C 1 | Orals

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Title
Improving Primary Care: Evaluating the Implementation of a Disease Management Program

Name
Maria Carlander

Affiliation
ZHAW, Winterthur Institute of Health Economics

Abstract

Background and Objective
By evaluating a disease management program (DMP) for patients with diabetes mellitus implemented in a primary care setting, we aimed to provide evidence of the efficacy and effectiveness of the DMP under review. Our feedback will also enable involved health care providers to address areas for improvement.

Methods
The DMP in question was introduced over a four-year period at several health care centers. We employed two approaches to evaluate the DMP for up to four years following its introduction:
(1) A difference-in-difference (DiD) design using claims data of participating patients and a control group was used to analyze the DMPs’ impact on treatment guideline adherence, hospitalization risk, and health care costs at the patient level.
(2) Descriptive analysis of eight routinely collected process and clinical measures developed by the Swiss Society of Endocrinology and Diabetology (SGED). These enabled us to assess the quality of care for the participating health care centers.

Results
(1) 22’222 patients were included in this analysis. We identified a positive impact of the DMP on guideline adherence (DiD estimates for improvement in Year 1: +4%-points; Year 2: +7%-points; Year 3: +6%-points; and Year 4: +6%-points). No impact on hospitalization risk was found. Generally, the intervention group incurred lower health care expenditures. At the same time, the increase in health care costs was smaller in the intervention group compared to the control group (DiD estimates in Year 1: CHF -483 CHF; Year 2: CHF -144; Year 3: CHF -347; and Year 4: CHF -1,129).
(2) The number of participating patients included was 1,078 in 2017 and increased to 1,652 in 2021. The SGED measures mostly improved slightly or remained stable during the follow-up period.

Conclusion and Implications
Implementation of the DMP was found to have a positive impact on the quality and cost of diabetes care, as reflected in an improvement in guideline-adherent care, slightly improved or stable SGED measures, and lower health care costs. Our contribution shows how scientific evidence can be used to inform improvements in health care practice by collaborating closely with health care providers. We will present some challenges we faced and provide some lessons learned, in particular: effective communication of findings, issues with data quality, lack of time and resources among health care personnel, and insufficient digitalization.

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Title
Development and evaluation of a guide for doctor’s visits – the DocVISITguide

Name
Elena Guggiari

Affiliation
Careum Center for Health Literacy

Abstract

Background
During doctor’s visits, fundamental decisions regarding a patient’s diagnosis and therapy are taken. However, consultations often take place within a limited time frame and are characterized by an asymmetric interaction. Therefore, patients’ questions can remain unanswered and concerns unspoken. As a consequence, decisions about treatment might be made on the basis of insufficient information.

Objective
The aim of the project was to develop a tool for patients (a “DocVISITguide”) to prepare them for their visits, supporting them to take an active role in the communication and leave the consultation well-informed. In a second step, the guide was used and evaluated in a small sample of patients.

Methods 

A first draft of the DocVISITguide was developed based on an Internet search of existing tools. This first draft was then discussed and adapted with a group of experts and patients and then translated into easy language. For the evaluation, a small sample of patients took part in an online survey before and after their visit to the doctor. In addition, individual indepth telephone interviews were conducted.

Results
Most participants found the DocVISITguide easy to understand and clear. The guide helped them to take a closer look at their own health situation and be better prepared for the visit. More than three-quarters (82%) of the participants would probably use the DocVISITguide again in the future, and all (100%) would recommend it to family and friends. However, some patients felt unsure about using the DocVISITguide within the consultation and showing it to their physician.

Discussion
Although the DocVISITguide had a positive effect overall and enabled the patients through a targeted preparation to take an active role during the consultation, some patients might feel insecure about using the guide during the visit and showing or mentioning its use to the doctor. To counteract this, health professionals should also be actively involved in the process of using such tools in the future.

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Title
Measuring Access to Primary Health Care Services

Name
Lucas Haldimann

Affiliation
Schweizer Gesundheitsobservatorium (Obsan)

Abstract

Access to health care is recognized as an essential requirement for adequate health care, both at the international level and in national legislation. In order to ensure an adequate level of access, health care services must be available in sufficient numbers and must be accessible within a reasonable period of time. Based on the current state of international research, the Swiss Health Observatory has developed a methodology to analyze the spatial accessibility of health care. The methodology uses Geographic Information System (GIS) tools and takes into account not only the spatial distribution of the resident population, but also commuter flows, tourism, demand from abroad, and differences in care needs resulting from regionally diverse population composition. When applied to primary care, the method reveals significant differences in the regional density of health care services across communities. These findings can help policymakers to address regional challenges of health care access by optimizing incentive systems and resource allocation.  

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Title 
Primary Care Social Work in Switzerland

Name
René Rüegg

Affiliation
Bern University of Applied Sciences

Abstract

Hospitals, emergency rooms, and psychiatric clinics in Switzerland and many other countries in Europe operate at their capacity limits. Outpatient psychotherapy declare waiting times of multiple months and health care expenditures are rising at a already high level. An aging society, a shortage of skilled workers, and chronic and multiple illnesses are explanations on the demand-side. Surprisingly, little attention is given to the causes on the supply-side: How can inpatient treatments be avoided? How can prevention and early detection of poor health conditions be strengthened? How can patients emancipate themselves from health consumerism and be empowered to become responsible and health literate citizens?

Concerning the supply-side, the World Health Organization (WHO) is unequivocal. Health care services need a significant shift toward the outpatient sector. To make this shift successful, it recommends that all countries in the world invest an additional one percent of their gross domestic product in patient-centered primary health care (WHO & UNICEF 2018). Strengthening primary health care reduces unnecessary hospitalization, strengthens prevention and early detection of poor health conditions, improves patients' navigation of the health care system, enhances health literacy, and also increases health equity.

For the WHO, social workers reflect an integral part of interprofessional primary care teams. Their interventions support patients in accessing health services (e.g. by ensuring entitled social transfer payments) and navigating within the increasingly complex social and health systems. Social workers act closely together with community services, specialized agencies and civil society services. In addition, they promote the social integration of patients and relieve the medical staff in the case of socially complex problems.

In contrast to some Anglo-American countries, primary care social work is yet not well established in Switzerland and its surrounding countries. In Switzerland, only a few pilot project emerged within the last five years. In 2021 and 2022, four of these pilot projects were scientifically accompanied and evaluated by the Bern University of Applied Sciences (BFH). The study results show that the primary care social workers are not only of great benefit to the patients, but also to the medical professionals.
In the talk, the study results as well as the established cooperation models and their funding in Switzerland will be explained and discussed.

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Title
Family medicine’s position in society: Reflecting on the past and looking into the future

Name
Eva Pfarrwaller

Affiliation
University Institute for Primary Care, Faculty of Medicine, University of Geneva

Abstract

Efforts to improve the effectiveness of health care systems have stressed the importance of integrated, high-value health care strongly based on family medicine/primary care. Research has demonstrated the benefits of a strong primary care base on population health. For successful system change, primary care and public health must align: The roles of family medicine and public health in the health care system overlap and complement each other, with the common goal of both individual and population health. Historically, primary care and public health share many common interests and goals, yet developments during the 20th century have led them to function independently, with health care being delivered in « silos ». This has translated into training of physicians focusing on solving individual clinical problems. Also, for a long time, community-oriented primary care remained largely confined to « safety net » practices focusing on patients with special needs.

This workshop aims to reflect on the synergies to build between primary care and public health missions to improve our health system. It targets primary care practitioners and public health professionals interested in discussing the current and future position of family medicine in our society and reflecting on their own roles in this process.

Two presentations (Eva Pfarrwaller, Institute for Primary Care, University of Geneva) will provide a short overview of the historical developments of family medicine as a specialty, and a narrative review of the most important research demonstrating the benefits of family medicine on population health.

A third presentation (Hubert Maisonneuve, Institute for Primary Care, University of Geneva) will address ways in which the public health benefits of primary care can serve as a basis to implement change in the context of primary care practice.

The content of the presentations will serve as a framework for the discussion with the public to reflect on the present role of primary care in the society in Switzerland, discuss current challenges, and project into the future: Where would we like to stand 10 or 20 years from now, and how can we together build the conditions for developments and innovations to optimize the benefits of primary care for the population?