Feasibility of implementing a web-based tool built from pharmacy claims data (e-MEDRESP) to monitor adherence to respiratory medications in primary care.

Objective: 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 cohort study, e-MEDRESP was integrated into electronic medical records.

Electrocatalytic reduction of CO in water by a -functionalized Ni-cyclam complex grafted onto carbon.

We present here a novel strategy based on the covalent grafting of a -functionalized Ni-cyclam complex onto glassy carbon to achieve heterogeneous electrocatalytic CO reduction in neutral water at low overpotential (-500 mV NHE), with moderate turnover number (TON = 454), high selectivity (85% CO produced) and good faradaic efficiency (56% CO). Direct comparison with the -functionalized Ni-cyclam analogue highlights the benefits of this approach in terms of CO electroreduction.

Identifying asthma patients at high risk of exacerbation in a routine visit: A machine learning model.

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 adherence to asthma medications.

Association Between Asthma Control Trajectories in Preschoolers and Long-Term Asthma Control.

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 after diagnosis in preschoolers are associated with long-term unsatisfactory asthma control.

Methods: We conducted a multicenter population-based retrospective cohort study, including four Canadian provincial birth cohorts derived from administrative databases.

Development of an operational definition of treatment escalation in adults with asthma adapted to healthcare administrative databases: A Delphi study.

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 for claims-based asthma treatment escalation are highly variable in the literature.

Objective: The aim of this study was to develop an operational definition of treatment escalation in adults with asthma that can be applied to healthcare administrative data.

Predictors of Asthma Control and Exacerbations: A Real-World Study.

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 cohort study assessing 738 patients enrolled in the Quebec registry in respiratory health (RESP) with a diagnosis of asthma confirmed by a respirologist and treated in a tertiary care center from April 2010 to March 2016.

Association between the timing of asthma diagnosis and medication use during pregnancy.

Study Objective: To assess whether asthma medication use during pregnancy differs in women newly diagnosed with asthma early in pregnancy (first 19 weeks of pregnancy) compared to those newly diagnosed up to 2 years pre-pregnancy.

Design: A retrospective population-based cohort study.

Data Source: To conduct this study, we used the Quebec Asthma and Pregnancy Database (QAPD) constructed by linking two administrative health databases from the province of Quebec (Canada): the Régie de l'Assurance Maladie du Québec and Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière databases.

Association between asthma control trajectories in preschoolers and disease remission.

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 remission.

Methods: We conducted a multicentre population-based retrospective cohort study consisting of 48 687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in four Canadian provinces who had prolonged disease activity post-diagnosis.

Impact of discretization of the timeline for longitudinal causal inference methods.

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 discretizing data to assess longitudinal causal parameters.

Development of a Web-Based Tool Built From Pharmacy Claims Data to Assess Adherence to Respiratory Medications in Primary Care.

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 clinical practice (exploratory phase), and to develop a novel web-based tool (e-MEDRESP) that will allow physicians to monitor adherence using pharmacy claims data (development phase).

Timing of Maternal Asthma Diagnosis in Relation to Adverse Perinatal Outcomes.

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 retrospectively analyzed a cohort of pregnant women aged ≥15 years with and without incident asthma, constructed from health administrative databases.

Risk of Postpartum Depression Among Women with Asthma.

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 administrative databases.

Methods: A cohort of 35,520 pregnancies in women with asthma during pregnancy and 197,057 pregnancies in women without asthma who delivered between 1998 and 2009 was extracted from the Quebec Asthma and Pregnancy Database.

Development of a graphical tool to measure medication adherence in asthma patients: A mixed-methods pilot study.

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 sequential exploratory design was used: ( 1 ) Prototype design in collaboration with respiratory physicians and patients via focus groups; ( 2 ) Med-Resp creation based on algorithms developed and applied to prescription refills data recorded in the drug claims database reMed; ( 3 ) Feasibility assessment of the implementation of Med-Resp in the outpatient asthma clinic; and ( 4 ) Exploration of the effectiveness of Med-Resp through a pre-post design.

Results: A total of 29 patients and six respiratory physicians participated in this pilot study.

Understanding and diagnosing the potential for bias when using machine learning methods with doubly robust causal estimators.

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 biased estimates of the treatment effect. To motivate the problem, we evaluated the Targeted Minimum Loss-based Estimation procedure using a simulation scenario to estimate the average treatment effect.

Long-Acting β-Agonists and Risk of Hypertensive Disorders of Pregnancy: A Cohort Study.

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.

Objective: To investigate whether exposure to a LABA in addition to an inhaled corticosteroid increases the risk of HDP or preeclampsia/eclampsia, as compared with nonexposure to LABAs, in pregnant women with asthma.

Adherence and Persistence to Long-Acting Anticholinergics Treatment Episodes in Patients With Chronic Obstructive Pulmonary Disease.

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.

Methods: A retrospective cohort of LAAC-treated COPD patients was reconstructed from Quebec databases.

Assessing adherence to inhaled corticosteroids in asthma patients using an integrated measure based on primary and secondary adherence.

Purpose: There 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.

The Impact of Different Case Ascertainment Definitions on the Prevalence of Major Congenital Malformations and their Association with Asthma During Pregnancy.

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 Classification (TCMC) and the Canadian Congenital Anomalies Surveillance System (CCASS).

Impact of Patient Reimbursement Timing and Patient Out-of-Pocket Expenses on Medication Adherence in Patients Covered by Private Drug Insurance Plans.

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 from Quebec, Canada, with different patient reimbursement timing and levels of patient out-of-pocket expenses.

Adverse events among COPD patients treated with long-acting anticholinergics and β2-agonists in an outpatient respiratory clinic.

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.

Asthma exacerbations during the first trimester of pregnancy and congenital malformations: revisiting the association in a large representative cohort.

Background: 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 congenital malformations in a new large representative cohort of asthmatic pregnant women.

Is drug insurance status an effect modifier in epidemiologic database studies? The case of maternal asthma and major congenital malformations.

Background: Our previous work on the association between maternal asthma and congenital malformations was based on cohorts formed by women with public drug insurance, i.e., over-represented by women with lower socioeconomic status, questioning the generalizability of our findings.