Papers by Marie-Claude Vanier
Cross-Sector Collaboration to Improve Access to Community Services for People Living With Diabetes: Contributions From Actor-Network Theory
Health services insights., 2024
Implementation of targeted deprescribing of potentially inappropriate medications in patients on hemodialysis
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...
Can Google apps for education (GAFE) be an effective tool for collaborative learning in an IPE ?
HAL (Le Centre pour la Communication Scientifique Directe), Sep 29, 2015
International audienc
Structuring and organizing interprofessional healthcare in partnership with patients with diabetes: the INterprofessional Management and Education in Diabetes care (INMED) pathway
Journal of Interprofessional Care
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.
Engaging patients in revising the medical training curriculum: a mixed study on integrating the clinical ethics perspective
HAL (Le Centre pour la Communication Scientifique Directe), Oct 23, 2020
Rythmes et coagulation sanguine
Chronopharmacologie. Rythmes biologiques et administration des médicaments
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...
Biological Rhythms in Pain and Analgesia
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.
Patients-as-educators in IPE workshops : Training patients for this new teaching role
HAL (Le Centre pour la Communication Scientifique Directe), Sep 29, 2015
The Montreal Model: The Challenges of the Patient-Health Professional Relationship Partnership
Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes, 2015
From the Patient Expert to the Patient Trainer : The example of the University of Montreal
Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes, 2014
A health professional in collaboration with: the collaborative practice in partnership with the patient
Le Centre pour la Communication Scientifique Directe - HAL - Université de Nantes, 2016
Rythmes, douleur et analgésiques
Journal of Interprofessional Care, 2020
To develop collaborative competencies of future health and social services professionals, the Uni... more To develop collaborative competencies of future health and social services professionals, the Université de Montréal (UdeM) offers interprofessional education (IPE) in partnership with patients. To meet the challenges of IPE, UdeM turned to digital tools to enable interprofessional teams of students to collaborate online and face-to-face. The collaborative flipped classroom for IPE with patient partnership is the conceptual framework for the pedagogical method used for this study. It is based on: 1) a competency framework and 2) collaborative learning concept and dimensions. The study aimed to: 1) demonstrate how interprofessional teams of students mobilize framework competencies and care approaches during online and face-to-face collaborative learning activities; and 2) analyze how students collaborate during a hybrid IPE course using a patient partnership approach. Using a qualitative methodology, the contents of the online collaborative journals (OCJs) of 12 interprofessional student teams were analyzed, along with the individual comments (n = 994) of IPE course learners collected through the Interprofessional Team Collaboration questionnaire (n = 321). The results suggest that the course under study enabled teams to collaborate online and face-to-face throughout the term, and indicate that students were better prepared to adopt a patient partnership approach.
Santé Publique, 2015
s41 s41 1 re partie-Nouveaux rôles et compétences des patients Synthèse des connaissances Le « Mo... more s41 s41 1 re partie-Nouveaux rôles et compétences des patients Synthèse des connaissances Le « Montreal model » : enjeux du partenariat relationnel entre patients et professionnels de la santé The Montreal model: the challenges of a partnership relationship between patients and healthcare professionals
These abstracts have been peer reviewed | Ces résumés ont fait l'objet d'une révision par des pairs
American Journal of Health-System Pharmacy, 2008
Purpose. The effect of a medication discharge plan (MDP) on the rate of medication discrepancies ... more Purpose. The effect of a medication discharge plan (MDP) on the rate of medication discrepancies between hospital and outpatient settings was evaluated. Methods. In a pragmatic, open, randomized, controlled trial, MDPs were completed for all patients before discharge from the hospital. Patients were then assigned to either an MDP group, for whom MDPs were sent to community pharmacies and treating physicians, or a usual care group, for whom an MDP was not sent. Discrepancies between MDPs and community pharmacy dispensing records and medication use reported by patients during a telephone interview were documented. The percentage of patients with discrepancies and the mean percentage of medications with discrepancies were compared between the two groups. The clinical severity of discrepancies was blindly evaluated. Results. A total of 83 patients agreed to participate in the study. The percentage of patients with at least one discrepancy was high and similar in both groups when MDPs were compared with pharmacy dispensing records and patient self-reports. Comparison of MDPs to pharmacy dispensing records revealed discrepancies for 13-15% of medications; more than a third were clinically significant. Comparison of MDPs to patient self-reports revealed discrepancies for 10-12% of medications; 48% were clinically significant. No significant differences were observed between the two groups. Conclusion. The rate of medication discrepancies was not decreased in patients whose MDP was provided to their community pharmacy and physician at the time of hospital discharge compared with the rate in patients who received usual care.
American Heart Journal, 2008
Background Some pharmacist-managed anticoagulation services (PMAS) provide initial follow-up to p... more Background Some pharmacist-managed anticoagulation services (PMAS) provide initial follow-up to patients on oral anticoagulant, who are transferred to their physician once they are stabilized. This may be as effective as and less expensive than long-term PMAS follow-up. Methods Once PMAS patients were stabilized and ready for discharge, they were randomized to be transferred to their physician or stay with the PMAS. Quality of international normalized ratio (INR) control, incidence of complications, health-related quality of life, use of health care services, and direct incremental cost of PMAS follow-up were evaluated. Results One hundred thirty-eight physicians and 250 patients participated. Patients were initially followed at the PMAS for a mean of 11.3 weeks and afterwards were followed by their physician (n = 122) or by the PMAS pharmacists (n = 128) for a mean of 14.9 and 14.5 weeks, respectively. Pharmacist-managed anticoagulation services' and physician's patients were within the exact target range 77.3% and 76.7% of the time (95% CI of the difference −4.9% to 6.0%) and within the extended range 93.0% and 91.6% of the time (95% CI −2.1% to 4.7%), respectively. Pharmacist-managed anticoagulation services patients have seen their family physician less often (95% CI −3.1 to −0.1 visit per year). Number of INR tests, incidence of complications, and health-related quality of life were similar in both groups. The incremental cost of PMAS follow-up was estimated at CAN$123.80 per patient year. Conclusion Once PMAS patients are well stabilized, maintaining a PMAS follow-up or transferring them to their physician is associated with excellent INR control. However, long-term PMAS follow-up may be more expensive.
American Heart Journal, 2010
Background In a collaborative care model (CCM) for managing oral anticoagulant therapy, patients ... more Background In a collaborative care model (CCM) for managing oral anticoagulant therapy, patients are followed at a pharmacist-managed anticoagulation service and, once stabilized, are transferred to their primary care physician. The objective of this study was to describe physicians' clinical practices and the practice characteristics associated with better international normalized ratio (INR) control in a CCM. Methods A telephone questionnaire about their practices was administered to 121 physicians exposed to a CCM. The physicians followed 121 patients for a mean of 14.5 weeks. The percentage of time within the exact INR target range was computed and dichotomized (≥ or b median time within target range). Determinants of better INR control were identified using logistic regression models. Results The survey revealed that, after discharge from the pharmacist-managed anticoagulation service, patients are followed mainly by physicians and their secretaries. Physicians do not often consult other health professionals. Few report using technological resources to obtain INR results (39.7%), document medical follow-up (6.6%), or detect drug (32.2%) and food (9.9%) interactions. The median percentage of time within the exact INR target range was 84%. Determinants of better INR control include using computerized support to monitor patients (odds ratio [OR] 9.16, 95% CI 1.77-47.4) and detect drug interactions (OR 3.49, 95% CI 1.71-7.10) and consulting specialists (OR 5.92, 95% CI 1.49-32.48). Conclusions Primary care physicians are poorly supported by technological and human resources to monitor patients on oral anticoagulant. Even in a CCM, interprofessional collaboration and better technological support may be associated with optimal INR control.
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Papers by Marie-Claude Vanier