Marie-Claude Vanier | Université de Montréal (original) (raw)
Papers by Marie-Claude Vanier
Health services insights., 2024
Handbook of experimental pharmacology, 1997
Pain is one of the most common causes for which patients seek advice and help from health profess... more Pain is one of the most common causes for which patients seek advice and help from health professionals. This is a very complex phenomenon always characterized as an unpleasant sensation which often disturbs the normal patterns of a patient’s activity, sleep and thoughts. Pain is a subjective phenomenon and factors such as anxiety, fatigue, suggestion or emotion as well as prior experiences can influence its perception. Thus, the patient is the only person who can describe the intensity of his or her pain and clinicians must rely on this subjective information to prescribe analgesic drugs. This is also why it is very difficult to have a good experimental model of pain.
American Journal of Health-System Pharmacy
Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using d... more Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach. Methods The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted med...
Purpose. Patients on hemodialysis have a high risk of medication-related problems. Studies using ... more Purpose. Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach. Methods. The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted medication were collected at 4 and 16 weeks. Descriptive statistics were used to examine the effects of the deprescribing intervention. Results. Of 270 patients, 256 were taking at least one targeted medication. Of the 122 patients taking at least one targeted medication who were approached to participate, 66 were included in the study. At enrollment, these patients were taking 252 targeted medications, of which 59 (23.4%) were determined to be inappropriate. Deprescription was initiated for 35 of these 59 medications (59.3%). At 4 weeks, 33 of the 59 medications (55.9%) were still deprescribed, while, at 16 weeks, 27 of the 59 medications (45.8%) were still deprescribed. Proton pump inhibitors and benzodiazepines or Z-drugs were the most common inappropriate medications, and allopurinol was the most deprescribed medication. Conclusion. A pharmacist-led intervention with a patient-partnership approach and using deprescribing algorithms reduced the number of inappropriate medications in patients on hemodialysis.
HAL (Le Centre pour la Communication Scientifique Directe), Sep 29, 2015
Journal of Interprofessional Care, Apr 11, 2022
Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessi... more Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessional team to prevent complications. The INMED (INterprofessional Management and Education in Diabetes) care pathway was developed by our team to optimize primary care services for these patients and their families. The objective of this study is to describe the preliminary results of its adoption and implementation. The INMED care pathway is organized into four axes: (a) continuing professional education, (b) self-management support, (c) case management, and (d) ongoing evaluation of the quality of diabetes care and services. A multiple-case study is underway to document its effects on practice change using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Preliminary results on the adoption and implementation revealed some strengths: (a) regular patient follow-up by the case manager, (b) scheduling of physician appointments when required, and (c) regular screening for risk factors. Barriers were also identified: (a) lack of clear understanding of the case manager role, (b) lack of referrals to team members, and (c) lack of use of the motivational interview approach. The INMED care pathway is being adopted by primary care teams but challenges need to be overcome to improve its reach and effectiveness.
American Journal of Health-system Pharmacy, Jul 26, 2022
Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using d... more Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach. Methods The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted medication were collected at 4 and 16 weeks. Descriptive statistics were used to examine the effects of the deprescribing intervention. Results Of 270 patients, 256 were taking at least one targeted medication. Of the 122 patients taking at least one targeted medication who were approached to participate, 66 were included in the study. At enrollment, these patients were taking 252 targeted medications, of which 59 (23.4%) were determined to be inappropriate. Deprescription was initiated for 35 of these 59 medications (59.3%). At 4 weeks, 33 of the 59 medications (55.9%) were still deprescribed, while, at 16 weeks, 27 of the 59 medications (45.8%) were still deprescribed. Proton pump inhibitors and benzodiazepines or Z-drugs were the most common inappropriate medications, and allopurinol was the most deprescribed medication. Conclusion A pharmacist-led intervention with a patient-partnership approach and using deprescribing algorithms reduced the number of inappropriate medications in patients on hemodialysis.
HAL (Le Centre pour la Communication Scientifique Directe), Oct 23, 2020
HAL (Le Centre pour la Communication Scientifique Directe), Sep 29, 2015
International audienc
Genetics in Medicine, 2005
Purpose: Hemochromatosis is a treatable disorder with a major genetic predisposition. It provides... more Purpose: Hemochromatosis is a treatable disorder with a major genetic predisposition. It provides an example in which genotypic and phenotypic strategies for screening may be compared. We previously showed noninferiority of uptake of a genotypic population screening strategy for hemochromatosis compared with a phenotypic strategy. In this article we present the psychologic effects of each strategy. Methods: A sample of 3000 individuals from primary care were randomly allocated to a phenotypic or genotypic screening strategy for hemochromatosis, and the 939 individuals who accepted screening provide the sample for this article. Standardized assessments of anxiety, general health, and depression were made at invitation, testing, result-giving, and 6 months. Results: Screening did not lead to significant changes in the self-rated assessments of anxiety, depression, and general health over time, and there were no significant differences between the two screening strategies. The unemployed or permanently disabled had lower ratings of health and higher anxiety and depression. Conclusion: The two screening strategies appeared to cause little adverse psychologic disturbance in the short term, and there was no difference between the two strategies This study provides some empiric data to support arguments against "genetic exceptionalism" and suggests that genetic testing when used for population screening for a treatable disease has few adverse effects.
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada, 2009
Objective: To develop a pharmacist liaison service in a family medicine teaching clinic in order ... more Objective: To develop a pharmacist liaison service in a family medicine teaching clinic in order to optimize and facilitate community pharmacists' interventions. Target groups: Community pharmacists involved in the care of patients registered at the family medicine clinic (FMC) of Cité de la Santé de Laval and clinical pharmacists working at this clinic. Activities: The FMC is a medical teaching clinic located in a general care hospital. The FMC operates as a multidisciplinary group of GPs, nurses and pharmacists providing care to enlisted patients. Due to their clinical experience, proximity to the medical team and direct access to FMC patients' charts, FMC pharmacists (FMC-PH) are in a key position to support community pharmacists (COM-PH) in order to optimize the quality of pharmaceutical care dispensed to their common patients. The liaison pharmacist service was created within a larger study of COM-PH interventions and their impact on medication when receiving a doctor r...
Chronopharmacologie. Rythmes biologiques et administration des médicaments
Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes, 2015
Le Centre pour la Communication Scientifique Directe - HAL - Université de Nantes, 2016
These abstracts have been peer reviewed | Ces résumés ont fait l'objet d'une révision par des pairs
Pain, 1993
In this pilot randomized, double-blind, cross-over study, the effectiveness and safety of hydromo... more In this pilot randomized, double-blind, cross-over study, the effectiveness and safety of hydromorphone administration by continuous subcutaneous (s.c.) infusion (mode A) and by continuous basal rate S.C. infusion + PCA (mode B) were compared in 8 cancer patients. Patients experimented with each infusion mode during 48 h. Statistical analysis was performed on data collected in 7 patients during 36 h from 22:00 h on day 1 to 10:00 h on day 3 and from 22:00 h on day 3 to 10:00 h on day 5. Mean hydromorphone dose f S.D. was 56.6 f 30.1 and 40.4 + 24.5 mg/36 h for modes A and B, respectively. There was no statistically significant difference observed in mean pain intensity, but the absence of significant difference may be related to the small sample size and high individual variability. Both methods provided adequate overall pain control in most patients. However, a large interindividual variation was detected. Indeed, some patients reported in the subjective questionnaire that they felt marked discomfort during hydromorphone administration with mode B. Only 2 patients chose mode B at the end of the study, but it was interesting to note that those 2 patients were the youngest of the group. This study demonstrated the effectiveness and safety of both modes of hydromorphone administration. The data suggest that it may be possible to identify particular cancer patients which can really benefit from an association of a basal rate infusion and PCA for opiate administration.
Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes, 2014
Objective To describe the management and distribution of drug samples in family medicine teaching... more Objective To describe the management and distribution of drug samples in family medicine teaching units (FMUs). Design Cross-sectional descriptive study. Setting All 16 FMUs affiliated with the Department of Family Medicine and Emergency Medicine at the University of Montreal in Quebec. Participants Health care professionals (physicians, residents, pharmacists, and nurses) who manage (n = 22) and dispense (n = 294) drug samples in the FMUs. Methods Data were collected between February and March 2013 using 2 self-administered questionnaires completed by health care professionals who manage or dispense drug samples. The data were subjected to descriptive and bivariate analyses. Results The participation rate was 100.0% for staff who manage drug samples and 72.5% for those who dispense them. Of the 16 participating FMUs, 12 have drug sample cabinets. Eight of the FMUs have a written institutional policy governing the management of drug samples. Of the 76.2% of respondents who said they...
Health services insights., 2024
Handbook of experimental pharmacology, 1997
Pain is one of the most common causes for which patients seek advice and help from health profess... more Pain is one of the most common causes for which patients seek advice and help from health professionals. This is a very complex phenomenon always characterized as an unpleasant sensation which often disturbs the normal patterns of a patient’s activity, sleep and thoughts. Pain is a subjective phenomenon and factors such as anxiety, fatigue, suggestion or emotion as well as prior experiences can influence its perception. Thus, the patient is the only person who can describe the intensity of his or her pain and clinicians must rely on this subjective information to prescribe analgesic drugs. This is also why it is very difficult to have a good experimental model of pain.
American Journal of Health-System Pharmacy
Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using d... more Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach. Methods The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted med...
Purpose. Patients on hemodialysis have a high risk of medication-related problems. Studies using ... more Purpose. Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach. Methods. The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted medication were collected at 4 and 16 weeks. Descriptive statistics were used to examine the effects of the deprescribing intervention. Results. Of 270 patients, 256 were taking at least one targeted medication. Of the 122 patients taking at least one targeted medication who were approached to participate, 66 were included in the study. At enrollment, these patients were taking 252 targeted medications, of which 59 (23.4%) were determined to be inappropriate. Deprescription was initiated for 35 of these 59 medications (59.3%). At 4 weeks, 33 of the 59 medications (55.9%) were still deprescribed, while, at 16 weeks, 27 of the 59 medications (45.8%) were still deprescribed. Proton pump inhibitors and benzodiazepines or Z-drugs were the most common inappropriate medications, and allopurinol was the most deprescribed medication. Conclusion. A pharmacist-led intervention with a patient-partnership approach and using deprescribing algorithms reduced the number of inappropriate medications in patients on hemodialysis.
HAL (Le Centre pour la Communication Scientifique Directe), Sep 29, 2015
Journal of Interprofessional Care, Apr 11, 2022
Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessi... more Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessional team to prevent complications. The INMED (INterprofessional Management and Education in Diabetes) care pathway was developed by our team to optimize primary care services for these patients and their families. The objective of this study is to describe the preliminary results of its adoption and implementation. The INMED care pathway is organized into four axes: (a) continuing professional education, (b) self-management support, (c) case management, and (d) ongoing evaluation of the quality of diabetes care and services. A multiple-case study is underway to document its effects on practice change using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Preliminary results on the adoption and implementation revealed some strengths: (a) regular patient follow-up by the case manager, (b) scheduling of physician appointments when required, and (c) regular screening for risk factors. Barriers were also identified: (a) lack of clear understanding of the case manager role, (b) lack of referrals to team members, and (c) lack of use of the motivational interview approach. The INMED care pathway is being adopted by primary care teams but challenges need to be overcome to improve its reach and effectiveness.
American Journal of Health-system Pharmacy, Jul 26, 2022
Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using d... more Purpose Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach. Methods The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted medication were collected at 4 and 16 weeks. Descriptive statistics were used to examine the effects of the deprescribing intervention. Results Of 270 patients, 256 were taking at least one targeted medication. Of the 122 patients taking at least one targeted medication who were approached to participate, 66 were included in the study. At enrollment, these patients were taking 252 targeted medications, of which 59 (23.4%) were determined to be inappropriate. Deprescription was initiated for 35 of these 59 medications (59.3%). At 4 weeks, 33 of the 59 medications (55.9%) were still deprescribed, while, at 16 weeks, 27 of the 59 medications (45.8%) were still deprescribed. Proton pump inhibitors and benzodiazepines or Z-drugs were the most common inappropriate medications, and allopurinol was the most deprescribed medication. Conclusion A pharmacist-led intervention with a patient-partnership approach and using deprescribing algorithms reduced the number of inappropriate medications in patients on hemodialysis.
HAL (Le Centre pour la Communication Scientifique Directe), Oct 23, 2020
HAL (Le Centre pour la Communication Scientifique Directe), Sep 29, 2015
International audienc
Genetics in Medicine, 2005
Purpose: Hemochromatosis is a treatable disorder with a major genetic predisposition. It provides... more Purpose: Hemochromatosis is a treatable disorder with a major genetic predisposition. It provides an example in which genotypic and phenotypic strategies for screening may be compared. We previously showed noninferiority of uptake of a genotypic population screening strategy for hemochromatosis compared with a phenotypic strategy. In this article we present the psychologic effects of each strategy. Methods: A sample of 3000 individuals from primary care were randomly allocated to a phenotypic or genotypic screening strategy for hemochromatosis, and the 939 individuals who accepted screening provide the sample for this article. Standardized assessments of anxiety, general health, and depression were made at invitation, testing, result-giving, and 6 months. Results: Screening did not lead to significant changes in the self-rated assessments of anxiety, depression, and general health over time, and there were no significant differences between the two screening strategies. The unemployed or permanently disabled had lower ratings of health and higher anxiety and depression. Conclusion: The two screening strategies appeared to cause little adverse psychologic disturbance in the short term, and there was no difference between the two strategies This study provides some empiric data to support arguments against "genetic exceptionalism" and suggests that genetic testing when used for population screening for a treatable disease has few adverse effects.
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada, 2009
Objective: To develop a pharmacist liaison service in a family medicine teaching clinic in order ... more Objective: To develop a pharmacist liaison service in a family medicine teaching clinic in order to optimize and facilitate community pharmacists' interventions. Target groups: Community pharmacists involved in the care of patients registered at the family medicine clinic (FMC) of Cité de la Santé de Laval and clinical pharmacists working at this clinic. Activities: The FMC is a medical teaching clinic located in a general care hospital. The FMC operates as a multidisciplinary group of GPs, nurses and pharmacists providing care to enlisted patients. Due to their clinical experience, proximity to the medical team and direct access to FMC patients' charts, FMC pharmacists (FMC-PH) are in a key position to support community pharmacists (COM-PH) in order to optimize the quality of pharmaceutical care dispensed to their common patients. The liaison pharmacist service was created within a larger study of COM-PH interventions and their impact on medication when receiving a doctor r...
Chronopharmacologie. Rythmes biologiques et administration des médicaments
Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes, 2015
Le Centre pour la Communication Scientifique Directe - HAL - Université de Nantes, 2016
These abstracts have been peer reviewed | Ces résumés ont fait l'objet d'une révision par des pairs
Pain, 1993
In this pilot randomized, double-blind, cross-over study, the effectiveness and safety of hydromo... more In this pilot randomized, double-blind, cross-over study, the effectiveness and safety of hydromorphone administration by continuous subcutaneous (s.c.) infusion (mode A) and by continuous basal rate S.C. infusion + PCA (mode B) were compared in 8 cancer patients. Patients experimented with each infusion mode during 48 h. Statistical analysis was performed on data collected in 7 patients during 36 h from 22:00 h on day 1 to 10:00 h on day 3 and from 22:00 h on day 3 to 10:00 h on day 5. Mean hydromorphone dose f S.D. was 56.6 f 30.1 and 40.4 + 24.5 mg/36 h for modes A and B, respectively. There was no statistically significant difference observed in mean pain intensity, but the absence of significant difference may be related to the small sample size and high individual variability. Both methods provided adequate overall pain control in most patients. However, a large interindividual variation was detected. Indeed, some patients reported in the subjective questionnaire that they felt marked discomfort during hydromorphone administration with mode B. Only 2 patients chose mode B at the end of the study, but it was interesting to note that those 2 patients were the youngest of the group. This study demonstrated the effectiveness and safety of both modes of hydromorphone administration. The data suggest that it may be possible to identify particular cancer patients which can really benefit from an association of a basal rate infusion and PCA for opiate administration.
Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes, 2014
Objective To describe the management and distribution of drug samples in family medicine teaching... more Objective To describe the management and distribution of drug samples in family medicine teaching units (FMUs). Design Cross-sectional descriptive study. Setting All 16 FMUs affiliated with the Department of Family Medicine and Emergency Medicine at the University of Montreal in Quebec. Participants Health care professionals (physicians, residents, pharmacists, and nurses) who manage (n = 22) and dispense (n = 294) drug samples in the FMUs. Methods Data were collected between February and March 2013 using 2 self-administered questionnaires completed by health care professionals who manage or dispense drug samples. The data were subjected to descriptive and bivariate analyses. Results The participation rate was 100.0% for staff who manage drug samples and 72.5% for those who dispense them. Of the 16 participating FMUs, 12 have drug sample cabinets. Eight of the FMUs have a written institutional policy governing the management of drug samples. Of the 76.2% of respondents who said they...
La pratique collaborative ? Tout le monde en parle, mais nos formations sont tellement cloisonnée... more La pratique collaborative ? Tout le monde en parle, mais nos formations sont tellement cloisonnées qu’on a du mal à la promouvoir...
On entend partout dire que l’apprentissage de la collaboration est fondamental, mais en pratique, comment fait-on ?
Introduction : Les patients, grâce à leur expérience de vécu avec la maladie et leur parcours dans le système de santé pourraient-ils contribuer utilement à l’enseignement de la pratique collaborative ?
4.1 Qu’est-ce que la pratique collaborative en partenariat avec le patient et pourquoi la promouvoir ?
4.2 Quelles sont les modalités de la pratique collaborative ?
4.3 Quelle est la place du patient dans la pratique collaborative ?
4.4 Comment former les professionnels de santé aux pratiques collaboratives en partenariat avec les patients ?