This study aimed to develop an efficient data collection and curation process for all drugs and natural health products (NHPs) used by participants to the Canadian Longitudinal Study on Aging (CLSA). The three-step sequential process consisted of (a) mapping drug inputs collected through the CLSA to the Health Canada Drug Product Database (DPD), (b) algorithm recoding of unmapped drug and NHP inputs, and (c) manual recoding of unmapped drug and NHP inputs. Among the 30,097 CLSA comprehensive cohort participants, 26,000 (86.4%) were using a drug or an NHP with a mean of 5.3 (SD 3.8) inputs per participant user for a total of 137,366 inputs. Of those inputs, 70,177 (51.1%) were mapped to the Health Canada DPD, 20,729 (15.1%) were recoded by algorithms, and 44,108 (32.1%) were manually recoded. The Direct algorithm correctly classified 99.4 per cent of drug inputs and 99.5 per cent of NHP inputs. We developed an efficient three-step process for drug and NHP data collection and curation for use in a longitudinal cohort.

Drug benefits policy-making for seniors in British Columbia has been increasingly influenced by research since 1993. The "evidence-based medicine" paradigm, which emphasizes the primacy of direct evidence from randomized control trials, inspired key policy-makers and influenced policy concerning coverage of new and existing drugs. New drugs, if more expensive than existing similar drugs, are not covered unless published randomized control trials show superior effectiveness. Indirect evidence of effectiveness, based on surrogates, is given less weight, and non-randomized studies are rarely considered. Evidence of cost-effectiveness of new drugs is reviewed separately. For existing drugs, a new reimbursement policy, Reference Based Pricing (RBP), was introduced, based on both direct and indirect evidence of comparative effectiveness of drugs. Implementation of RBP was complex and necessarily rapid, which meant that independent systematic review of evidence relevant to implementation issues was infeasible, particularly in regard to rapid prior authorization of exemptions to RBP. Contrasts between the processes for new and existing drugs provide insights into the difficulties of applying the idea of direct evidence-based policy-making in practice.

Bien que les cliniciens français restent majoritairement prudents et attentifs aux recommandations concernant la prescription de médicaments psychotropes chez l’enfant et l’adolescent, celle-ci augmente depuis quelques années. Antipsychotiques, antidépresseurs, mais aussi psychostimulants, mélatonine, ocytocine…la palette s’élargit, les indications se diversifient et les effets indésirables sont de mieux en mieux étudiés. Afin d’apporter aux praticiens des informations concrètes et démontrées, pour les aider dans leur appréciation du rapport « bénéfices-risques » d’une prescription médicamenteuse, la Société française de psychiatrie de l’enfant et de l’adolescent (SFPEADA) propose, au cours de cette rencontre avec l’expert :

– dans un premier temps une mise au point sur les données actualisées et démontrées pouvant être utiles aux médecins amenés à prescrire chez des jeunes de moins de 18 ans : indications, AMM, éléments pouvant guider vers le choix de telle ou telle molécule au sein d’une même famille thérapeutique, examens à pratiquer avant mise sous traitement et modalités de surveillance en pratique clinique, mesures d’accompagnement de la prescription, articulation avec les autres formes d’interventions thérapeutiques…

– Dans un second temps une discussion avec les participants sous la forme « questions-réponses » et de « partage d’expériences ».

La rencontre avec l’expert sera modérée par le professeur Jean-Philippe Raynaud (Toulouse), président du conseil scientifique de la SFPEADA.

Because medication prescribing and use have become a normative aspect of health care for older adults, we seek to understand how individuals navigate prescribed-medication use within the context of aging. We reasoned that, for those who are ambulatory, medication use is likely influenced by ethnocultural meanings of health and experiences with alternative approaches to health care. Accordingly, we conducted a qualitative study, with in-depth interviews, on a diverse sample of older adults in order to identify elderly persons’ perceptions and uses of medicines. Our findings depict older adults as active agents – who draw on a lifetime of experience and knowledge – who take responsibility for adherence (or non-adherence) to medicines and their associated effects on their own bodies. We represent the older person as a “pharmaceutical person” whose experiences of aging are inextricably tied up with the negotiation of medicine-reliant health care.

Patients and professionals have difficulty communicating with one another about prescriptions and alternative therapies. The aim of this research was to investigate and contrast 714 seniors and health-professionals' perceptions and communication about the above mentioned health products. First, intensive face-to-face, ethnographic interviews with health professionals and seniors were conducted to elicit relevant issues of concern. Second, focus groups were used to evaluate the issues and wording of question probes developed initially. Third, a survey established associations and predictive validity of variables found in the first two phases. Highlights from the emergent themes include different perceptions of (a) the value and usage of alternative therapies, (b) information adequacy about prescriptions and alternative therapies, and (c) communication about prescription misuses and alternative therapy use. Seniors and professionals suggested insights for improving clinical practice.