Background: Canada is the only developed country with universal healthcare but no universal prescription drug coverage. Prescription drug coverage in Canada is often described as a “patchwork” system; eligibility for coverage varies by province and influenced by circumstance. Subsets of the population are eligible for partial or full provincial coverage for their prescription medications through public and/or private coverage. Methods: The extent and factors associated with misreporting of drug insurance and cost-related non-adherence (CRNA) to prescribed medicines were investigated in three study populations: Ontario seniors 65 and over, Quebec seniors 65 and over, and Quebec adults 25-64 using pooled data from the 2015/2016 Canadian Community Health Survey (CCHS). The rationale for these study cohorts was that the vast majority had partial or full coverage for prescription medications from a public and/or private source. The factors associated with CRNA to prescribed medicines were also explored in these three subgroups. Results: There is a degree of misreporting of drug insurance among Ontario seniors (17%), Quebec seniors (18%) and Quebec adults (9%). Quebec adults who declared CRNA to prescribed drugs had twice the odds of misreporting prescription drug coverage (OR 2.1 95% CI 1.3-3.4). Lower-income earners among Ontario seniors (OR 1.8, 95% CI 1.3-2.6), Quebec seniors (OR 1.7 95% CI 1.2-2.6), and Quebec adults (OR 3.4, 95% CI 2.3-5.1) were more likely to misreport coverage. Quebec seniors were more likely to misreport if they had less than a secondary school education (OR 1.4, 95% CI 1.1-1.8). Ontario seniors who were immigrants were more likely to misreport coverage (OR 1.5, 95% CI 1.2-1.8), as were Quebec seniors who were immigrants (OR 2.2, 95% CI 1.4-3.5). Ontario seniors who had a flu shot in the past 12 months (OR 0.7, 95% CI 0.5-9.9) and Quebec adults who had visited a GP in the past 12 months (OR 0.6, 95% CI 0.45,0.77) were less likely to misreport coverage. CRNA to prescribed drugs was reported by Ontario seniors (3.3%), Quebec seniors (2.5%), and Quebec adults (5.3%). Low-income Ontario seniors (OR 2.9, 95% CI 1.5-5.7) and Quebec adults (2.5, 95% CI 1.6-3.8) were more likely to report CRNA to prescribed medicines. Quebec adults with chronic conditions (OR 1.7, 95% CI 1.2-2.4) and those in self-reported poor health (OR 2.4, 95% CI 1.3-4.4) were also more likely to report CRNA to prescribed drugs. Conclusions: There appears to be a socio-economic gradient in misreporting and CRNA among Ontario seniors, Quebec seniors, and Quebec adults. Given most of these subgroups will have coverage, we hypothesize a degree of measurement error among responses. More specifically, respondents who report CRNA to prescribed medicines may reflect measurement error. / Thesis / Master of Science (MSc) / Canada is a country that prides itself on universal healthcare yet lacks an important component - universal prescription drug coverage. Hence, it is often described as a “patchwork system” whereby Canadians must rely on a combination of public and private drugs plans depending upon circumstance. As a result, a proportion of Canadians lack prescription drug coverage and may be unable to afford prescription medications. This study aimed to investigate self-reported knowledge of prescription drug insurance in three populations: Ontario seniors 65 years and over, Quebec seniors 65 years and older, and Quebec adults 25-64 years old. The determinants of misreporting of drug insurance among these study populations was the primary objective of this analysis. The association between cost-related nonadherence (CRNA) to prescribed drugs and misreporting was a key variable in the analysis. Although only a small proportion of respondents reported CRNA to prescribed drugs, Quebec adults 25-64 were more likely to misreport drug coverage if they also reported CRNA. This study has provided some clarity on the factors that influence misreporting of drug insurance by Ontario seniors, Quebec seniors, and Quebec adults. Given health policy decisions are often guided by studies based on this data, researchers may consider a degree of misreporting in responses. Policy should aim to reduce misunderstandings about their drug coverage.

Prescription drug advertisements are commonly seen in magazines and on television, and as a result, the public is familiar with them. Many drug ads are targeted toward older adults, who tend to use more medications, because they suffer from more chronic conditions than younger adults. Nonetheless, the effectiveness of drug advertising at persuading older adults to ask physicians for specific medications remains uncertain. Older adults’ explicit memory for drug ads is poor, but their implicit memory for drug ads may be better. Therefore, older adults may be implicitly persuaded by drug ads even when they cannot explicitly remember seeing them. The current study measured implicit memory with an incidental ratings exercise and an indirect test of preference; explicit memory was measured with intentional studying and a direct test of recognition. The purposes of the study were to compare implicit and explicit memory for drug ads in older and younger adults, to determine whether age differences in memory are affected by salient information or anxiety, and to demonstrate that a test of implicit memory may be useful in estimating advertising effectiveness. The results showed no age difference for implicit memory for drug ads, but an age difference was found for explicit memory for drug ads. However, contrary to hypotheses, neither salient information nor anxiety had an effect on implicit or explicit memory. The results were consistent with previous research demonstrating implicit memory in the absence of explicit memory. Although older adults had slightly worse explicit memory, both implicit and explicit memory for drug ads was generally good in both groups. The results were also obtained within the everyday context of prescription drug advertising, which extends memory research to an important real-world setting. Ethical considerations for research on aging and advertising are discussed. Drug ads are designed to be persuasive, but ads should be carefully designed to inform consumers, rather than to manipulate them. The implicit memory manipulation succeeded in demonstrating that ads are persuasive, suggesting that a complete assessment of advertising effectiveness should include a test of implicit memory.

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No / This research seeks to measure citizen satisfaction with the electronic Prescription Prepayment Certificate (PPC) offered by National Health Service (NHS) in the United Kingdom (UK). The paper reports on the findings of a survey of over 500 users of the NHS PPC service. Satisfaction is measured using the four dimensions from the COBRA framework (Osman et al. (2011) [1]) which comprise the cost, opportunity, benefits and risk assessment constructs. This is the first study to measure citizen satisfaction with the electronic PPC in the UK across these constructs. The results show that most citizens using the PPC electronic service are satisfied with this service and that the service meets their essential needs. The paper also presents the results of qualitative feedback obtained from the participants that can be used to determine the areas that need further improvement in the current electronic PPC service and potential influence on user satisfaction.

Le vieillissement de la population s’accompagne d’une augmentation de la multimorbidité et de la polymédication qui en résulte. Au Canada, deux tiers des personnes âgées de 65 ans ou plus recevaient au moins cinq classes de médicaments par année en 2016, malgré le fait que la polymédication soit associée à des effets indésirables. Plusieurs études ont démontré la possibilité de réduire significativement le nombre de médicaments chez les personnes dans ce groupe d’âge grâce aux interventions dites de déprescription. La déprescription des benzodiazépines (BZD) est d’une importance capitale compte tenu de la prévalence élevée de cette classe de médicaments chez les personnes aînées. La déprescription des BZD serait possiblement associée à une réduction des effets indésirables et une meilleure qualité de vie. Les objectifs de ce projet de recherche étaient de décrire les caractéristiques des interventions pour déprescrire les BZD chez les personnes aînées et leurs impacts sur la santé de ces personnes grâce à une revue systématique. Cette revue décrit les interventions de déprescription de BZD issues de 11 études et leurs effets sur la santé de 1 042 participants âgés en moyenne de 71 ans. Les effets des interventions sur la santé des participants des groupes interventions ont été comparés aux résultats sur la santé des participants des groupes témoins. Dans l'ensemble, le retrait des BZD est bien sécuritaire et les impacts négatifs sur le sommeil sont plutôt négligeables et temporaires chez certains patients. Dans la plupart des études, les patients n'ont pas présenté de symptômes de sevrage significatifs, sauf dans quelques études où les participants des groupes d'intervention ont connu plus d'insomnie et d'anxiété à 6 mois par rapport aux participants des groupes témoins (p <0,0001). / People are living longer than ever, but this increase in life expectancy is also associated with increased multimorbidity and the resulting polypharmacy. In Canada, two thirds of people aged 65 years or older received at least five prescribed classes of medications a year in 2016, even though polypharmacy is linked with increased medication adverse effects and mortality. Several studies demonstrated the possibility to reduce significantly the number of prescribed drugs in this age group using deprescribing interventions. Benzodiazepine (BZD) discontinuation is of paramount importance given the high prevalence of this class of drugs in seniors. BZD discontinuation may be associated with the reduction of adverse effects and a better quality of life. The objectives of this research project were to describe the characteristics of interventions to discontinue BZD in older persons and their impact on their health through a systematic review. This study describes BZD deprescribing interventions from 11 BZD discontinuation studies and their impacts on the health of 1042 participants aged on average 71 years. The health impacts of these interventions were compared between the intervention and the control groups. Overall, the withdrawal from BZDs is safe and its adverse impacts on health are rather negligible and temporary in some patients. In most studies, patients did not suffer significant withdrawal symptoms, except few studies in which participants in intervention groups had experienced more insomnia and anxiety at 6 months compared to participants in the control groups (p<0.0001).

Background: Getting admitted to CCU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients‘ perspective so that appropriate nursing measures can be directed towards minimizing such stressors. Objectives: The purpose of this study was to explore the perception of CCU stressors experienced by patients from both patients and nurses perspective and to compare between them, identify the effect of socio-demographic characteristics of participant's on the level of stress perception and to what extent clinical guidelines fulfil CCU needs. Methodology: A mixed method approach (qualitative and quantitative) was applied. Purposive random sampling was used to recruit data. Ethical approval was obtained prior to data collection. Data was collected from three CCUs within the West and Northwest NHS Trusts. Participants who met the inclusion criteria were interviewed and asked to rank the Environmental Stressor Questionnaire (ESQ). Qualitative data was analyzed using Gorgi's method of analysis. A quantitative data was analyzed using the SPSS software version 15. Results: There was some consistency in the data where patients and nurses provided same ranking for CCU stressors. Consistently nurses ranked physiological stressors higher than psychological stressors. Patients showed consistency in the findings between what they ranked in the ESQ and their narratives more than their counterparts. Perception of stress was affected by participant's socio-demographic characteristics. A key finding is that the current guidelines do not serve patients and nurses needs. Conclusions: Nurses should be well equipped with knowledge and experience to overcome stressful situations. Educational programs should be made available for nurses to improve stress management. Nurses should assess patient's needs by applying effectively communication skills.

En pharmaco-épidémiologie, les études visant à évaluer l’impact des médicaments sur la santé de la population en situation réelle d’utilisation à la demande des Autorités de Santé en France, sont conduites dans un contexte contraint, en l’absence de bases de données médicalisées populationnelle. Le choix des critères d’évaluation des études de terrain à mener est donc crucial. Les critères directs de mesure d’impact (mortalité, morbidité, qualité de vie) sont parfois complexes à obtenir à large échelle, aussi, l’utilisation de critères indirects est souvent nécessaire. La persistance des traitements est un critère combinant de nombreux avantages : reflet de la pratique médicale courante et simplicité de recueil. Dans le cadre de cette thèse, nous avons proposé d’étudier l’intérêt de la persistance des traitements comme critère de mesure d’impact, angle peu exploré jusque là, la persistance étant usuellement considérée comme paramètre d’exposition. Aussi, dans le Chapitre 1, nous avons précisé à quels niveaux la persistance des traitements entre dans le champ de l’évaluation de l’impact. Puis, à partir de trois études de terrain, nous avons évalué l’intérêt de la mesure de la persistance au sein de deux niveaux d’impact. La persistance comme mesure directe de l’utilisation et du respect des recommandations est illustrée dans le Chapitre 2 (prévention secondaire du post-infarctus du myocarde). La persistance comme mesure indirecte de l’efficacité en vie réelle est illustrée : dans le Chapitre 3 où la persistance signe l’échec thérapeutique (traitement curatif de la sinusite aigue) puis dans le Chapitre 4 où la persistance est considérée comme un succès thérapeutique (traitement suspensif de l’épilepsie). Pour finir, nous avons discuté l’intérêt des résultats issus de ces travaux au regard du contexte actuel des demandes d’étude requises par les Autorités de Santé avec la perspective de la mise en place de la nouvelle législation européenne d’évaluation du médicament. / Pharmacoepidemiological studies requested by French Health Authorities to assess impact of treatment in real-life medical practice are performed in a restricted context, in the absence of a national health care databases. The choice of evaluation criteria for field studies is thus crucial. Direct impact measure criteria (mortality, morbidity, quality of life) are sometimes difficult to obtain on a large scale, therefore, the use of indirect criteria is often required. Treatment persistence is a criterion that combines several advantages: reflection of real-life medical practice and ease of collection. In this thesis, we studied persistence of treatment as a measure of impact, an original point of view as persistence is usually considered as a parameter of exposure. In Chapter 1, we have detailed at which level persistence of treatment is part of the field of impact evaluation. Thereafter, using three field studies, we assessed measure of persistence within two aspects of impact. Persistence as a direct measure of use and respect of recommendations is illustrated in Chapter 2 (secondary prevention in post-myocardial infarction). Persistence as an indirect measure of effectiveness is illustrated: in Chapter 3 where persistence is a sign of treatment failure (curative treatment of acute sinusitis) then in Chapter 4 where persistence is considered as treatment success (long-term treatment in epilepsy). In conclusion, we have discussed the results of this work with regards to the current context of studies requested by Health Authorities and with the forthcoming implementation of new European pharmacovigilance legislation.

MEDICAL PRESCRIPTIONS IN CYPRUS Author: Papadopoulos V. Philippos Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis is to get: current knowledge about medical prescriptions (MP) in Cyprus and rules of their use their basic division according their kinds, formal look, practical handle, payment knowledge of the current Health system of Cyprus Results: The Health system of Cyprus is a unique arrangement in the EU since is a simultaneous participation of public and the private sector which has many phenomena of inequality and non- accessibility mainly from the economically weaker. In the future plans of Ministry of Health is the complete redesign of entire Health System in a direction of electronic services for all the parts of health system chain including doctors, pharmacists and insured patients. The basic and significant informations about medical prescriptions in Cyprus according aim of diploma thesis are demonstrated in the Summary Table at chapter 11. All prescriptions in Cyprus are in common form for all type of drugs and there is no rule for size and color of the paper. Pharmacist is checking the signature of the doctor as well as name of the patient and...