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Delphine Hoegy,1– 3 Ronald Guilloux,3,4 Nathalie Bleyzac,5– 7 Alexandra Gauthier-Vasserot,7– 9 Giovanna Cannas,7,9,10 Yves Bertrand,7– 9 Claude Dussart,1,3,11 Audrey Janoly-Dumenil1,3,12 1University of Lyon, University Claude Bernard Lyon 1, Health, Systemic, Process (P2S), Research Unit 4129, Lyon, France; 2Pharmacie, Groupement Hospitalier Est, Hospices civils de Lyon, Lyon, France; 3Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 4Unité de recherche (UR) Sciences, Société, Historicité, Éducation et Pratiques (S2HEP), Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 5Equipe Mixte de Recherche (EMR) 3738, PK/PD Modeling in Oncology, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 6Pharmacie, Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France; 7Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l’Erythropoïèse, Hospices Civils de Lyon, Lyon, France; 8Institut d’Hématologie et d’Oncologie Pédiatrique de Lyon, Hospices civils de Lyon, Lyon, France; 9Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; 10Médecine Interne, Hôpital Edouard Herriot, Hospices civils de Lyon, Lyon, France; 11Pharmacie centrale, Hospices Civils de Lyon, Lyon, France; 12Pharmacie, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon, FranceCorrespondence: Delphine Hoegy, Pharmacy, Groupement Hospitalier Est, 59 boulevard Pinel, Bron, 69500, France, Tel +334 26 73 97 80, Fax +334 72 35 73 31, Email delphine.hoegy@chu-lyon.frIntroduction: The pediatric-adult care transition, which takes place during adolescence, is a high-risk period for medical care adherence in chronic diseases, this encompasses treatment adherence, attending medical consultations and following healthcare advice. Studying perceptions is needed to get a more comprehensive picture of this care transition and to propose interventions to address the gaps. The authors analyzed perceptions from patients and caregivers in adolescents with sickle cell disease. Although this is the first step to improving the actual care management, to our knowledge, no study has explored perceptions from healthcare providers and compared it to patients’ perceptions. The purpose of this study was to provide an insight on the experience of adolescent and adult patients, pediatric and adult healthcare providers in the context of pediatric to adult care transition, and analyze those concerns in order to better understand medical care adherence and improve patient care.Material and Methods: Semi-structured interviews were conducted with adolescent and adult patients, as well as healthcare professionals (HCPs) in pediatric and adult departments. These interviews were audiotaped and transcribed before manual inductive content analysis.Results: A total of 15 adolescent patients, 10 adult patients, 9 pediatric HCPs and 13 adult HCPs - including 12 nurses - were interviewed. Patients and healthcare providers all agreed that the pediatric-adult care transition was poorly experienced. This was mainly due to various changes in habits, physicians, and care organization. Anticipating this transition and acquiring new skills both for patients and HCPs are essential steps for improving medical care adherence during this challenging pediatric-adult care transition.Conclusion: Propositions emerged from patients and healthcare providers to improve care and subsequently to improve medical care adherence in patients with sickle cell disease during and after the pediatric to adult care transition.Keywords: sickle cell disease, qualitative research, pediatric to adult care transition

Karen Beny,1,2 Benjamin du Sartz de Vigneulles,1 Valerie Chamouard,3,4 Ronald Guilloux,5 Valérie Gay,6 Claude Negrier,3 Claude Dussart1,2 1EA 4129 Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard Lyon 1, Lyon, France; 2Central Pharmacy, Hospices Civils de Lyon, Lyon, France; 3Reference center on hemophilia and other constitutional hemorrhagic diseases, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 4Pharmacy, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 5Laboratory S2HEP, University of Lyon, University Claude Bernard Lyon 1, Lyon, France; 6Hemophilia Care Center, Centre hospitalier Métropole Savoie, Chambéry, FranceCorrespondence: Karen BenyCentral Pharmacy, Hospices Civils de Lyon, 57 rue Francisque Darcieux, CS 60004, 69563 Saint Genis Laval Cedex, Lyon, FranceTel +33 4 78 86 66 92Fax +33 4 72 67 88 74Email karen.beny@chu-lyon.frBackground: New therapies provide a favorable evolution in the care management of persons with hemophilia. However, the impact of these new therapies on patient care organization remains to be determined. A qualitative study will be implemented to analyze patients’ perception regarding the impact of innovation on the organization of their care management. Secondary objectives will include refining specific factors related to persons with hemophilia (barriers or facilitators, especially the place of treatment) to consider within an organizational impact analysis.Patients and Methods: Semi-structured individual interviews will be conducted via videoconferencing or by phone by two researchers using an interview guide. Participants will be recruited from the Rhône-Alpes region, in France. Physicians from two hemophilia treatment centers will identify eligible patients. Moreover, a call for volunteers will be launched by the Rhône-Alpes committee of the French hemophilia association. Interviews will be conducted with adult patients, adolescent patients or parents of a minor with hemophilia regularly treated prophylactically or on demand. Data analysis will be performed with NVivo® software. Each interview will be analyzed by two researchers using an inductive content analytic method.Discussion: The INNOVHEMO study is an original study analyzing the way patients perceive the impact of an innovation on their care management organization. The resulting patient-specific factors, identified as barriers or facilitators, will need to be integrated into a more comprehensive analysis of the impact of innovation on care management organization.Keywords: therapeutic innovation, hemophilia, care pathway, qualitative research, organizational aspect, patient experience data

Najwa Taghy, 1 Linda Cambon, 2 Jean-Marie Cohen, 3 Claude Dussart 4 1Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard of Lyon 1, Lyon, EA4129, France; 2Research Chair in Prevention, University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team Methods for Population Health Intervention Research, Bordeaux, France; 3Open Rome, Paris, France, Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard Lyon 1, EA4129, France; 4Lyon Public Hospices, Central Pharmacy, Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard Lyon 1, EA4129, FranceCorrespondence: Najwa TaghyUniversity of Lyon, University Claude Bernard Lyon 1, Laboratory P2S (Health Systemic Process), Lyon EA4129, FranceTel +33 633740378Email najwa.taghy@gmail.comIntroduction: The risk of polypharmacy is on the rise in most industrialized countries, threatening to burden their health systems. Although many definitions exist and numerous concepts are found in literature as synonyms, the phenomenon of polypharmacy remains poorly defined. The aim of this literature review is to provide an overview of available definitions of polypharmacy, to analyse their convergences and divergences and to discuss the consequences on the assessment of the problem.Methods: A literature review was conducted to identify all published systematic reviews on definitions of polypharmacy available via Scopus and Pubmed databases. The Assessment of Multiple Systematic Reviews (AMSTAR) tool was used to appraise the methodological quality of the selected reviews. Available definitions and other characteristics were extracted; summarised in a table and analysed.Results: Six systematic reviews were identified. They were published between 2000 and 2018. Three focussed on definitions of polypharmacy in the elderly; two in the general population and one in children. The strategy adopted in reviews is more rigorous in the most recent ones. However, they remain, at best, partially exhaustive. The definitions found in the literature used two main approaches, either (i) quantitative, applying varying thresholds and types of polypharmacy based on the number of medications being taken by the patient (ii) qualitative, based on the clinical indications and effects of a given drug regimen, with a growing number of characteristics to describe polypharmacy. The term “inappropriate” is increasingly associated with polypharmacy especially in studies that aimed to use this definition to identify possible solutions for healthcare providers in the field related to aging.Conclusion: This review confirms a high variability and an evolution in the approaches defining “polypharmacy” in the absence of a consensus following standardized criteria. That makes it very difficult to estimate and measure the outcomes associated with this phenomenon.Keywords: polypharmacy, definition, literature review

Delphine Hoegy,1,2 Nathalie Bleyzac,3,4 Philip Robinson,5 Yves Bertrand,3,6 Claude Dussart,1,7 Audrey Janoly-Dumenil1,21EA 4129 P2S Parcours Santé Systémique – Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France; 2Pharmacy, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; 3Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France; 4EMR 3738, PK/PD Modeling in Oncology, université Lyon-Sud, Lyon, France; 5Direction de la Recherche Clinique et de l’Innovation, Hospices Civils de Lyon, Lyon, France; 6U1111-CNRS UMR 5308, University of Lyon I, ENS Lyon, Lyon, France; 7Central Pharmacy, Hospices Civils de Lyon, Lyon, FranceBackground: Medication adherence is a major concern in public health. It is fully established that immunosuppressive therapy (IT) and concomitant medications affect transplant outcomes in the pediatric population, showing interest in adherence to this therapy. The aim of the present review was to report on medication adherence in pediatric population post-transplantation. This will enable us to know the situation in this particular population.Methods: A literature search was performed using the MEDLINE database. Studies that were published from January 1999 to January 2016 in English language and which investigated medication adherence in pediatric transplantation were included. The type of organ and the methods used to assess medication adherence were studied.Results: A total of 281 records were identified, from which 34 studies were selected: 38% (n=13) on kidney transplantation, 32% (n=11) on liver transplantation, and 23% (n=10) on the transplantation of other organs. Medication adherence was found to be lower than 80% in two-thirds of the studies (64%), and varied from 22% to 97%. This wide range was explained in part by the important heterogeneity of assessment methods among studies. The methods used were objective, non-objective, or combined both types. Most studies did not fully describe the data collected: the time since transplantation, the period over which adherence was assessed, the population, the medications, and the threshold discriminating adherence and non-adherence.Conclusion: The present study found poor medication adherence in the pediatric population post-transplantation. There was a wide range of medication adherence, explained largely by the heterogeneity of assessment methods. Future studies must consider the characteristics of each methodology, but also the threshold defining adherence should be chosen on the basis of clinical outcomes, and describe all data collected to gain precision. To improve adherence in this population, it is essential to identify factors influencing medication (IT and concomitant medications) adherence.Keywords: medication adherence, patient compliance, child, transplantation