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Biomedical subjects

Yves Lacasse

Publications and source records attributed to Yves Lacasse.

25 records · Page 2Linked to original sources
PubMedDate not supplied

Patterns and determinants of compliance with inhaled steroids in adults with asthma.

BACKGROUND: Patient compliance with inhaled corticosteroids (ICS) in asthma is considered to be suboptimal. OBJECTIVES: To describe the patterns of compliance with ICS and identify factors determining the compliance to ICS in adults with asthma. METHODS: Based on a review of the literature and interviews with asthmatic patients who require the regular use of ICS, potential determinants of compliance to ICS were identified. Questionnaires related to these determinants were then administered to a cohort of patients from three subspecialty clinics, including two from university-affiliated centres. Patients with mild-to-moderate asthma who were 15 years of age and older and required (from the physician's point of view) ICS as maintenance medication because of persistent asthma were included in the study. Patients were followed for a period of 12 weeks. Compliance was measured using electronic devices. RESULTS: Data from 124 patients (51 men; mean age 47+/-15 years; mean prescribed daily dose of ICS [fluticasone propionate] 643+/-385 microg) were analyzed. On average, the patients took 72+/-24% of their prescription. Four patterns of compliance were observed and are described: 1A -- regular compliance (n = 29); 1B -- irregular compliance (n = 37); 2A -- regular noncompliance (n = 24); and 2B -- irregular noncompliance (n = 34). Among the potential predictors of noncompliance, age was the only significant predictor (compliance increased with increasing age). There was no difference in asthma control between compliant and noncompliant patients. CONCLUSION: Compliance to ICS in patients with asthma is often suboptimal and difficult to predict. The observations suggest that some asthmatics may be overtreated with ICS.

Administration, Inhalation↗
PubMedDate not supplied

The validity of diagnosing chronic obstructive pulmonary disease from a large administrative database.

BACKGROUND: Health authorities create and maintain administrative databases. Despite the potential advantages of these databases, the validity of the information they include must be considered. OBJECTIVE: To examine the validity of diagnosing chronic obstructive pulmonary disease (COPD) from a large administrative database. METHODS: Physician services and prescription claims data related to COPD and asthma were extracted from the Quebec universal medical insurance register (Régie de l'assurance-maladie du Québec; RAMQ) from the period of April 1, 1994 to March 31, 1999. Before obtaining the data, criteria for the validity of the COPD diagnosis in the database were formulated based on the epidemiology of COPD in the province. The extent to which the database satisfied these criteria are described within the present paper. RESULTS: For patients aged 65 years or older, COPD was two times more prevalent in the RAMQ database than in the 1994/1995 National Population Health Survey. One in three patients with a RAMQ-diagnosis of COPD also had a RAMQ-diagnosis of asthma, and 47% of patients aged 65 years or older with a RAMQ-diagnosis of COPD did not fill any prescription for beta-2-agonists. In addition, 42% of patients with a RAMQ-diagnosis of COPD who never had a RAMQ-diagnosis of asthma appeared only once with that diagnosis in the database. Of all patients aged 65 years or older with a RAMQ-diagnosis of COPD, 37% and 23% met the operational definitions of 'possible COPD' and 'probable COPD', respectively. CONCLUSIONS: Most RAMQ-diagnoses of COPD lack validity; therefore, the validity of database diagnoses should be routinely ascertained before using administrative databases in clinical and health services research.

Adult↗
PubMedDate not supplied

A Canadian, multicentre, randomized clinical trial of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease: rationale and methods.

BACKGROUND: Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation. OBJECTIVE: To report the rationale and methods of a trial comparing the effectiveness of self-monitored, home-based rehabilitation with hospital-based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD). STUDY DESIGN: A parallel-group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD. INTERVENTION: Patients will be randomly assigned to conventional, supervised, hospital-based outpatient rehabilitation or self-monitored, home-based rehabilitation. Both interventions will include a standardized, comprehensive self-management program, in addition to the hospital-based outpatient or home-based exercise program. After the three-month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthly with telephone interviews and in person at enrollment, three months and 12 months. OUTCOMES: The dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months is the primary outcome variable. Secondary outcome variables include total and domain-specific CRQ scores; exercise tolerance and activity of daily living; health service use over the one-year study period; and direct and indirect costs of COPD treatment. ANALYSIS: An intent-to-treat approach will be used as the primary analysis. The primary analysis will focus on the change in the CRQ dyspnea score using a two-sided t distribution based on 95% CIs. The same approach will be used for secondary continuous outcome variables. CONCLUSION: The present trial will address two unresolved issues in pulmonary rehabilitation for patients with COPD: the short-term and long-term effectiveness of home-based pulmonary rehabilitation strategies. The authors will also determine if home-based pulmonary rehabilitation can reduce health service use (eg, hospitalizations and emergency visits) and if it can be done at a lower cost than the traditional hospital-based outpatient pulmonary rehabilitation.

Adult↗
PubMedDate not supplied

Cost-effectiveness of positron emission tomography for the management of potentially operable non-small cell lung cancer in Quebec.

BACKGROUND: The potential benefits of positron emission tomography (PET) scanning stem from the fact that it can reduce the number of diagnostic examinations; particularly, the number of unnecessary thoracic surgeries. OBJECTIVE: To evaluate the economic impact and cost-effectiveness of PET scanning in the management of potentially operable non-small cell lung cancer in Quebec. METHODS: A decision tree was developed. Two strategies were compared: chest computed tomography (CT) alone or CT and whole-body PET. The various paths of each strategy were dependent on the numerous variables that were determined from a literature review. The costs and life expectancy were determined for each strategy under consideration. Life expectancy was calculated using the declining exponential approximation of life expectancy. Costs were obtained from the Quebec diagnosis-related group database and Quebec physician fee schedules. RESULTS: The mean cost of the CT strategy was US dollars 8,455 per patient compared with US dollars 9,723 for the PET strategy, for a cost differential of US dollars 1,268. The PET strategy extended life expectancy by slightly more than three months (0.27 years) compared with the survival of the CT strategy. The incremental cost-effectiveness ratio was US dollars 4,689. Considering the number of new cases and the prevalence of mediastinal metastases, the budget impact would be US dollars 8,613,693. CONCLUSION: The use of PET to detect local and distant metastases in non-small cell lung cancer is an intervention that would require an acceptable investment for each life-year gained.

Analysis of Variance↗