Medication and Population Health

Aim. Statins have been shown to significantly reduce morbidity and mortality both in patients with coronary artery disease and in those with dyslipidemia when they are taken regularly. Middle-aged patients have the highest level of forecasting benefit, and little is known about the persistence rate of these therapies in a real-life setting.Objective. To evaluate the persistence rate of middle-aged patients initiating statin therapy as well as its relation to patients’ demographic and clinical characteristics.Methods. A cohort of 25,733 patients was reconstructed from prescription data recorded in the Régie de l’assurance maladie du Québec administrative database. All patients aged 50–64 years old who received at least one statin prescription between January 1, 1998 and December 31, 2000 for a new intention of treatment for dyslipidemia were included in the cohort and followed up until June 30, 2001. The date of the first prescription of statin was defined as the index date. The cumulative persistence rate was estimated using a Kaplan-Meier analysis. Cox regression models were used to estimate the rate ratio of ceasing statins after adjustment. Results. Mean age of patients initiating statin agents was 58 years; 39%were male, 24% received social assistance, 19% had diabetes, 30% had hypertension and 11% had a respiratory disease at cohort entry. Persistence with statin therapy fell to 67% in the first 6 months after treatment and continued to decline over the next 3 years to 39%. At 3 years, persistence varied significantly with statin agents. After controlling for individual patients’ demographic and clinical characteristics, we found that patients who were prescribed fluvastatin, lovastatin and atorvastatin had a higher rate of cessation than those on simvastatin and pravastatin. The adjusted rate ratio of ceasing statin agents in patients with other risk factors of cardiovascular disease, such as diabetes (HR: 0.78; 0.75–0.82) or hypertension (HR: 0.72; 0.69–0.74), demonstrated a lower cessation rate. We observed lower persistence in patients who used the greatest number of pharmacies and prescribing physicians.Conclusion. This analysis indicates that barriers to persistence occur early in the therapeutic course. Overall persistence with statins is low, particularly among patients with few other cardiovascular risk factors.

Cette recension des écrits s'intéresse au recours à la médication psychotrope auprès des jeunes. Dans un contexte global où la psychiatrie, la génétique et les neurosciences sont en plein essor, il importe de requestionner les politiques, les paramètres de pratiques (« guidelines ») et les environnements cliniques « réels » caractérisant la prescription de médicaments psychotropes aux enfants et aux

To identify the reasons for which people fail to take blood-pressure-lowering medication regularly, a qualitative study was conducted. Interviews lasting approximately 90 min were conducted with 27 patients (15 women, 12 men) aged 40-70. The verbatim of the 27 interviews was first read and divided into segments with explanatory value. This was followed by the production of a final text in vignette form for all interviews. An integrative, analytical phase consisted of identifying trends, significant central themes, regularities, and divergences in the vignettes. Analysis revealed the explanatory power that 3 broad groups of subjective meanings could hold for given medication noncompliance scenarios. These scenarios are expressing the role of: (1) stress and living conditions in the occasional skipping or deferral of medication-taking; (2) doubt as the motivating factor for transitory, irregular medication use; (3) subjective risk as the motivating factor for persistent irregular use. Life and social contexts, doubt and risk subsume extremely meaning-rich constructs that can help identify dilemmas facing people about medication-taking. By discussing these dimensions with their patients, health professionals will be better able to understand patient medication behaviors that sometimes run counter to their recommendations.

In recent years, there has been a growing concern for the non-medical use of prescription drugs by young adults, and particularly college and university students. These expanding practices of pharmaceutical drug use have been associated with different phenomena such as physical and cognitive enhancement, non-medical prescription drug use and recreational use. All of these various consuming practices involve a blurring of the boundaries between curing, preventing and enhancing and between recreational and productive activities. Some studies show the importance of linking pharmaceutical drug use with broader issues among students in academic settings, such as competitiveness, pressure, stress, depression and mental health issues. The main objective of this article is to explore some of the perceptions and rationales that underlie the use of non-medical and medical prescription drugs, natural products, energy drinks and other pharmaceutical or natural substances among university students in Montreal (Canada). Focus-groups and in-depth, semi-structured interviews were realized with a sample of 42 students in order to link the consumption cultures of the participants with other variables, such as their lifestyle, their experience of psychological distress and anxiety and their need of achievement. Focusing on the young population fulfills the function of sociological forecast about the future trends in the expansion of pharmaceutical drug use for the management of everyday life in contemporary Western societies.

Most studies on benzodiazepines emphasize overconsumption and warn of addiction, especially by older adults. This article is about the avoidance of benzodiazepine medications by ‘aging’ women living in a Brazilian village. This case study helps to support our central concern: to call attention to the ambiguities that exist in discussing these medications, and to stress the importance of a multilayered understanding of effect. We argue that benzodiazepines, like other psychopharmaka, induce bodily sensations that, at least in part, correspond to and are shaped by the situated self-image of individuals in distress.