Lucie Blais

• Université de Montréal

Background End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied. Objective T...

Objectives Randomized clinical trials are used to evaluate the efficacy of various pain treatments individually, while a limited number of observational studies have portrayed the overall relief experienced by persons living with chronic pain. This study aimed to describe pain relief in real-world clinical settings and to identify associated factor...

Objective: Where a person lives is a recognized socioeconomic determinant of health and influences healthcare access. This study aimed to compare the pain treatment profile of persons with chronic pain (CP) living in remote regions to those living in non-remote regions (near or in major urban centers). Methods: A cross-sectional study was performe...

Treatment of chronic pain should be multimodal and include pharmacological, physical, and psychological treatments. However, because various barriers to physical and psychological treatments (PPTs) exist, a better understanding of biopsychosocial factors leading to their use is relevant. This study aimed to explore the association between gender id...

Purpose Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, as the use of ≥10 medications. Objectives were to (1) assess the prevalence of polypharmacy and excessive polypharmacy among persons living with chronic pain, and (2) identify sociodemographic and clinical factors associated with excessive polyp...

Background: In Canada, a state of health emergency was declared in May 2020 as a result of the COVID-19 pandemic. This study aimed to assess trends in the use of prescription medication for pain management by people living with chronic pain before and during the first wave of the pandemic. Methods: Participants (n = 177) were adults reporting ch...

Objectives: e-MEDRESP is a novel web-based tool that provides easily interpretable information on patient adherence to asthma/chronic obstructive pulmonary disease (COPD) medications, using pharmacy claims data. This study investigated the feasibility of implementing e-MEDRESP in primary care. Material and methods: In this 16-month prospective c...

Background Achieving asthma control is often difficult, despite the availability of effective medications. Because of their expertise, regular contact with patients, and accessibility, community pharmacists can play an important role in helping patients manage uncontrolled asthma. Objective To develop a community pharmacy-based intervention for im...

Objectives Understanding gender differences in chronic pain (CP) outcome research is essential to optimal treatment delivery. This study explored the associations between gender identity, gender roles, and the number of non-life-threatening pain medication adverse effects reported as severe by people living with CP. Methods The analyses were condu...

Reliable treatment burden measures are needed given the aging population and the associated increase in multimorbidity and polypharmacy. Treatment burden is defined as the effort to care for one’s health and the resulting impact on one’s daily life. This study aimed to translate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for French-Ca...

Objectives: Understanding gender differences in chronic pain (CP) outcome research is essential to optimal treatment delivery. This study explored the associations between gender identity, gender roles, and the number of non-life-threatening pain medication adverse effects reported as severe by people living with CP. Methods: The analyses were cond...

BACKGROUND: Conflicting results have been found among studies assessing the effect of smoking on airway inflammation among asthmatic subjects. OBJECTIVE: We sought to compare the inflammatory and clinical characteristics of active smokers and nonsmokers with uncontrolled moderate-to-severe asthma. Methods: We conducted a cross-sectional study compa...

Background Tools capable of predicting the risk of asthma exacerbations can facilitate asthma management in clinical practice. However, existing tools require additional data from patients beyond electronic medical records. Objective To predict asthma exacerbation in an upcoming year using electronically accessible data conditional on past adheren...

Background: Medical cannabis has been legal in Canada since 2001, and recreational cannabis was legalized in October 2018, which has led to a widespread increase in the accessibility of cannabis products. Aims: This study aimed to estimate the prevalence of cannabis use among adults living with chronic pain (CP) and investigate the relationship...

Background We expect a difference in drug cost between private drug plans and the Public Drug Plan (PDP) because the dispensing fee is fixed and regulated by the PDP for publicly insured patients, whereas it is determined freely by the pharmacy owner for privately insured patients. This study compared the drug cost of Quebec residents covered by pr...

Background Social inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectori...

Background The potential influence of asthma control in early life on long-term outcomes in childhood remains largely unknown. Objective To examine whether asthma control trajectories in the 2 years post-diagnosis in preschoolers are associated with long-term unsatisfactory asthma control. Methods We conducted a multicenter population-based retro...

Many studies seek to evaluate the effects of potentially harmful pregnancy exposures during specific gestational periods. We consider an observational pregnancy cohort where pregnant individuals can initiate medication usage or become exposed to a drug at various times during their pregnancy. An important statistical challenge involves how to defin...

Effect modification occurs when the effect of a treatment on an outcome differsaccording to the level of some pre-treatment variable (the effect modifier). Assessing an effect modifier is not a straight-forward task even for a subject matter expert. In this paper, we propose a two-stageprocedure to automatically selecteffect modifying variables in...

To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associ...

Objectives: e-MEDRESP is a novel web-based tool that provides easily interpretable information on patient adherence to asthma/chronic obstructive pulmonary disease medications, using pharmacy claims data. This study investigated the feasibility of implementing e-MEDRESP in primary care. Materials and Methods: In this 16-month prospective cohort stu...

Background In recent years, there has been growing interest in studying asthma treatment escalation patterns in the real-world setting, particularly with the advent of expensive biologic therapies. Healthcare administrative claims databases can be used to study treatment escalation patterns at a population-level; however, the reported definitions f...

Background Achieving optimal asthma control and minimizing the risk of exacerbation are the main goals of asthma treatment. Objective This study aimed to assess the predictors of poor asthma control and asthma exacerbations within a population of moderate to severe asthmatic patients treated in a tertiary care center. Methods We conducted a cohor...

Introduction: Asthma guided self-management enhances patients' control of their condition under the guidance of the treating physician. The aim of the present study was to understand how physicians perceive, endorse, uptake, and support asthma guided self-management. Methods: We conducted a secondary supplementary analysis of data originally col...

Purpose: The linkage between patient-reported data and medico-administrative claims is of great interest for epidemiologic research. The goal of this study was to assess the willingness of people living with chronic pain to share personal identifiers on the web for the linkage of medico-administrative and patient-reported data. Methods: This met...

Background: International guidelines recommend asthma medication use during pregnancy. Reduced asthma medication use might lead to poorly controlled asthma and increase the risk of adverse perinatal outcomes. Objective: To assess whether asthma medication use during pregnancy differs in women newly diagnosed with asthma early in pregnancy (first...

Introduction: Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remissio...

Effect modification occurs when the effect of the treatment on an outcome differs according to the level of a third variable (the effect modifier, EM). A natural way to assess effect modification is by subgroup analysis or include the interaction terms between the treatment and the covariates in an outcome regression. The latter, however, does not...

Objectives To review the available evidence supporting the validity of algorithms to identify asthma patients in healthcare administrative databases. Methods A systematic literature search was conducted on multiple databases from inception to March 2020 to identify studies that reported the validity of case-finding asthma algorithms applied to hea...

In longitudinal settings, causal inference methods usually rely on a discretization of the patient timeline that may not reflect the underlying data generation process. This article investigates the estimation of causal parameters under discretized data. It presents the implicit assumptions practitioners make but do not acknowledge when discretizin...

Background Community pharmacists are best placed to improve medication adherence because they frequently interact with patients and have been trained to manage medication-related problems. Therefore, it is essential to equip pharmacists adequately to detect non-adherent patients quickly and intervene to improve medication adherence. Objective To d...

Background: Medication adherence in asthma and COPD is notoriously low. To intervene effectively, family physicians need to assess adherence accurately, which is a challenging endeavor. In collaboration family physicians and individuals with asthma or COPD, we aimed to explore the barriers and facilitators of assessing medication adherence in clin...

Although medical research frequently involves an exposure variable with three or more discrete levels, detailed presentations of mediation techniques for dealing with multicategorical (multilevel) exposures are sparse. In this paper, we study two causal mediation approaches applicable to such a type of exposure for continuous mediator and outcome:...

RATIONALE: There exists no validated index to assess pediatric asthma control in pharmacoepidemiologic studies. OBJECTIVE: The objective of this study was to develop and validate a pharmacoepidemiologic pediatric asthma control index (PPACI) based on dispensed medications and health care utilization. METHODS: Using a population-based birth cohort,...

Background: Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. Objectives: This systematic review aimed at assessing evidence about the validity of algorithms for the identificati...

Background Community pharmacists have direct access to prescription refill information and regularly interact with their patients. Therefore, they are in a unique position to promote optimal medication use. Objectives To describe how community pharmacists in Quebec, Canada, identify nonadherent patients, monitor medication use and promote optimal...

Background: It is unclear if asthma diagnosed during pregnancy puts the fetus at a higher risk of poor perinatal outcomes than pre-existing asthma. Objective: To assess if the risks of prematurity, major malformations, and small-for-gestational age (SGA) are higher in women with asthma diagnosed during versus pre-pregnancy. Methods: We retrosp...

Background: The Observational Study of the Use and Safety of Xolair (omalizumab) during Pregnancy (EXPECT) pregnancy registry was a prospective observational study established in 2006 to evaluate perinatal outcomes in pregnant women exposed to omalizumab and their infants. Objective: This analysis compares EXPECT outcomes with those from a disea...

Purpose The purpose of this study was to better understand patients’ perspective of asthma self-management by focusing on the sociocultural and medical context shaping patients’ illness representations and individual decisions. Patients and methods We conducted a secondary analysis of semi-structured interviews carried out as part of a multicenter...

OBJECTIVES: Asthma affects nearly one-tenth of the Canadian population. The purpose of these studies was to estimate the direct and indirect costs of asthma in Canada, using data from the Registre de données en Santé Pulmonaire (RESP), Quebec health administration databases, and prospective data from randomly selected patients from the RESP registr...

Electronic health data are routinely used for population drug studies. Due to the ethical dilemma in carrying out experimental drug studies on pregnant women, the effects of medication usage during pregnancy on fetal and maternal outcomes are largely evaluated using this data collection medium. One major limitation in this type of study is the dela...

Background: Several epidemiological studies have suggested that the risk of depression is increased in patients with asthma, but the impact of asthma during pregnancy on postpartum depression remains unknown. Objective: To assess the association between maternal asthma and postpartum depression in a population-based cohort study retrieved from a...

Background Data on treatment expectation and perception towards vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), and low molecular weight heparins (LMWH) for the management of venous thromboembolism (VTE) are sparse. Methods Prospective observational study including subjects admitted to the hospital with a diagnosis of VTE and a pr...

Building on the work of Schwartz et al, Joint Bayesian analysis of birthweight and censored gestational age using finite mixture models in Statistics in Medicine, we propose a Bayesian finite mixture of bivariate regression model for causal mediation analyses. Using an identifiability condition within each component of the mixture, we express the n...

Asthma is a heterogeneous disease, and responses to asthma medications vary noticeably among patients. A substantively oriented objective of this study was to explore the potential heterogeneous effects of maternal inhaled corticosteroids (ICS) exposure on gestational age (GA) at delivery and birthweight (BW) using a cohort of 6,197 pregnancies fro...

OBJECTIVES: 1) To develop Med-Resp, a graphical tool based on prescription refills to measure adherence and use of asthma medications; 2) To test the feasibility of implementing Med-Resp in a hospital outpatient asthma clinic; 3) To explore the effectiveness of Med-Resp to improve medication adherence to asthma controller medications. METHODS: A se...

Data-adaptive methods have been proposed to estimate nuisance parameters when using doubly robust semiparametric methods for estimating marginal causal effects. However, in the presence of near practical positivity violations, these methods can produce a separation of the two exposure groups in terms of propensity score densities which can lead to...

Background: Inhaler technique and patient preferences are often overlooked when selecting maintenance treatments for patients with chronic obstructive pulmonary disease (COPD), but are important issues in ensuring drug efficacy and patient adherence. Few data on these issues are available for new inhalation devices. Objectives: To evaluate the i...

Asthma: ENCOURAGING DOCTORS TO PROVIDE WRITTEN ACTION PLANS: Changes to practice organization and doctors' perceptions should encourage the provision of written action plans for all asthma patients. International guidelines state that effective long-term treatment of asthma requires educated self-management, regular reviews and provision of a writ...

Background: Maternal asthma has been found to be associated with an increased risk of hypertensive disorders of pregnancy (HDP), that is, gestational hypertension, preeclampsia, and eclampsia. There is limited data, however, regarding the relationship between the use of long-acting beta-agonists (LABAs) during pregnancy and these outcomes. Object...

Background: No studies have examined adherence or persistence to long-acting anticholinergics (LAAC) treatment episodes in patients with chronic obstructive pulmonary disease (COPD). Objective: To estimate 1-year adherence and 5-year persistence to LAAC during treatment episodes, and the likelihood of initiating a subsequent treatment episode....

Contexte Cet article vise à décrire les facteurs associés à la prescription d’antipsychotiques par un psychiatre plutôt qu’un omnipraticien, la prescription d’un antipsychotique de seconde plutôt que de première génération, la prescription d’une multithérapie d’antipsychotiques et le non-renouvellement de la prescription initiale. Méthodologie Il s...

Approximately 15-20% of patients with chronic obstructive pulmonary disease (COPD) also display characteristics of asthma. In May 2014, the asthma-COPD overlap syndrome (ACOS) was briefly addressed in the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy documents. We evaluated how pulmon...

Objectives To compare the prevalence of major malformations using different case ascertainment definitions and to evaluate their impact on maternal asthma-major malformations association. Methods A cohort of pregnancies with and without asthma between 1990 and 2010 was formed. We used two classification methods: the Two step Congenital Malformation...

Purpose: Several factors have been associated with the prescription of direct oral anticoagulants (DOAC) over warfarin such as younger age, fewer concomitant medications, and lower CHADS2 or bleeding scores. The primary objective of this study was to identify predictors of DOAC choice compared with warfarin for patients who are starting a new oral...

PurposeThere are very few studies on primary adherence (i.e., first filling of a prescription) to inhaled corticosteroids (ICS) in asthma patients; two have involved children. Moreover, adherence can be overestimated when considering only secondary adherence (i.e., following the medication recommendations for a defined period) and ignoring primary...

Atrial fibrillation (AF) is a common cardiovascular disease for which newer oral anticoagulants are available. The main objective of this study was to evaluate the appropriateness in prescriptions of direct oral anticoagulant (DOACs), more specifically apixaban, dabigatran and rivaroxaban. This was a singlecentre, retrospective study conducted in t...

Background: Few studies have identified patterns and predictors of use of direct oral anticoagulants for venous thromboembolism (VTE). Objective: To describe the use of anticoagulants and assess predictors associated with the prescription of rivaroxaban over vitamin K antagonist (VKA) for the subsequent treatment of VTE. Methods: This cross-se...

Background: Asthma control remains suboptimal in Canada. Expansion of pharmacist's professional activities offers the opportunity to improve the interdisciplinary management of patients with asthma. Objective: The aim of this study was to determine the level of agreement of physicians regarding the expansion of pharmacists' professional activiti...

Supporting info item

Objective: The objective was to compare, in a real-world setting, the risk of mental and physical health events associated with different antipsychotic drugs (clozapine, olanzapine, risperidone, quetiapine and first-generation antipsychotics) in patients with SZ. Methods: This is a retrospective cohort study using administrative data. Outcome me...

Background: Despite recommendations to use inhaled corticosteroids as treatment to control asthma during pregnancy, it is unknown whether inhaled fluticasone propionate (FP) reaches the fetus. Results & methodology: We collected maternal blood on the morning following delivery. FP was detected by ultra-performance LC-MS/MS (UPLC-MS/MS) in 9/17 ast...

Introduction: Multiple pregnancies are a recognized adverse effect of assisted reproductive technologies; nevertheless, there is no consensus on the incremental risk associated with the Ovarian Stimulation (OS) used alone and intrauterine insemination (IUI). The relationship between OS and IUI and the risk of Major Congenital Malformations (MCM) i...

The biennial CSEB National Student Conference is a Canadian conference for students by students. The hosting university changes every year, and the conference attracts highly motivated graduate students in the fields of epidemiology and biostatistics to disseminate their current research methods and findings. The conference provides a platform for...

Background: Adherence to prescribed medications used in the treatment of chronic diseases is suboptimal, and drug insurance plans can have an impact on adherence. There is little evidence on the impact of patient reimbursement timing on medication adherence. Objective: To compare adherence to prescribed medications in privately insured patients...

Aim: Domperidone is preferentially used over other antiemetic agents to treat digestive symptoms in Parkinson's disease (PD). Concerns have been raised regarding an increased risk of ventricular tachyarrhythmia and sudden cardiac death (VT/SCD) associated with domperidone in the general population. However, the risk in PD is unknown. Methods: We...

Background: Although there is strong evidence that some medications are teratogenic, the current lists of teratogens to be used in research are outdated. The objective of this study was to develop an updatable and systematic procedure to the classification of medications proven and potentially teratogenic in the first trimester of pregnancy, for u...

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in Canada. Most patients with COPD receive long-term treatment with long-acting anticholinergics (LAAC) and/or long-acting β2-agonists (LABA). Adverse events (AEs) are also likely during long-term treatment with these medications. Objective: To evaluate...

Objective . We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods . We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child...

The supplemental materiel describes the clinical vignettes (Table E1), the comparison between participants and non-participants (Table E2), the reported assessment of, and prescription for, each case vignette (Table E3), the beliefs about capabilities and consequences regarding the prescription of long-term asthma controller (Table E4), the multiva...

Objectives To assess whether depression and anxiety increase the risk of mortality and major adverse cardiovascular events (MACE), among patients with and without coronary artery disease (CAD). Design and setting, and patients DECADE (Depression Effects on Coronary Artery Disease Events) is a prospective observational study of 2390 patients referre...

Background: In 2009, the concern has been raised that insulin analogues, especially insulin glargine, might increase risk of (breast) cancer. Many in vitro and epidemiological and some animal studies have been performed, but there is still no clarity on this issue. Objectives: The aim of this study was to investigate the association between insulin...

Background: It is known that antimalarial drugs reduce the risk of low birth weight (LBW) in pregnant patients. However, a previous Cochrane review did not evaluate whether the level of antimalarial drug resistance could modify the protective effect of antimalarial drugs in this regard. In addition, no systematic review exists comparing current re...

BACKGROUND Despite clear guidelines, many school-aged children with persistent asthma are not prescribed long-term asthma controller by their physician. OBJECTIVES To identify of key facilitators and solutions proposed by physicians to facilitate long-term prescription of asthma controller in children with persistent asthma (for ≥3 months or until...

Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients' insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translati...

We previously reported an increased prevalence of any congenital malformation among women experiencing moderate-to-severe asthma exacerbations during the first trimester of pregnancy, based on a study in which 90.1% of the cohort of women were social welfare recipients. This study re-examined the association between asthma exacerbations and congeni...

The management of Clostridium difficile infection (CDI) has become very daunting over the past decade because of increased incidence and severity both in hospital and the community. Guidelines recommend metronidazole, vancomycin, or fidaxomicin, depending on clinical presentation. Our objective was to describe CDI management and assess empirical CD...