Room
Rez-de-chaussée E040
Theme
How to improve healthcare
Chair
TBD.
Title
Multidisciplinary strategies for the management of heart failure patients improves patients’ outcomes and reduce costs
Name
Ariane Stengers
Affiliation
AstraZeneca Schweiz
Abstract
Heart failure (HF) affects one in five persons over the age of 40 and is the most common reason for hospitalization in people over 60 [1,2]. The condition has high mortality rates, as 50% of patients die within 5 years after diagnosis [3]. HF is associated with periodic decompensations and hospital admissions, which not only worsen patients’ prognosis, but also reduce quality of life (QoL) and cause immense costs [4,5].
HF patients discharged from hospital are in a vulnerable phase characterised by high mortality and morbidity. In a Swiss clinical trial, about 20% of HF patients were readmitted to the hospital within the first 30 days after discharge [6]. The transition from the in-hospital to the outpatient setting involves not only changes in the physician(s) providing care but also modifications in diet, self-dependence in the administration of new and complex drug therapies, demands for more physical activity, and confrontation with familial and social stresses. All these factors make the early post-discharge period a vulnerable phase [7].
Prescheduled follow-up visits, adherence to therapy and up-titration of HF medication have been shown to reduce the mortality risk during the transition phase after hospital discharge. Accordingly, ESC Guidelines recommend the use of multidisciplinary HF management programmes, to reduce the risk of HF hospitalization and mortality (evidence level IA) [2,8].
In addition to cardiologists and general practitioners (GPs) playing a key role in the multidisciplinary care of HF patients, ESC Guidelines underscore the need for specialist HF nurses to help provide care. Adequate patient self-care is essential in the effective management of HF and allows patients to understand what is beneficial, and to agree to self-monitoring and management plans. HF patients who report more effective self-care have a better QoL, lower readmission rates, and reduced mortality [2].
Experts agree that comprehensive care with education regarding lifestyle measures, medication knowledge, training regarding behaviour when warning signs occur, adjustment of medication and titration up to the maximum tolerated dose, instructions for exercise training, etc. can significantly improve prognosis of HF patients.
References:
- Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017 Apr;3(1):7-11.
- McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.
- Jones NR et al. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail. 2019;21(11):1306–1325.
- Metra M et al. Pre-discharge and early post-discharge management of patients hospitalized for acute heart failure: A scientific statement by the Heart Failure Association of the ESC. Eur J Heart Fail. 2023 Jul;25(7):1115-1131.
- Rosano GMC et al. Impact analysis of heart failure across European countries: an ESC-HFA position paper. ESC Heart Fail. 2022 Oct;9(5):2767-2778.
- Garnier A et al. Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study. ESC Heart Fail. 2018;5(4):657–67.
- Metra M et al. Postdischarge assessment after a heart failure hospitalization: the next step forward. Circulation. 2010 Nov 2;122(18):1782-5.
- Mueller C et al. Roadmap for the treatment of heart failure patients after hospital discharge: an interdisciplinary consensus paper. Swiss Med Wkly. 2020 Feb 6;150:w20159.
Title
Monitoring des Arzneimittelzugangs zur Messung der Strukturqualität
Name
Lars Peters
Affiliation
AstraZeneca
Abstract
Hintergrund:
«Ein qualitativ hochstehendes Gesundheitswesen zu möglichst niedrigen Kosten», das ist der gesetzliche Auftrag und das Leitbild des Schweizer Gesundheitssystems. In der Öffentlichkeit werden vor allem die Kosten debattiert. Wie steht es jedoch um den Arzneimittelzugang als Qualitätsmerkmal? Wie lange müssen Patient:innen auf Arzneimittelzugang warten?
Methodik:
Zur Analyse der Geschwindigkeit führen wir eine Kaplan-Meier-Analyse für Time to Reimbursement (TTR) für das Portfolio der AstraZeneca in der Schweiz durch. Als Basis dienen Neuzulassungen und Indikationserweiterungen der EMA im Zeitraum 2020 bis 2023, sowie die Aufnahme auf die Spezialitätenliste (SL). Datenschnitt war der 31.12.2023.
Resultate:
Im Beobachtungszeitraum wurden 20 Zulassungen identifiziert mit einer TTR zwischen 28 und 954 Tagen (Median 393 Tage). Von den 20 Zulassungen waren zum Zeitpunkt der Analyse 7 (35%) noch nicht auf der SL.
Diskussion:
Die Resultate zeigen, dass für Patient:innen in der Schweiz Arzneimittel im Median erst über ein Jahr später zugänglich sind, als Patient:innen in Deutschland, wo die Arzneimittel gleichzeitig mit EMA-Zulassung vergütet werden. Ein erheblicher Anteil (35%) der Medikamente/Indikationen stand Patient:innen überhaupt nicht zur Verfügung, und es ist unklar, ob diese jemals auf die SL aufgenommen werden. Nachbarländer schaffen es zusammen mit den Zulassungsinhaberinnen einen schnelleren und breiteren Arzneimittelzugang zu schaffen. So besteht offenbar systemische Fehlanreize, die dies in der Schweiz verhindern. Durch diesen Systemmangel stehen Patient:innen in der Schweiz weniger Behandlungsoptionen zur Verfügung mit Folgen für die Behandlungsqualität. Der Zugang zu Arzneimitteln sollte als standardmässiger Qualitätsindikator etabliert werden, um eine Diskussion zur Abwägung von Qualität und Kosten zu ermöglichen.
Title
Are integrated care models associated with improved drug safety in Swiss primary care? A cross-sectional analysis using healthcare claims data
Name
Renato Farcher
Affiliation
Helsana Group
Abstract
Background:
Although patients’ drug safety is a primary goal in high-quality healthcare systems, evidence repeatedly show high proportions of potentially inappropriate prescribing in the general but also in the older population – exposing them at risk of adverse events and long-term consequences. In this context, few studies showed promising effects of integrated care models (ICMs) on drug safety. Nevertheless, evidence of health insurance models incorporating key aspects of integrated care such as the family-doctor model (FDM) remains scare. Thus, the main aim of this study was to compare different innovative ICMs and a standard care model (SCM) on selected drug safety outcomes in Swiss primary care setting.
Methods:
We performed a cross-sectional study using health insurance claims data from persons who were continuously enrolled in an ICM or in a SCM between 2020 and 2021. Analyzed ICMs were varying in the degree of integrated care and included the FDM, FDM light and the telemedicine model (TM). Drug safety was assessed by the prescription of potentially inappropriate proton pump-inhibitors (PIPPI), opioids (PIO), medications (PIM), and polypharmacy. Propensity-score-weighted multiple logistic regression models were used to examine the association between different types of ICMs and drug safety.
Results:
We found a robust and significant association between persons enrolled in ICMs and drug safety outcomes for most of the ICMs. Furthermore, persons enrolled in FDM were less likely to receive PIM and polypharmacy than those in FDM light, whereas the chance of receiving PIPPI and polypharmacy were higher in FDM than in TM.
Conclusion:
Related to the high number of prescribed medications and enrollments into ICMs, the study provides crucial information on the role of ICMs on drug safety. This is particularly important in the context of aging population and rising prevalence of chronic diseases, in which extensive medication use is highly prevalent and associated with potentially serious adverse events at high costs.
Title
Job satisfaction in hospital-based healthcare.
Name
Livia Freitag
Affiliation
Faculty of Health Sciences and Medicine, University of Lucerne
Abstract
Job satisfaction has been identified as an essential factor contributing to the turnover of healthcare professionals. To our knowledge, no systematic review exists about interventions to improve job satisfaction among hospital-based healthcare professionals. Therefore, our aims are i) to provide an overview of the currently available literature and ii) to identify implications for policy and practice.
A systematic literature search will be conducted using the five online databases Pubmed, MEDLINE, Scopus, Cochrane, and PsycINFO. The following criteria will be considered: (1) human participants are over 18 years of age; (2) they work in a hospital; (3) they live in an OECD country; (4) they have no diagnosed physical or mental health conditions; (5) the strategy to improve job satisfaction will be compared to a control intervention (passive control group, care-as-usual group or waitlist control group); (6) the study will be randomised or quasi-randomised into an intervention and control group, (7) articles will be high-quality, peer-reviewed studies; (8) written in English or German; and (9) will be published in or since 2010. Studies will be categorised by intervention type into working conditions and environment, working time arrangements, remuneration and recognition, career development and training, employee participation and influence, health promotion and well-being, corporate culture and social relations, and work tasks and content.
The review highlights the importance of addressing job satisfaction among healthcare professionals to mitigate workforce shortages.