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The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation.

https://arctichealth.org/en/permalink/ahliterature107816
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Publication Type
Article
Date
Aug-2013
Author
Frederieke M Brouwers
Josiane Courteau
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Alain Lesage
Marie-Josée Fleury
Alain Vanasse
Author Affiliation
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antipsychotic Agents - therapeutic use
Cohort Studies
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Schizophrenia - drug therapy - epidemiology
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
PubMed ID
23972107 View in PubMed
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Agreement between staff and service users concerning the clientele's mental health needs: a Quebec study.

https://arctichealth.org/en/permalink/ahliterature167409
Source
Can J Psychiatry. 2006 Apr;51(5):281-6
Publication Type
Article
Date
Apr-2006
Author
Marie-Josée Fleury
Guy Grenier
Alain Lesage
Author Affiliation
Department of Psychiatry, McGill University, Montreal, Quebec. flemar@douglas.mcgill.ca
Source
Can J Psychiatry. 2006 Apr;51(5):281-6
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Female
Humans
Male
Mental Disorders - epidemiology - therapy
Mental Health Services - standards - utilization
Needs Assessment
Professional-Patient Relations
Quebec - epidemiology
Rural Population - statistics & numerical data
Urban Population - statistics & numerical data
Abstract
This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas.
We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared.
The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs.
The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.
PubMed ID
16986817 View in PubMed
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[Can mental health problems be diagnosed by general physicians? Perspectives of family physicians according to administrative standards].

https://arctichealth.org/en/permalink/ahliterature150725
Source
Sante Ment Que. 2009;34(1):161-72
Publication Type
Article
Date
2009
Author
Youcef Ouadahi
Alain Lesage
Jean Rodrigue
Marie-Josée Fleury
Author Affiliation
MBA, Agent de planification, programmation et recherche, Agence de la santé et des services sociaux de la Montérégie.
Source
Sante Ment Que. 2009;34(1):161-72
Date
2009
Language
French
Publication Type
Article
Keywords
Chronic Disease
Humans
Mental Disorders - diagnosis
Physicians, Family
Quebec
Societies, Medical
PubMed ID
19475199 View in PubMed
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[Community trajectories of mentally ill and intellectually disabled young people].

https://arctichealth.org/en/permalink/ahliterature105367
Source
Sante Publique. 2013 Jul-Aug;25(4):453-63
Publication Type
Article
Author
Marie-Josée Fleury
Guy Grenier
Author Affiliation
Department de psychiatrie, Université McGill, 825, rue Sherbrooke ouest, H4H 1R3 Montreal, Canada. flemar@douglas.mcgill.ca
Source
Sante Publique. 2013 Jul-Aug;25(4):453-63
Language
French
Publication Type
Article
Keywords
Adolescent
Adult
Community Mental Health Services - statistics & numerical data
Disabled persons - statistics & numerical data
Female
Humans
Intellectual Disability - epidemiology
Male
Mentally Ill Persons - statistics & numerical data
Quebec - epidemiology
Young Adult
Abstract
In the context of reforms in the field of disability, this study documents the trajectories and mechanisms of support for young people with mental illness or intellectual disability or pervasive developmental disorders, during the teen-adult life transition period; andfactorsfostering or impeding this transition for their maintenance in an everyday environment, particularly in SESSAD (special education and home care service) and the SAMSAH/ SPAC (medico-social support for adults with disabilities/support services in social life).
This study was conducted in the French department of Seine-et-Marne. It was supported by a mixed call for tenders, in which 77 respondents (professionals, families and users), and 26 organizations were consulted.
The study shows that few young adults in SAMSAH/SPAC programmes are derived from SESSAD, and they encounter major difficulties living in an everyday environment, particularly during the transition period. Clinical or socio-economic factors related to the profiles of users or healthcare service organization facilitate or hinder the inclusion of young people in an everyday environment. Support for users was also often limited to followup over a suboptimal period, and was hampered by insufficient networking within the regional healthcare system. On the other hand, empowerment of users and their optimal inclusion in an everyday environment, as founding principles of the reform, constitute major action priorities for healthcare structures.
Strengthening services for young people (16-25 years), including integration strategies, is recommended in order to establish an integrated network of services in the field of disability.
PubMed ID
24404727 View in PubMed
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Components associated with adequacy of help for consumers with severe mental disorders.

https://arctichealth.org/en/permalink/ahliterature145062
Source
Adm Policy Ment Health. 2010 Nov;37(6):497-508
Publication Type
Article
Date
Nov-2010
Author
Marie-Josée Fleury
Myra Piat
Guy Grenier
Jean-Marie Bamvita
Richard Boyer
Alain Lesage
Jacques Tremblay
Author Affiliation
Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada. flemar@douglas.mcgill.ca
Source
Adm Policy Ment Health. 2010 Nov;37(6):497-508
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cross-Sectional Studies
Female
Humans
Interviews as Topic
Male
Mental disorders
Middle Aged
Needs Assessment
Quality of Health Care
Quebec
Severity of Illness Index
Young Adult
Abstract
Needs assessment is key in mental health rehabilitation. Using a representative sample of consumers with severe mental disorders living in supervised housing in Montréal, Québec, the study describes consumer needs and variables associated with the adequacy of help provided. Descriptive, component, and regression analyses were performed. Four needs components, including 20 domains, were examined. Greater adequacy of help was found to be associated with five variables: "daytime social relations"; number of needs; number of unmet needs; gender; and help from services. Components associated with "daytime social relations" and "higher social needs" would be more effectively addressed by integrated healthcare providers.
PubMed ID
20204492 View in PubMed
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Comprehensive determinants of health service utilisation for mental health reasons in a Canadian catchment area.

https://arctichealth.org/en/permalink/ahliterature125584
Source
Int J Equity Health. 2012;11:20
Publication Type
Article
Date
2012
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Yan Kestens
Jean Caron
Author Affiliation
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montreal, Quebec H4H 1R3, Canada. flemar@douglas.mcgill.ca
Source
Int J Equity Health. 2012;11:20
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Catchment Area (Health) - statistics & numerical data
Community Mental Health Services - utilization
Crime Victims - psychology
Female
Humans
Male
Mental Disorders - diagnosis - epidemiology - therapy
Middle Aged
Patient Acceptance of Health Care - psychology
Regression Analysis
Residence Characteristics - statistics & numerical data
Sex Distribution
Social Class
Violence - psychology - statistics & numerical data
Abstract
This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area.
To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out.
Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females.
Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.
Notes
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PubMed ID
22469459 View in PubMed
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Determinants associated with the utilization of primary and specialized mental health services.

https://arctichealth.org/en/permalink/ahliterature134251
Source
Psychiatr Q. 2012 Mar;83(1):41-51
Publication Type
Article
Date
Mar-2012
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Jean Caron
Author Affiliation
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada. flemar@douglas.mcgill.ca
Source
Psychiatr Q. 2012 Mar;83(1):41-51
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Catchment Area (Health) - statistics & numerical data
Female
Health Care Surveys
Health Services Needs and Demand - statistics & numerical data
Humans
Logistic Models
Male
Mental Disorders - epidemiology - therapy
Mental Health Services - utilization
Middle Aged
Models, Psychological
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - utilization
Quality of Life
Residence Characteristics
Risk factors
Social Support
Socioeconomic Factors
Young Adult
Abstract
The study aims to compare variables associated with the exclusive and joint use of primary and specialized care for mental health reasons by individuals diagnosed with a mental disorder in a Montreal/Canadian catchment area. Data were collected from a random sample (2,443 individuals). Among 406 people, diagnosed with a mental disorder 12 months pre-interview, 212 (52%) reported having used healthcare services. Compared to users of primary care only, people who sought both primary and specialized care presented more mental disorders and lower quality of life. People using only specialized healthcare received significantly less social support than persons using primary care exclusively and lived in neighborhoods with a high proportion of rental housing. Healthcare service provision should favor social networking and enable social cohesion and integration, particularly in neighborhoods with a high proportion of rental housing. Shared care and enhanced collaboration with other public and community-based resources should be encouraged.
PubMed ID
21607642 View in PubMed
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Determinants of the utilization of diversified types of professionals for mental health reasons in a Montreal (Canadian) catchment area.

https://arctichealth.org/en/permalink/ahliterature120697
Source
Glob J Health Sci. 2012 May;4(3):13-29
Publication Type
Article
Date
May-2012
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Jean Caron
Author Affiliation
Douglas Hospital Research Centre, Montreal, Quebec, Canada. flemar@douglas.mcgill.ca
Source
Glob J Health Sci. 2012 May;4(3):13-29
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Catchment Area (Health)
Female
Health Care Surveys
Health Services - utilization
Humans
Male
Mental disorders
Middle Aged
Quebec
Specialization
Urban Population
Young Adult
Abstract
The study was designed to identify factors associated with the diversity of professionals consulted by 212 individuals affected by at least one mental disorder in the past 12 months in a Montreal catchment area. For inclusion in the study, participants had to be aged 15 to 65 and reside in the study zone. A comprehensive set of variables were analyzed in accordance with the Andersen's behavioural model of health service use. General practitioners, psychiatrists, and psychologists were the main professionals consulted in this study. Having post-secondary education, more than a single mental disorder, excellent relationships with neighbours, and (marginally) being a lifelong victim of violence were associated with higher numbers of professionals consulted. As this study highlights the large number of diversified professionals consulted for reason of mental disorders, shared care initiatives may prove beneficial. Greater effort could also be made in increasing services toward those deemed more vulnerable.
PubMed ID
22980229 View in PubMed
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Does elapsed time between first diagnosis of schizophrenia and migration between health territories vary by place of residence? A survival analysis approach.

https://arctichealth.org/en/permalink/ahliterature116633
Source
Health Place. 2013 Mar;20:66-74
Publication Type
Article
Date
Mar-2013
Author
André Ngamini Ngui
Alan A Cohen
Josiane Courteau
Alain Lesage
Marie-Josée Fleury
Jean-Pierre Grégoire
Jocelyne Moisan
Alain Vanasse
Author Affiliation
Groupe PRIMUS, Centre de recherche clinique Étienne-Le Bel, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada, J1H 5N4. ngaminingui@gmail.com
Source
Health Place. 2013 Mar;20:66-74
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cohort Studies
Emigration and Immigration
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Schizophrenia - diagnosis - epidemiology
Survival Analysis
Time Factors
Transients and Migrants - psychology
Young Adult
Abstract
Migration of patients with schizophrenia might influence health care access and utilization. However, the time between diagnosis and migration of these patients has not yet been explored. We studied the first migration between health territories of 6873 patients newly diagnosed with schizophrenia in Quebec in 2001, aiming to describe the pattern of migration and assess the influence of the place of residence on migration. Between 2001 and 2007, 34.5% of patients migrated between health territories; those living in metropolitan areas were more likely to migrate than others but tended to remain in metropolitan areas. Migrant patients were also more likely to stay in or migrate to the most socially or materially deprived territories.
PubMed ID
23376731 View in PubMed
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[Factors associated with high exposure to psychotropic drugs in a Montreal catchment epidemiological area].

https://arctichealth.org/en/permalink/ahliterature105682
Source
Sante Ment Que. 2013;38(1):259-78
Publication Type
Article
Date
2013
Author
Michel Perreault
Mechakra-Tahiri Djemaâ-Samia
Marie-Josée Fleury
El Hadj Touré
Emma Mitchell
Jean Caron
Author Affiliation
Institut universitaire en santé mentale Douglas; Université McGill, Montréal, Québec.
Source
Sante Ment Que. 2013;38(1):259-78
Date
2013
Language
French
Publication Type
Article
Keywords
Adolescent
Adult
Catchment Area (Health)
Female
Humans
Male
Mental Disorders - drug therapy - epidemiology
Middle Aged
Psychotropic Drugs - adverse effects
Quebec
Risk factors
Young Adult
Abstract
This article examine the associations between elevated exposure to psychotropic medications, presence of a diagnosis of mental illness, and sociodemographic characteristics in the adult population. A questionnaire was administered by interview to 2433 individuals aged 15 and over in the epidemiological catchment area of South-West Montreal. The determinants of psychotropic medication consumption were analyzed using bivariate analysis and multivariate logistic regression. A significant association was observed between the consumption of sleeping medications, anxiolytics, and antidepressants and being older, female, living alone, having a low level of education and income, being unemployed during the 12 months preceding the study, and presence of a mental disorder. An elevated exposure to different psychotropic medications (three or more) was reported in 3.1% of the respondants. All things being equal, this increased with age, living alone, being unemployed over the course of the last year, and presence of a mental illness. The results suggest that it is necessary to consider social isolation and prevalence of mental illness in order to contextualize the elevated exposure to psychotropic medication. Polypharmacy may indeed pose important risks if it does not follow the logic of a coherent clinical intervention.
PubMed ID
24337000 View in PubMed
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34 records – page 1 of 4.