Marie-Claude Breton

Burden of Diabetes on the Ability to Work: A systematic review

Type 2 diabetes is an increasingly common disease (1) that places a considerable economic burden on society. An estimated 171 million people were suffering from diabetes in 2000, and this number could total 366 million by 2030 (1). Type 2 diabetes accounts for more than 90% of all diabetes cases, and it often appears in middle age (2). In 2010, the prevalence of diabetes in the U.S. was 11.3 and 26.9% among individuals aged 20 years or over and 65 years or older (2), respectively. In 2007, costs related to diabetes in the U.S. were an estimated

Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids

174 billion;

Important Treatment Gaps in Vascular Protection for the Elderly After Type 2 Diabetes Therapy Initiation

116 billion in direct costs and

Psychosocial factors associated with adherence to non-insulin antidiabetes treatments

58 billion in indirect costs (3). Direct costs include the cost of personal expenditures, drugs, and health care services, whereas indirect costs include lost productivity at work. Lost productivity at work may be measured through absenteeism (time lost from work due to illness), presenteeism (time at work impaired due to illness), productivity (time lost from work due to illness plus time at work impaired due to illness), or early retirement (retirement before the official retirement age due to illness). Lost productivity at work is an important concern for employees, employers, and society. Moreover, the complications related to diabetes are a major cause of disability, reduced quality of life, and death (4). Employees with diabetes may stop working prematurely (5–8) and may experience unemployment (7,9–12), which could translate into a reduction in earned income and savings (13) and loss of self-esteem (14). For employers too, lost productivity due to absenteeism (6,8,13,15–23), presenteeism (17), and early retirement (5–7) is an important economic issue. To the best of our knowledge, there are no published systematic reviews answering the following question: Do individuals …

Factors associated with adherence to asthma treatment with inhaled corticosteroids: A cross-sectional exploratory study

Abstract Objective: To measure the effectiveness of an integrated care program for individuals with asthma aged 12–45 years, on asthma control and adherence to inhaled corticosteroids (ICS). Methods: Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. Results: Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (p = 0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (p = 0.02). Conclusion: An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.

The Drug Utilization Review Network of Quebec

BACKGROUND Canadian practice guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) for vascular protection in individuals with diabetes who are at high risk of cardiovascular events, including those ≥ 65 years. We estimated the proportion of elderly persons who initiated an ACEI or an ARB in the year after beginning oral antidiabetes (OAD) treatment, and we identified factors associated with this initiation. METHODS Using the Quebec Health Insurance Board (RAMQ) databases, we conducted a population-based cohort study of individuals ≥ 65 years recently prescribed an OAD. We excluded those who were already taking an ACEI or ARB. Factors associated with ACEI or ARB initiation were identified using multivariate logistic regression. RESULTS Among 43,700 individuals, 13,621 (31.2%) initiated an ACEI or ARB in the year after beginning OAD. Individuals were more likely to begin an ACEI or an ARB if they initially received both metformin and a sulfonylurea, lived in a rural region, began OAD treatment between 2001 and 2006, were hospitalized, or had ≥ 22 medical visits in the year before OAD initiation. Individuals ≥ 75 years, those who were prescribed an OAD by a general practitioner, initially received a sulfonylurea, or received ≥ 4 different medications in the year before OAD initiation were less likely to begin an ACEI or ARB. CONCLUSIONS In the elderly not already taking ACEIs or ARBs, a low proportion of those undertaking OAD treatment are prescribed the recommended cardioprotection of an ACEI or ARB in the following year. Interventions are needed to close this treatment gap.

Hypoglycemia-Related Emergency Department Visits and Hypoglycemia-Related Hospitalizations among New Users of Antidiabetes Treatments

AIMS To discern psychosocial factors of non-insulin antidiabetes drug (NIAD) adherence. METHODS A cross-sectional study based on the theory of planned behavior (TPB). Adults with type 2 diabetes (T2D) who were members of Diabète Québec, a provincial association of persons with diabetes, and were prescribed at least one NIAD were invited to complete a web-based questionnaire. We measured variables ascertaining TPB constructs and other factors potentially associated with NIAD adherence (e.g., habit, social support, and mental health). NIAD adherence was assessed using the 8-item Morisky Medication Adherence Scale. Factors were identified using a multivariate logistic regression model. RESULTS In our study, 901 participants (373 women; 515 retired; mean age: 62.7 years) with T2D for a mean of 10 years, completed the questionnaire. Participants exhibited a high intention to adhere to their NIAD treatment (mean score=5.8/6), positive attitudes toward adherence (mean score=5.5/6), and elevated perceived behavioral control in taking their medication (mean score=5.7/6). Only 405 (45%) participants reported high adherence (score=8/8). Perceived behavioral control, habit, older age, no perceived side effects, a longer period since T2D diagnosis and a lower number of NIAD daily doses were significantly associated with adherence (p<0.05). CONCLUSION We identified several factors that may be modified for NIAD adherence and thereby provided insight into future adherence-enhancing intervention targets.

Cohort Profile: The PROspective Québec (PROQ) Study on Work and Health

ABSTRACT Background: Understanding factors at the patient, provider or organizational level associated with inhaled corticosteroids (ICSs) adherence is important when planning adherence-enhancing interventions. Objective: To explore factors associated with adherence to ICS among patients with asthma aged 12–45 years. Methods: A cross-sectional study was conducted among patients with asthma reporting ICS prescription during the baseline interview of an intervention study. Three methods were used to measure ICS adherence: a 4-item self-report questionnaire, a single question (SQ) measuring past 7-day exposure to ICS and a medication possession ratio (MPR, i.e., the sum of ICS days of supply/365). We assessed 46 potential factors of ICS adherence derived from the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Their association with ICS adherence was measured using multivariate logistic regressions. Results: Among the 319 participants included, 16.0% were deemed adherent according to the 4-item questionnaire. This proportion was 43.0% and 9.1% for the SQ and the MPR method, respectively. Ten factors were associated with good ICS adherence. Among these factors, four were associated with adherence through one of the measuring methods: a low family income level, a high number of asthma drugs used, a good knowledge of asthma pathophysiology and the perception that following the ICS prescription was easy. Two factors emerged through more than one measure: perceiving asthma severity as moderate to very severe and perceiving a high risk of death if ICSs are not taken as prescribed. Conclusion: ICS adherence was poor in those individuals with asthma. Future adherence-enhancing interventions could target the identified modifiable risk factors. Trial registration: ClinicalTrials.gov Identifier NCT02093013

The Burden of Type 2 Diabetes on Work Productivity: A Systematic Review

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebecs Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The networks main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the networks efforts.