Background:The COVID-19 pandemic highlighted the need for innovative approaches to healthcare delivery, particularly for older adults with frailty in crowded settings. In Québec, Canada, the shortage of hospital beds during the pandemic exposed critical gaps in the capacity to provide appropriate end-of-life care for affected residents of residential care facilities (RCFs). Aim:This study aimed to examine the implementation of the COVID-19 Intensive Home Care Team (IHCT) and how it transformed the physical and social environment of RCFs to enable end-of-life care and "dying at home" in an unprecedented time. Design:A qualitative case study design was used. Between September 2020 and January 2021, qualitative data were collected through 30 in-depth interviews with front-line workers of the IHCT, healthcare managers, and academics in the home care sector. Thematic analysis reveals three interrelated themes: the ambiguities of caring spaces, the centrality of medication management, and the reconfiguration of RCFs through new spatial, technological, and relational arrangements that enabled "dying at home" during the COVID-19 pandemic. Results:Findings revealed that the IHCT initiative reshaped RCFs into a necropolitical space, showing the complex interplay between space, care practices, and societal values toward older adults with frailty. The transformation enabled a form of compassionate end-of-life care within familiar settings as well as exposed underlying societal hierarchies that determine whose lives, and deaths, are valued. Conclusion:The IHCT model illustrates how emergency health interventions can reconfigure care spaces and challenge conventional boundaries between home, private, and public care systems. However, it also underscores the ethical and political dimensions of care for frail older adults in crisis contexts.

The use of human enhancement drugs (HED), which include prescription drugs and other substances used for reasons beyond their intended medical use, has been the subject of considerable interest since the late 2000s. However, there is a lack of research exploring how working conditions and organisational norms may significantly contribute to an individual's decision to use substances for enhancement or performance purposes. Building on the concept of pharmaceuticalisation to examine the case of enhancement drugs use in the financial industry, this article highlights how the social context, particularly the workplace, can be central to analysing the causes and modalities of substance use for performance or enhancement purposes. This study therefore approaches the financial sector as a site where such processes may be observed in particularly acute forms. Through a qualitative analysis of an online forum, this study explores the experiences, motivations, opinions and beliefs about such substance use in the financial industry. The findings suggest that substance use is openly discussed in the forum and that difficult working conditions appear to contribute to shaping the modalities of such use. Stress and long working hours were the most reported problems associated with substance use. The study also shows that, far from being neutral, medicines and in particular HED themselves play a key social and normative role in the process of accepting these extreme working conditions. The narratives about the use of performance-enhancing substances created and disseminated within the community studied contribute to the idea that the micromanagement of the worker's bodies is ultimately the main tool available to adapt to their working conditions.

The COVID-19 pandemic has brought to the forefront profound questions surrounding dying and the concept of a "good death". This qualitative case study, conducted in a health center in Quebec, Canada, severely affected by outbreaks during the pandemic's first wave, explores end-of-life care for older adults in retirement homes. Through thirty interviews with healthcare practitioners, researchers, and managers, we investigate the critical role of a pharmacological device referred to as the "baby bottle" in providing end-of-life care to older adults infected with COVID-19 in their homes. Drawing upon the boundary object framework, we examine the ambiguities surrounding the use of this device and explores its agency. In this unprecedented context, we argue that the device facilitated a form of death that could be described as "better than nothing", embodying practitioners' efforts to provide some dignity to the dying person, by minimally controlling the distress and ensuring a connection between the dying person and the care team. Additionally, it served as a means of coping with the pandemic's intolerable aspects, such as the exclusion of frail older adults for the supposed common good. This study raises questions about the legitimacy and normalization of such compensatory measure within under-resourced healthcare systems for older people experiencing a loss of autonomy.

Dans l’historiographie québécoise, l’histoire de la pharmacie et des pharmaciens se situe en quelque sorte entre l’histoire de la médecine, des médecins et de la santé, d’un côté, et l’histoire du petit commerce et de la consommation de l’autre. Sans doute trop hybride pour s’inscrire fermement dans l’un ou l’autre de ces champs d’études, elle n’a que très peu attiré l’attention des historiens à ce jour. Cette hybridité n’en demeure pas moins fascinante. Non seulement est-elle au cœur de la trajectoire et de l’évolution de la pharmacie au Québec, mais elle met en évidence de manière explicite le fait que santé, médicament et consommation sont historiquement étroitement liés. Après avoir brossé le contexte qui mène à une importante enquête menée en 1899, l’article déroulera le fil rouge de cette tension entre commerce et profession du milieu du XIXe siècle jusqu’à la crise économique et identitaire à laquelle feront face les pharmaciens dans les années 1960 et 1970.

Le medicament occupe une place significative dans les societes contemporaines, au-dela des finalites therapeutiques qui lui sont traditionnellement reconnues. D’une part, parce que le concept meme de therapeutique s’est considerablement elargi au cours du dernier siecle pour inclure, tres en amont, la prevention – voire la preparation a l’apparition de la maladie – et, en aval, l’extension des limites corporelles – comme en temoigne l’engouement pour la medecine regenerative. D’autre part, pa...

Background: Community pharmacists are best placed to improve medication adherence because they frequently interact with patients and have been trained to manage medication-related problems. Therefore, it is essential to equip pharmacists adequately to detect non-adherent patients quickly and intervene to improve medication adherence. Objective: To design e-AdPharm, a tool that addresses unmet needs and barriers of community pharmacists to provide medication adherence support to patients with chronic diseases. Methods: A qualitative study using 4 focus group discussions with community pharmacists was conducted with a semi-structured interview guide and discussions lasting for 1-2 h. The discussions covered the barriers and needs of pharmacists related to medication adherence support provided to patients, their expectations of an electronic tool based on prescription refills to help them provide this support, and the design of the tool. Focus group data were coded and analyzed using an iterative process, with thematic and descriptive analyses. Results: Twenty-six community pharmacists participated. Lack of time and motivation from pharmacists and patients were common barriers to the provision of medication adherence support. Accordingly, community pharmacists wished to measure medication adherence quickly, provide easily interpretable data to patients on their medication use, and raise the patient's awareness of non-adherence. The pharmacists expressed their need to have an electronic tool to share medication adherence information with the treating physician. Regarding the design of e-AdPharm, the pharmacists wanted a table displaying medication adherence with a color code representing adherence level. They also stressed the importance of a structured section enabling them to continuously document the interventions made and the need for patient follow-ups. Conclusions: e-AdPharm meet the needs and overcome the barriers of community pharmacists to provide medication adherence support to their patients. Future studies should examine the feasibility of implementing eAdPharm in community pharmacies and test its efficacy for improving medication adherence.

In Quebec's historiography, the history of pharmacies and pharmacists straddles the history of medicine, doctors and health, on the one side, and the history of small business and consumerism, on the other. Too much of a hybrid to fit neatly in either of those fields of study, it has largely flown under the historians' radar. This duality is nonetheless fascinating. Not only is it at the very heart of pharmacies' trajectory and evolution in Quebec, but it explicitly highlights the fact that health, medication, and consumerism have historically close ties. Having given the background to an important investigation held in 1899, the paper illustrates the tension between commerce and profession from the mid-19th century to the economic and identity crisis facing pharmacists in the Sixties and Seventies.

Johanne Collin : J’aimerais pour debuter revenir sur votre parcours comme anthropologue. Vous etes l’une des figures les plus connues de l’anthropologie de la sante et en particulier du medicament en France et au-dela. Vous etes cofondatrice du reseau international de recherche MAAH (Medical Anthropology At Home) qui existe maintenant depuis plus de vingt ans. Comment et pourquoi en etes-vous venue a deplacer votre regard des societes dites traditionnelles aux societes occidentales contempora...

Introduction: Asthma guided self-management enhances patients' control of their condition under the guidance of the treating physician. The aim of the present study was to understand how physicians perceive, endorse, uptake, and support asthma guided self-management.Methods: We conducted a secondary supplementary analysis of data originally collected as part of a multicenter collective case study in which physicians treating patients with asthma were interviewed. Using reflective thematic analysis, we aimed to explore physicians' understanding of guided asthma self-management as related to four ideas, namely: (a) understanding of the disease management and treatment goals; (b) defining medical frame and guidance; (c) describing the importance of patient-physician relationship; and (d) implementing asthma guided self-management. Results: Evidence indicates that physicians perceived optimal guided self-management as related to patients' adherence to physician's instructions and recommendations, supported by the adjustment of prescribed pharmaceutical therapy contingent upon patient's symptoms. Some physicians also perceived behavior change and environmental control along with the medical recommendations. While physicians' perception of asthma and its treatment were aligned with the recommended guidelines-i.e., patient-centered care approach based on guided self-management, the actual guidance offered to patients remained primarily directive and paternalistic. Non-pharmacological approaches, such as exercise, smoking cessation, patient self-monitoring, and self-management supported by education and written self-management plans, were given little consideration in the context of the recommended treatment plan.

Cet article propose une analyse du médicament comme révélateur de notre rapport au corps et au temps en contexte de modernité avancée. Il offre un nouveau regard sur la problématique de la consommation de médicaments chez les personnes âgées en déplaçant la focale, du discours médical et de santé publique (surconsommation, prescription inadéquate, inobservance, etc.) vers celui, plus intérieur, concernant la façon dont les personnes âgées vivent leur vieillissement et la perspective d’une mort proche. Il contribue ainsi à une réflexion plus large et en construction sur le médicament comme objet social et culturel dans nos sociétés occidentales avancées.

Background: Community pharmacists have direct access to prescription refill information and regularly interact with their patients. Therefore, they are in a unique position to promote optimal medication use. Objectives: To describe how community pharmacists in Quebec, Canada, identify nonadherent patients, monitor medication use and promote optimal medication adherence. Methods: An invitation to complete a web-based survey was published online through different platforms, including a Facebook pharmacists’ group, an electronic newsletter, a pharmacy network forum and e-mail. The survey included questions on participant characteristics, methods used by pharmacists to identify nonadherent patients and monitor medication use and interventions they used to promote medication adherence. Results: In total, 342 community pharmacists completed the survey. The participants were mainly women (71.6%), staff pharmacists (56.7%) and aged 30 to 39 years (34.2%). The most common method to identify nonadherent patients was to check gaps between prescription refills (98.8%). The most common intervention to promote adherence was patient counselling (82.5%). The most common barriers to identifying nonadherent patients were lack of time (73.1%) and lack of prescription information (65.8%), whereas the most common barriers to intervening were anticipation of a negative reaction from their patients (91.2%) and lack of time (64%). Conclusion: Lack of time and lack of prescription information are frequent challenges encountered by community pharmacists regarding effective monitoring and management of patients with poor medication adherence. Pharmacists could benefit from electronic tools based on prescription refills that would provide quick and easily interpretable information on their patients’ medication adherence. Can Pharm J (Ott) 2020;153:xx-xx.

PURPOSE:The purpose of this study was to better understand patients' perspective of asthma self-management by focusing on the sociocultural and medical context shaping patients' illness representations and individual decisions.PATIENTS AND METHODS:We conducted a secondary analysis of semi-structured interviews carried out as part of a multicentered collective qualitative case study. In total, 24 patients, aged 2-76 years with a confirmed diagnosis of asthma (or were parents of a child), who renewed the prescription for inhaled corticosteroids in the past year, participated in this study. The thematic analysis focused on asthma-related events and experiences reported by the patients. Consistent with narrative inquiry, similar patterns were grouped together, and three vignettes representing the different realities experienced by the patients were created.RESULTS:The comparison of experiences and events reported by the patients suggested that patients' perceptions and beliefs regarding asthma and treatment goals influenced their self-management-related behaviors. More specifically, the medical context in which the patients were followed (ie, frame in which the medical encounter takes place, medical recommendations provided) contributed to shape their understanding of the disease and the associated treatment goals. In turn, a patient's perception of the disease and the treatment goals influenced asthma self-management behaviors related to environmental control, lifestyle habits, and medication intake.CONCLUSION:Current medical recommendations regarding asthma self-management highlight the importance of the physicians' guidance through the provision of a detailed written action plan and asthma education. These data suggest that while physicians contribute to shaping patients' beliefs and perceptions about the disease and treatment goals, patients tend to listen to their own experience and manage the disease accordingly. Thus, a medical encounter between the patient and the physician, aiming at enhancing a meaningful conversation about the disease, may lead the patient to approach the disease in a more effective manner, which goes beyond taking preventative paths to avoid symptoms.

The field of palliative care and serving the dying reflects the broader individualization of death. Focused on the notion of autonomy, the ideal death is now defined as discrete, unsconscious and hygienic. Based on a significant medical expertise which allows to alleviate physical pain, to chemically control anguish and fear, to neutralize odours and marks of agony, this ideal involves an ongoing tension between control and dependance. Emblematic of what sociologists Nikolas Rose refers as biocitizenship, that is a form of citizenship focused around the politicisation of individual health and the emergence of identity-based claims bound to biomedical issues, the hospice palliative care movement is embedded in the global process of pharmaceuticalization that characterises contemporary western societies. Starting from a sociological questionning on the increasing use of continuous deep sedation in the biomedical management of the end of life, this article analyses the phenomenon of pharmaceutical control of suffering from the theoretical perspective of pharmaceuticalization. Beyond the death denial and pain refusal thesis, the article shows that deep sedation is indissociable from a will of control and self-enhancement that is symptomatic of biocitizenship. Far from a simple refusal of pain, the norm of deep sedation rather indicates that « unproductive » pain – that is pain that is not part of therapeutic, enhancement or experimental rationales – tends to become socially intolerable. In this way, deep sedation both appears as the limit and the ultimate expression of biocitizenship.

Si les NBIC et leur convergence sont au cœur des revendications transhumanistes en faveur d’un humain augmenté, le médicament y occupe également une place centrale. Il constitue dans les nombreux écrits et discours du mouvement l’un des premiers moyens systématiquement considérés pour repousser les limites biologiques humaines et améliorer les performances physiques, intellectuelles aussi bien qu’émotionnelles des individus. L’objectif de cet article est d’explorer d’un point de vue sociologique la place et le sens que revêt le médicament dans les discours transhumanistes. Revendiqué comme l’outil d’une véritable émancipation humaine, l’usage non thérapeutique du médicament porté par les transhumanistes fait en réalité fond sur une biomédicalisation accrue de nombre de problématiques sociales contemporaines. Après avoir exploré cette ambivalence, l’article montre ensuite que l’aspiration transhumaniste à faire « mieux que bien » grâce à la pharmacologie, loin d’être propre au mouvement, se rapproche en réalité plus largement des prétentions de la biomédecine contemporaine, au regard desquelles le transhumanisme ne constitue finalement que l’une des manifestations exacerbées.

Though NBICs and their overlap are at the heart of transhumanist claims in favour of human enhancement, medication also occupies a central place. In many of the movement's writings and lectures, it is one of the primary means systematically considered to extend human biological boundaries and improve physical, intellectual and emotional performance. Taking a sociological perspective, this article aims to explore the role and meaning medication holds in transhumanist discourse. Declared the tool for true human emancipation, the non-therapeutic use of medication for which transhumanists advocate is actually carried out against a heightened biomedicalization of many contemporary social issues. After having explored this ambivalence, our article demonstrates that, hardly specific to this fringe movement, transhumanists' aspirations of pharmacologically reaching ?better than well? fits more broadly into contemporary biomedical pretentions, of which transhumanism is just one extreme example.

The field of palliative care and serving the dying reflects the broader individualization of death. Focused on the notion of autonomy, the ideal death is now defined as discrete, unsconscious and hygienic. Based on a significant medical expertise which allows to alleviate physical pain, to chemically control anguish and fear, to neutralize odours and marks of agony, this ideal involves an ongoing tension between control and dependance. Emblematic of what sociologists Nikolas Rose refers as biocitizenship, that is a form of citizenship focused around the politicisation of individual health and the emergence of identity-based claims bound to biomedical issues, the hospice palliative care movement is embedded in the global process of pharmaceuticalization that characterises contemporary western societies. Starting from a sociological questionning on the increasing use of continuous deep sedation in the biomedical management of the end of life, this article analyses the phenomenon of pharmaceutical control of suffering from the theoretical perspective of pharmaceuticalization. Beyond the death denial and pain refusal thesis, the article shows that deep sedation is indissociable from a will of control and self-enhancement that is symptomatic of biocitizenship. Far from a simple refusal of pain, the norm of deep sedation rather indicates that unproductive pain - that is pain that is not part of therapeutic, enhancement or experimental rationales - tends to become socially intolerable. In this way, deep sedation both appears as the limit and the ultimate expression of biocitizenship.

Teaching public health principles such as health promotion to healthcare professionals has gained attention in the last decade. The objective of this paper is to describe an innovative course that was developed in the Pharm.D programme in the Faculty of Pharmacy at the Universite de Montreal with a focus on health promotion through community-based project learning. First, it describes the course which was structured in twelve learning units given in two semesters to first and second year students who were grouped in teams of eight to ten. Then, it describes the instructional and evaluation methods for the course, including the development of an application to perform two 360-degree assessments within each team. Finally, it gives an overview of the projects realised since the implementation of the course, as well as future development within the Pharm.D curriculum.

Social sciences are important for training in pharmacy faculties. The course set up at the Faculty of Pharmacy of the University of Montreal in 2011 is a very innovative way to meet this challenge. The purpose of this report is to share this experience by providing a synthetic description. Many students were able to develop new skills and strengthen their skills, including leadership and critical thinking. The Faculty of Pharmacy was also able to achieve greater visibility in the Montreal community, that is to say from the associations, but also with what is out there called the "local health network" linking various health care professionals and institutions. Beyond the quantifiable results, this course is an evolving learning process in which the group interactions, individual and collective values and the task sharing allow students to build a working knowledge of social factors, which d.etermine health problems.