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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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Community pharmacy loyalty among individuals with schizophrenia.

https://arctichealth.org/en/permalink/ahliterature115283
Source
Res Social Adm Pharm. 2013 Nov-Dec;9(6):806-16
Publication Type
Article
Author
Sophie Lauzier
Jean-Pierre Grégoire
Alain Lesage
Jocelyne Moisan
Author Affiliation
Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Québec, QC, Canada G1V 0A6; Chair on adherence to treatments, Université Laval, Québec, QC, Canada G1V 0A6; Santé des populations: URESP, Centre de recherche du CHU de Québec, 1050 Chemin Ste-Foy, Québec, QC, Canada G1S 4L8. Electronic address: sophie.lauzier@pha.ulaval.ca.
Source
Res Social Adm Pharm. 2013 Nov-Dec;9(6):806-16
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antipsychotic Agents - therapeutic use
Community Pharmacy Services - statistics & numerical data
Female
Humans
Male
Middle Aged
Quebec
Schizophrenia - drug therapy
Young Adult
Abstract
Community pharmacists can use medication records to assist individuals who are loyal to their pharmacy in better managing their pharmacotherapy. However, the extent of community pharmacy loyalty among individuals with severe mental illness such as schizophrenia remains unknown.
To assess the extent of community pharmacy loyalty among individuals with schizophrenia and identify factors associated with loyalty.
Using the Quebec Health Insurance Board databases, a cohort study of individuals with schizophrenia who claimed an antipsychotic drug for the first time between January 1, 2001 and December 31, 2005 was conducted. Such individuals were considered loyal to their community pharmacy if they filled all their prescriptions for any drug at the same community pharmacy during the second year after antipsychotics initiation. Logistic regression models were used to identify factors associated with community pharmacy loyalty (measured in the first year after antipsychotics initiation).
Of the 6159 individuals in the study, 57.8% were loyal to one pharmacy. Men were more likely to be loyal (Adjusted OR = 1.29; 95% CI = 1.16-1.44), as were individuals aged 30-64 years and those aged =65 years, when compared to individuals 20-29 years (1.70; 1.48-1.95 and 2.39; 1.97-2.90, respectively). Individuals who filled their antipsychotics on a weekly basis were also more likely to be loyal (1.39; 1.18-1.63). Factors associated with non-loyalty were welfare beneficiary status (0.79; 0.70-0.89), having substance-use disorder (0.69; 0.60-0.80), a greater number of different types of drugs (5-8 types = 0.76; 0.66-0.87; 9-51 = 0.59; 0.50-0.69), and emergency department visits (0.71; 0.60-0.82).
Results suggest that medication records in community pharmacies are incomplete for 42.2% of individuals with schizophrenia. Individuals more likely to experience more severe illness were also those less likely to be loyal. Given the potentially severe consequences of medication-related problems in this latter population, strategies to further improve the comprehensiveness of medication information should be promoted.
PubMed ID
23522802 View in PubMed
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Conceptualization and sources of costs from breast cancer: findings from patient and caregiver focus groups.

https://arctichealth.org/en/permalink/ahliterature178255
Source
Psychooncology. 2005 May;14(5):351-60
Publication Type
Article
Date
May-2005
Author
Sophie Lauzier
Elizabeth Maunsell
Maria De Koninck
Mélanie Drolet
Nicole Hébert-Croteau
Jean Robert
Author Affiliation
Population Health Research Unit, Department of Social and Preventive Medicine, Université Laval, Québec, Canada.
Source
Psychooncology. 2005 May;14(5):351-60
Date
May-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - complications - psychology - therapy
Canada
Caregivers
Cost of Illness
Costs and Cost Analysis
Female
Focus Groups
Health Care Costs - statistics & numerical data
Humans
Middle Aged
Abstract
Assessment of economic burden of breast cancer to patient and family has generally been overlooked in assessing the impact of this disease. We explored economic aspects from the perspective of women and their caregivers. Focus groups were conducted in 3 Quebec cities representing urban and semi-urban settings: 3 with 26 women first treated for non-metastatic breast cancer in the past 18 months, and 3 with 24 primary caregivers. We purposefully selected participants with different characteristics likely to affect the nature or extent of costs. Thematic content analysis was conducted on verbatim transcripts. Costs of breast cancer could be substantial, but were not the most worrisome aspect of the illness during treatments. Some costs were considered unavoidable, others depended on ability to pay. Costs occurred over a long period, with long term impact, and were borne by the whole family and not just the woman. Principal cost sources discussed were those associated with accessing health care, wage losses, reorganization of everyday life, and coping with the disease. This study provided deeper understanding of cost dynamics and the experience of costs among Canadian women with non-metastatic breast cancer, whose treatment and medical follow-up costs are borne through a system of universal, publicly funded health care.
PubMed ID
15386763 View in PubMed
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[Health inequities in mood disorders based on material and social deprivation in dwelling sectors ].

https://arctichealth.org/en/permalink/ahliterature118243
Source
Can J Psychiatry. 2012 Dec;57(12):772-81
Publication Type
Article
Date
Dec-2012
Author
Alain Vanasse
Josiane Courteau
Alain Lesage
Marie-Josée Fleury
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Claude Bergeron
Author Affiliation
Département de médecine de famille, Université de Sherbrooke, Sherbrooke, Canada.
Source
Can J Psychiatry. 2012 Dec;57(12):772-81
Date
Dec-2012
Language
French
Publication Type
Article
Keywords
Adult
Cohort Studies
Comorbidity
Female
Health Services - utilization
Humans
Male
Mood Disorders - drug therapy - epidemiology
Poverty - psychology - statistics & numerical data
Prescription Drugs - therapeutic use
Quebec - epidemiology
Social Isolation - psychology
Social Marginalization - psychology
Substance-Related Disorders - epidemiology
Abstract
To compare mood disorder (MD) prevalence in Quebec in 2006, and compare health services and medication use, mortality and morbidity in patients with MD based on sex and the dwelling sector level of material and social deprivation. The objective was also to identify subgroups of individuals using health services in a larger proportion and having a higher risk of morbidity and mortality.
We conducted a secondary analysis of the Régie de l’assurance maladie du Québec medico-administrative data. The cohort is composed of adults diagnosed with MD and living in Quebec in 2006. Variables include: physician consultation, medication demand, consultation for substance or alcohol abuse, emergency visit, hospitalization for a mental disorder, and death. Dwelling sector types are defined by crossing Pampalon material and social deprivation quintiles.
MD prevalence in 2006 was 3.06% (177 850 patients), with prevalence in women 1.7-fold with respect to men. Findings show a higher MD prevalence as well as a higher mortality and morbidity rate in materially and socially deprived dwelling sectors. Young men also represent a specifically vulnerable subgroup for many study variables.
Public policies aimed at improving material conditions (income, education, employment) and breaking out social isolation would have an important impact on the population mental health. Public health program development should pay close attention to young men population.
PubMed ID
23228237 View in PubMed
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Out-of-pocket costs for accessing adjuvant radiotherapy among Canadian women with breast cancer.

https://arctichealth.org/en/permalink/ahliterature131170
Source
J Clin Oncol. 2011 Oct 20;29(30):4007-13
Publication Type
Article
Date
Oct-20-2011
Author
Sophie Lauzier
Pascale Levesque
Mélanie Drolet
Douglas Coyle
Jacques Brisson
Benoît Mâsse
André Robidoux
Jean Robert
Elizabeth Maunsell
Author Affiliation
Centre Hospitalier Affilié Universitaire de Québec, Québec, Québec, Canada.
Source
J Clin Oncol. 2011 Oct 20;29(30):4007-13
Date
Oct-20-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Breast Neoplasms - economics - radiotherapy
Canada
Cost of Illness
Female
Health Care Costs
Health Expenditures
Humans
Middle Aged
Prospective Studies
Quebec
Radiotherapy, Adjuvant - economics
Young Adult
Abstract
Patients with breast cancer incur out-of-pocket costs when they receive adjuvant radiation. These treatments are administered in dedicated centers on a daily basis over 4 to 5 weeks. We assessed the extent of out-of-pocket costs to access radiotherapy and identified women at risk of experiencing higher costs.
This prospective study was conducted among 800 women from eight Quebec hospitals (participation, 86%), of whom 693 women received adjuvant radiotherapy. Costs to access treatment (transportation, parking, lodging, and meals) were estimated on the basis of information collected by telephone interviews. Generalized linear models were used to identify women at risk of having higher costs.
Mean and median total costs (including financial aid received) to access radiotherapy were 445 Canadian dollars (Can$; standard deviation, Can$407) and Can$311, respectively. Women who lived at home but far from the radiotherapy center had the highest risk of experiencing weekly costs of at least Can$122 (highest quartile; prevalence ratio [PR], 5.8; 95% CI, 4.7 to 7.1) followed by women who lived away from home and farther from the center (PR, 4.5; 95% CI, 3.4 to 6.0) and by women who lived away from home and closer to the center (PR, 2.14; 95% CI, 1.3 to 3.5). When women stayed at a cancer lodge during treatment, costs were reduced by 80%.
Considered in and of themselves, out-of-pocket costs for access to radiotherapy appeared relatively modest. Financial assistance initiatives for women who lived away from home during treatments contributed to a substantial reduction of access costs. These efforts should be maintained, but financial assistance should also target patients with cancer who live at home during treatments but have to travel relatively long distances on a daily basis.
PubMed ID
21931023 View in PubMed
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Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses.

https://arctichealth.org/en/permalink/ahliterature116911
Source
J Natl Cancer Inst. 2013 Feb 20;105(4):280-92
Publication Type
Article
Date
Feb-20-2013
Author
Sophie Lauzier
Pascale Lévesque
Myrto Mondor
Mélanie Drolet
Douglas Coyle
Jacques Brisson
Benoît Mâsse
Louise Provencher
André Robidoux
Elizabeth Maunsell
Author Affiliation
Unité de recherche en santé des populations (URESP), Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, QC, Canada, G1S 4L8. elizabeth.maunsell@uresp.ulaval.ca
Source
J Natl Cancer Inst. 2013 Feb 20;105(4):280-92
Date
Feb-20-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - economics - pathology
Canada
Cost of Illness
Educational Status
Employment
Female
Health Expenditures
Healthcare Financing
Humans
Interviews as Topic
Longitudinal Studies
Middle Aged
Neoplasm Staging
Prospective Studies
Salaries and Fringe Benefits
Spouses
Abstract
We lack comprehensive information about the extent of out-of-pocket costs after diagnosis of early breast cancer and their effects on the family's financial situation.
This longitudinal study assessed out-of-pocket costs and wage losses during the first year after diagnosis of early breast cancer among Canadian women and spouses. Out-of-pocket costs for treatments and follow-up, consultations with other practitioners, home help, clothing, and natural health products were estimated, with information collected from telephone interviews. Generalized linear models were used to identify women at risk of having higher costs and the effects of out-of-pocket costs on perceptions of the family's financial situation.
Overall, 829 women (participation, 86.2%) and 391 spouses participated. Women's median net out-of-pocket costs during the year after diagnosis were $1002 (2003 Canadian dollars; mean = $1365; SD = $1238), and 74.4% of these costs resulted from treatments and follow-up. Spouses' median costs were $111 (mean = $234; SD = $320), or 9% of couples' total expenses. In multivariable analyses, the percentage of women with out-of-pocket costs of $1773 or more (upper quartile) was statistically significantly associated with higher education, working at diagnosis, living more than 50 km from the hospital where surgery was performed, and having two and three different types of adjuvant treatment (all 2-sided P values = .01). However, when considered simultaneously with wage losses, out-of-pocket costs were not associated with perceived deterioration in the family's financial situation; rather, wage losses were the driving factor.
Overall, out-of-pocket costs from breast cancer for the year after diagnosis are probably not unmanageable for most women. However, some women were at higher risk of experiencing financial burden resulting from these costs.
Notes
Comment In: J Natl Cancer Inst. 2013 Feb 20;105(4):252-323349251
PubMed ID
23349250 View in PubMed
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Validity of information obtained from a method for estimating cancer costs from the perspective of patients and caregivers.

https://arctichealth.org/en/permalink/ahliterature145927
Source
Qual Life Res. 2010 Mar;19(2):177-89
Publication Type
Article
Date
Mar-2010
Author
Sophie Lauzier
Elizabeth Maunsell
Mélanie Drolet
Douglas Coyle
Nicole Hébert-Croteau
Author Affiliation
Unité de Recherche en Santé des Populations (URESP), Centre de Recherche FRSQ du Centre Hospitalier Affilié Universitaire de Québec, 1050 Chemin Sainte-Foy, Québec, QC G1S 4L8, Canada.
Source
Qual Life Res. 2010 Mar;19(2):177-89
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Algorithms
Breast Neoplasms - economics - radiotherapy
Caregivers - economics - psychology
Deductibles and Coinsurance - economics - statistics & numerical data
Female
Focus Groups
Health Care Costs - statistics & numerical data
Humans
Information Dissemination - methods
Patient Satisfaction - statistics & numerical data
Prospective Studies
Quebec
Questionnaires - standards
Women's Health - economics
Abstract
We describe a method we developed for estimating cancer costs from the perspective of patients and caregivers and evidence supporting validity of estimates obtained.
To increase validity, interview questions were anchored to treatments; costs were divided into their components; most questions focused on facts; and the research team combined responses into cost estimates. Evidence for validity comes from a prospective study of breast cancer costs using this method.
Estimates obtained using interview responses were similar to those from independent sources. Women reported being reimbursed $205 on average for prosthesis (government reimbursement =$200); paying $15.48 per night at cancer lodge (average rate =$17.52); receiving government illness insurance for 14.6 weeks at 53% of usual salary (governmental program covers 15 weeks at 55%). A priori hypotheses about relations of costs with other characteristics were also confirmed. For example, patients' weekly travel costs increased as a function of distance from the radiotherapy center, with patients living
PubMed ID
20094806 View in PubMed
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Wage losses in the year after breast cancer: extent and determinants among Canadian women.

https://arctichealth.org/en/permalink/ahliterature158514
Source
J Natl Cancer Inst. 2008 Mar 5;100(5):321-32
Publication Type
Article
Date
Mar-5-2008
Author
Sophie Lauzier
Elizabeth Maunsell
Mélanie Drolet
Douglas Coyle
Nicole Hébert-Croteau
Jacques Brisson
Benoît Mâsse
Belkacem Abdous
André Robidoux
Jean Robert
Author Affiliation
Unité de recherche en santé des populations, Centre de recherche du Centre Hospitalier Affilié Universitaire de Québec, Québec, Canada.
Source
J Natl Cancer Inst. 2008 Mar 5;100(5):321-32
Date
Mar-5-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Analysis of Variance
Breast Neoplasms - economics - pathology - therapy
Canada
Cohort Studies
Cost of Illness
Employment
Female
Humans
Linear Models
Middle Aged
Multivariate Analysis
Prospective Studies
Quebec
Questionnaires
Salaries and Fringe Benefits
Abstract
Wage losses after breast cancer may result in considerable financial burden. Their assessment is made more urgent because more women now participate in the workforce and because breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated wage losses, their determinants, and the associations between wage losses and changes for the worse in the family's financial situation among Canadian women over the first 12 months after diagnosis of early breast cancer.
We conducted a prospective cohort study among women with breast cancer from eight hospitals throughout the province of Quebec. Information that permitted the calculation of wage losses and information on potential determinants of wage losses were collected by three pretested telephone interviews conducted over the year following the start of treatment. Information on medical characteristics was obtained from medical records. The main outcome was the proportion of annual wages lost because of breast cancer. Multivariable analysis of variance using the general linear model was used to identify personal, medical, and employment characteristics associated with the proportion of wages lost. All statistical tests were two-sided.
Among 962 eligible breast cancer patients, 800 completed all three interviews. Of these, 459 had a paying job during the month before diagnosis. On average, these working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Multivariable analysis showed that a higher percentage of lost wages was statistically significantly associated with a lower level of education (P(trend) = .0018), living 50 km or more from the hospital where surgery was performed (P = .070), lower social support (P = .012), having invasive disease (P = .086), receipt of chemotherapy (P
PubMed ID
18314472 View in PubMed
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8 records – page 1 of 1.