropriate Geriatric Drug Use

BACKGROUND: Studies have suggested that elderly patients do not always use medications appropriately. Investigations that have relied on prescription claim databases or clinical records focus on acquisition or prescription, and hypotheses must be made to assess actual consumption. Population survey data constitute an alternative way to study inappropriate use. OBJECTIVE: To estimate the prevalence of potentially inappropriate use of medications in elderly patients in Québec based on self-reported use. METHODS: Using a cross-sectional, general population, health survey in which self-reported medication use in the 2 days prior to the survey was recorded, we estimated the prevalence of inappropriate medication use in elderly patients (≥65 y old) who responded. Two sets of published criteria were used to define inappropriate use: one to assess use of inappropriate drugs, and another to assess concomitant duplications and potential interactions. RESULTS: Of the 3400 patients surveyed, 6.5% had used ≥1 inappropriate drugs, 2.5% had ≥1 occurrences of potentially inappropriate duplication of medications, and 2.7% had ≥1 potential medication interactions. Concomitant use of at least 2 benzodiazepines was reported by 8.5% of respondents using these drugs. Use of ≥1 long-acting benzodiazepines was reported by 4.2% of the sample. CONCLUSIONS: Population health surveys are a useful tool for detecting potentially inappropriate medication use in the elderly. In particular, the high prevalence of inappropriate use of benzodiazepines signals a need for improved detection and intervention in this group. TRANSFONDO: Existen estudios que demuestran que los ciudadanos viejos no siempre usan sus medicamentos adecuadamente. Estudios basados en los bancos de datos de los reclamos de prescripción o expedientes clínicos se hacen a base de la adquisición o prescripción de medicamentos. De estos se crean hipótesis para estimar el consumo real de medicamentos. Una manera alterna de realizar estudios sobre el uso inapropiado de medicamentos lo es a través de datos obtenidos de encuestas poblacionales.

DOES CLINICAL TRIAL SUBJECT SELECTION RESTRICT THE ABILITY TO GENERALIZE USE AND COST OF HEALTH SERVICES TO “REAL LIFE” SUBJECTS?

OBJECTIVES To explore one aspect of the external validity of the randomized controlled trial (RCT), specifically how being selected for inclusion in a trial and having participated has influenced the use and cost of asthma-related health services. METHODS Services used by asthmatic users of inhaled corticosteroids (iCSTs) having previously participated in an RCT (TS, n = 46) were compared with individuals who had never participated (NS, n = 51). RESULTS TS were more likely to use higher (> or = 400 microg) daily doses of iCSTs than NS (OR, 3.3; 95% Cl, 1.1-8.3) but less likely to visit emergency departments (OR, 0.3; 95% Cl, 0.1-0.7). Total asthma-related costs did not differ significantly. CONCLUSIONS Subject differences may impede generalizing from RCTs to real life.

Effect of age on the conformity rate to short-acting beta-agonist use criteria in asthma.

Study Objectives. Assess compliance to asthma guidelines and influence of age concerning inhaled short-acting β2-agonist (SABA) utilization in 5 to 45-year-old asthmatic subjects in the province of Quebec. Design. Population-based retrospective drug utilization review using a computerized database of claims submitted to a private prescription drug insurance plan. Patients. Subjects who received at least one outpatient prescription of SABA (age range, 5 to 45 years) for the treatment of asthma between 01 1996 and 12 1997. Measurements. Percentages of patients whose use was appropriate according to the criteria regarding the average daily dose of SABA. Use was considered appropriate if the consumption rate corresponded to a maximum of two puffs per day (Salbutamol equivalent) in subjects who did or did not use inhaled corticosteroids (ICS) at an estimated maximum dose of 800 mcg/day of Beclomethasone (BDP) equivalent for the 5 to 11-year-olds and 1000 mcg/day for the 12 to 45-year-olds. Results. In 1996, use was found to be appropriate for 74.4% of the 394 patients who received an SABA without ICS as compared with 70.7% for 593 patients in 1997. If we consider those who received an ICS at low to moderate doses, appropriate use was found for 51% of the 375 patients in 1996 and 57.6% for 254 patients in 1997. If we exclude patients who did not renew their SABA, appropriate use drops to 46.3% for 1996 and 34.3% for 1997 for the group who receive SABA without ICS (29.4% and 37.6%, respectively, for those with ICS). There is a relationship between age and appropriateness; the percentage of appropriateness was higher for the younger ones (5 to 14-year-old group; 83% in 1996 and 86% in 1997 for the patients who received a SABA without IS and 58.5% in 1996 and 73% in 1997 for the patients who received a SABA using ICS (p < 0.05). Conclusion. Our results indicate that adherence to asthma guidelines concerning SABA is poor. SABA are still overused, particularly among ICS users, which might be explained by undertreatment or poor compliance. Appropriate SABA use was significantly more common among younger groups (p < 0.05). This can be explained by better treatment in that age group, better compliance or less severe asthma.