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  1. Article ; Online: Medical cannabis for chronic pain.

    Kröger, Edeltraut / Dionne, Clermont E

    BMJ (Clinical research ed.)

    2021  Volume 374, Page(s) n1942

    MeSH term(s) Chronic Pain/drug therapy ; Humans ; Medical Marijuana/administration & dosage ; Medical Marijuana/adverse effects ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/standards ; Self Administration/adverse effects ; Smoking/adverse effects
    Chemical Substances Medical Marijuana
    Language English
    Publishing date 2021-09-08
    Publishing country England
    Document type Editorial
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.n1942
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  2. Article ; Online: New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years.

    Attisso, Eugene / Guenette, Line / Dionne, Clermont E / Kröger, Edeltraut / Dialahy, Isaora / Tessier, Sebastien / Jean, Sonia

    BMJ open

    2024  Volume 14, Issue 4, Page(s) e077664

    Abstract: Objectives: Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020.: Design and setting: A ... ...

    Abstract Objectives: Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020.
    Design and setting: A retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data.
    Participants: A cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period).
    Intervention: No.
    Main outcome measure and analyses: A new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed.
    Results: There was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days' supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions' most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber's specialty or user's characteristics.
    Conclusions: New opioid prescription claims (incidence, dose and days' supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.
    MeSH term(s) Adult ; Humans ; Analgesics, Opioid/therapeutic use ; Quebec/epidemiology ; Routinely Collected Health Data ; Drug Prescriptions ; Retrospective Studies ; Cancer Pain/drug therapy ; Musculoskeletal Pain/drug therapy ; Practice Patterns, Physicians'
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2024-04-08
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-077664
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  3. Article ; Online: A nursing mentoring programme on non-pharmacological interventions against BPSD: Effectiveness and use of antipsychotics-A retrospective, before-after study.

    Plante-Lepage, Roxane / Voyer, Philippe / Carmichael, Pierre-Hugues / Kröger, Edeltraut

    Nursing open

    2021  Volume 9, Issue 1, Page(s) 181–188

    Abstract: Behavioural and psychological symptoms of dementia (BPSD) are common and have significant implications for patients and caregivers. Non-pharmacological interventions (NPI) have shown to be effective in the management of BPSD. However, the use of ... ...

    Abstract Behavioural and psychological symptoms of dementia (BPSD) are common and have significant implications for patients and caregivers. Non-pharmacological interventions (NPI) have shown to be effective in the management of BPSD. However, the use of antipsychotics to treat BPSD remains ubiquitous. This retrospective, before-after study aimed to examine whether a nurse mentoring programme promoting NPI for BPSD management had a significant association with the use of antipsychotics in older adults with major neurocognitive disorders residing in different settings. Results obtained from the medical files of 134 older adults having benefitted from the mentoring programme demonstrate that this intervention significantly reduced BPSD. The effect on antipsychotics use was modest: a 10% reduction in the use of antipsychotics has been observed among patients for which the NPI were effective. However, the use of antipsychotics remained widespread despite the nursing recommendations of the mentoring team of the Center of Excellence on Aging in Quebec (CEVQ).
    MeSH term(s) Aged ; Antipsychotic Agents/therapeutic use ; Controlled Before-After Studies ; Dementia/drug therapy ; Dementia/psychology ; Humans ; Mentoring ; Retrospective Studies
    Chemical Substances Antipsychotic Agents
    Language English
    Publishing date 2021-10-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2809556-X
    ISSN 2054-1058 ; 2054-1058
    ISSN (online) 2054-1058
    ISSN 2054-1058
    DOI 10.1002/nop2.1042
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  4. Article ; Online: Experience and Appreciation of Health Care Teams Regarding a New Model of Pharmaceutical Care in Long-Term Care Settings.

    Turcotte, Véronique / Kröger, Edeltraut / Rouleau, Rachel / Durand, Étienne / Poirier, Karine / Guénette, Line

    Canadian journal on aging = La revue canadienne du vieillissement

    2022  Volume 41, Issue 3, Page(s) 421–430

    Abstract: In long-term care (LTC) homes, the management of frail older residents' pharmacotherapy may be challenging for health care teams. A new pharmaceutical care model highlighting the recently expanded scope of pharmacists' practice in Quebec, Canada, was ... ...

    Abstract In long-term care (LTC) homes, the management of frail older residents' pharmacotherapy may be challenging for health care teams. A new pharmaceutical care model highlighting the recently expanded scope of pharmacists' practice in Quebec, Canada, was implemented in two LTC homes. This study aimed to evaluate health care providers' experience and satisfaction with this new practice model. Twenty-three semi-structured interviews were performed and analyzed thematically. Positive results of the model have been identified, such as increased timeliness of interventions. Barriers were encountered, such as lack of clarity regarding roles, and suboptimal communication. The increased involvement of pharmacists was perceived as useful in the context of scarce medical resources. Although requiring time and adjustments from health care teams, the new model seems to contribute to the health care providers' work satisfaction and to positively influence the timeliness and quality of care offered to LTC residents.
    MeSH term(s) Canada ; Health Personnel ; Humans ; Long-Term Care ; Patient Care Team ; Pharmaceutical Services
    Language English
    Publishing date 2022-03-08
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 632851-9
    ISSN 1710-1107 ; 0714-9808
    ISSN (online) 1710-1107
    ISSN 0714-9808
    DOI 10.1017/S0714980821000672
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  5. Article ; Online: The OptimaMed intervention to reduce medication burden in nursing home residents with severe dementia: results from a pragmatic, controlled study.

    Kröger, Edeltraut / Wilchesky, Machelle / Morin, Michèle / Carmichael, Pierre-Hugues / Marcotte, Martine / Misson, Lucie / Plante, Jonathan / Voyer, Philippe / Durand, Pierre

    BMC geriatrics

    2023  Volume 23, Issue 1, Page(s) 520

    Abstract: Background: Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed ... ...

    Abstract Background: Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed the effect of an interprofessional knowledge exchange (KE) intervention to decrease medication load and the use of medications of questionable benefit among these residents.
    Methods: A 6-month intervention was performed in 4 NHs in the Quebec City area, while 3 NHs, with comparable admissions criteria, served as controls. Published lists of "mostly", "sometimes" or "exceptionally" appropriate medications, tailored for NH residents with severe dementia, were used. The intervention included 1) information for participants' families about medication use in severe dementia; 2) a 90-min KE session for NH nurses, pharmacists, and physicians; 3) medication reviews by NH pharmacists using the lists; 4) discussions on recommended changes with nurses and physicians. Participants' levels of agitation and pain were evaluated using validated scales at baseline and the end of follow-up.
    Results: Seven (7) NHs and 123 participants were included for study. The mean number of regular medications per participant decreased from 7.1 to 6.6 in the intervention, and from 7.7 to 5.9 in the control NHs (p-value for the difference in differences test: < 0.05). Levels of agitation decreased by 8.3% in the intervention, and by 1.4% in the control NHs (p = 0.026); pain levels decreased by 12.6% in the intervention and increased by 7% in the control NHs (p = 0.049). Proportions of participants receiving regular medications deemed only exceptionally appropriate decreased from 19 to 17% (p = 0.43) in the intervention and from 28 to 21% (p = 0.007) in the control NHs (p = 0.22). The mean numbers of regular daily antipsychotics per participant fell from 0.64 to 0.58 in the intervention and from 0.39 to 0.30 in the control NHs (p = 0.27).
    Conclusions: This interprofessional intervention to reduce inappropriate medication use in NH residents with severe dementia decreased medication load in both intervention and control NHs, without important concomitant increase in agitation, but mixed effects on pain levels. Practice changes and heterogeneity within these 7 NHs, and a ceiling effect in medication optimization likely interfered with the intervention.
    Trial registration: The study is registered at ClinicalTrials.gov: # NCT05155748 (first registration 03-10-2017).
    MeSH term(s) Humans ; Antipsychotic Agents ; Dementia/drug therapy ; Dementia/epidemiology ; Nursing Homes ; Pain ; Research Design
    Chemical Substances Antipsychotic Agents
    Language English
    Publishing date 2023-08-28
    Publishing country England
    Document type Controlled Clinical Trial ; Journal Article ; Pragmatic Clinical Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2059865-8
    ISSN 1471-2318 ; 1471-2318
    ISSN (online) 1471-2318
    ISSN 1471-2318
    DOI 10.1186/s12877-023-04222-4
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  6. Article: Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults.

    Fanaki, Chaimaa / Fortin, Julie / Sirois, Marie-Josée / Kröger, Edeltraut / Elliott, Jacobi / Stolee, Paul / Gregg, Susie / Sims-Gould, Joanie / Giguere, Anik

    Canadian geriatrics journal : CGJ

    2023  Volume 26, Issue 2, Page(s) 227–238

    Abstract: Introduction: To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated ... ...

    Abstract Introduction: To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway.
    Methods: In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the
    Results: We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding.
    Conclusions: These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
    Language English
    Publishing date 2023-06-01
    Publishing country Canada
    Document type Journal Article
    ISSN 1925-8348
    ISSN 1925-8348
    DOI 10.5770/cgj.26.646
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  7. Article ; Online: Using co-creation focus groups to customise a remote multidomain programme designed to increase dementia literacy.

    Wittich, Walter / Kröger, Edeltraut / Aubin, Gabrielle / Fadhlaoui, Asma / Anderson, Nicole D / Ben Gaied, Nouha / Itzhak, Inbal / Belleville, Sylvie

    BMJ open

    2023  Volume 13, Issue 9, Page(s) e074555

    Abstract: Objectives: To adapt the content and functionalities of : Design: Five consecutive qualitative co-creation focus group sessions 30-90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, ... ...

    Abstract Objectives: To adapt the content and functionalities of
    Design: Five consecutive qualitative co-creation focus group sessions 30-90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, participant recruitment and retention.
    Setting: Virtual meetings.
    Participants: A 15-member team based in Québec and Ontario, Canada, consisting of 9 researchers (including a graduate student and the project coordinator), representing occupational therapy, sensory rehabilitation, neuropsychology, psychology, health science and research methods, 3 informal caregivers of older adults living with cognitive decline and 3 members of the Federation of Quebec Alzheimer Societies.
    Data analysis: Session recordings were summarised through both qualitative description and thematic analysis.
    Results: The synthesised recommendations included adjustments around diversity, the complexity and presentation styles of the materials, suggestions on refining the web interface and the measurement approaches; it influenced aspects of participant recruitment, retention efforts and engagement with the content of
    Conclusions: Co-creation in dementia prevention research is important because it involves collaboration between researchers, community support and service providers, and persons with lived experience as care providers, in the design and implementation of clinical studies. This approach helps to ensure that the content and presentation of educational material is relevant and meaningful to the target population and those involved in its delivery, and it leads to a greater understanding of their needs and perspectives.
    MeSH term(s) Humans ; Aged ; Focus Groups ; Literacy ; Medicine ; Ontario ; Dementia
    Language English
    Publishing date 2023-09-13
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-074555
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  8. Article: Job Satisfaction for Caregivers and Other Employees in Innovative Long-Term Care Homes for Residents With Cognitive Problems.

    Hardy, Marie-Soleil / Voyer, Philippe / Dallaire, Clémence / Morin, Diane / Durand, Pierre J / Kröger, Edeltraut / Savoie, Camille / Veillette, Anne-Marie

    Journal of gerontological nursing

    2023  Volume 49, Issue 10, Page(s) 36–43

    Abstract: New housing models have emerged in Europe, Australia, the United States, and Canada. Intended for individuals with neurocognitive disorders, these models are characterized by a philosophy centered on the person, self-determination, liberty of choice, ... ...

    Abstract New housing models have emerged in Europe, Australia, the United States, and Canada. Intended for individuals with neurocognitive disorders, these models are characterized by a philosophy centered on the person, self-determination, liberty of choice, flexibility of care, acceptance of risk, and autonomy. Work and care are organized according to the pace and preferences of residents. The current multiple case study highlights the main sources of job satisfaction for caregivers and other employees in four innovative residential settings. Five themes are addressed as perceived by 58 employees:
    MeSH term(s) Humans ; Caregivers ; Job Satisfaction ; Long-Term Care ; Australia ; Cognition
    Language English
    Publishing date 2023-10-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603140-7
    ISSN 0098-9134
    ISSN 0098-9134
    DOI 10.3928/00989134-20230918-02
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  9. Article ; Online: Fish Consumption, Brain Mercury, and Neuropathology in Patients With Alzheimer Disease and Dementia.

    Kröger, Edeltraut / Laforce, Robert

    JAMA

    2016  Volume 315, Issue 5, Page(s) 465–466

    MeSH term(s) Alzheimer Disease/pathology ; Brain Chemistry ; Fatty Acids, Omega-3/administration & dosage ; Female ; Humans ; Male ; Mercury/analysis ; Seafood/adverse effects
    Chemical Substances Fatty Acids, Omega-3 ; Mercury (FXS1BY2PGL)
    Language English
    Publishing date 2016-02-02
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2016.0005
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  10. Article ; Online: A New Care Model Reduces Polypharmacy and Potentially Inappropriate Medications in Long-Term Care.

    Garland, Carolina Tisnado / Guénette, Line / Kröger, Edeltraut / Carmichael, Pierre-Hugues / Rouleau, Rachel / Sirois, Caroline

    Journal of the American Medical Directors Association

    2020  Volume 22, Issue 1, Page(s) 141–147

    Abstract: Objectives: Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs).: Design: Pragmatic quasi-experimental study with a control group. This ... ...

    Abstract Objectives: Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs).
    Design: Pragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews.
    Setting and participants: Two LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs.
    Measures: Polypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables.
    Results: Over 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002).
    Conclusions and implications: Compared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.
    MeSH term(s) Canada ; Humans ; Inappropriate Prescribing/prevention & control ; Long-Term Care ; Polypharmacy ; Potentially Inappropriate Medication List ; Quebec
    Language English
    Publishing date 2020-11-19
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2020.09.039
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