Room
Paternot salle n°50 ( à côté de l'auditoire PATERNOT )
Theme
NCD - Countering NCDs and addiction
Chair
Alberto Marcacci
Title
International OECD survey of patients with chronic conditions: implementation and preliminary results of the Swiss field trial
Name
Chantal Arditi
Affiliation
Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
Abstract
IntroductionTo improve the quality of care and health outcomes of people with chronic conditions, health systems reshape care towards being more people-centred and coordinated. While primary care (PC) is expected to play a central role in this regard, little information is available on the performance of PC in most countries, especially in terms of patient-reported outcomes and experiences. Considering this critical gap, the Organisation for Economic Co-operation and Development (OECD) was mandated by the Member States to set up a new international survey called “PaRIS survey of Patients with Chronic Conditions”. It was designed to provide insights on outcomes and experiences of care as reported by these patients. The OECD launched the PaRIS survey in 2022 in 21 countries, including Switzerland where Unisanté is conducting the field trial until March 2023.
Methods
The survey follows a nested design, with the recruitment of PC practices first and their patients subsequently. For the Swiss field trial, 125 PC providers were randomly sampled from the federal register of medical professions (MedReg). Up to 200 patients fulfilling the following eligibility criteria were then sampled by the participating practices: 1) aged ≥ 45 years; 2) living in the community; 3) ≥ 1 contact with the practice in the previous 6 months. Data are collected with two online questionnaires: the provider questionnaire collects information on the characteristics of PC practices and the patient questionnaire includes patient-reported outcome measures (PROMs) and experience measures (PREMs), and other characteristics (demographics, chronic conditions, health and care capabilities, health behaviours). The nested design allows analysis of the variation in patient-reported data in relation to characteristics of PC practices. All survey materials were developed and tested in German, French and Italian.
Results
We will provide insights on the implementation of the PaRIS survey in Switzerland, and present the preliminary results of the field trial. Based on the findings from the field trial, the main trial will take place in late 2023.
Conclusion
The PaRIS survey aims to collect valuable information on the performance of PC, as reported by patients, which is currently lacking in Switzerland and other countries. It also intends to facilitate international comparisons on how health systems respond to the needs of people with chronic conditions, and to foster cross-country learning.
Title
Implementation of an incentive scheme in a family physician model: does it improve adherence to diabetes guidelines?
Name
Renato Farcher
Affiliation
Helsana Versicherungen AG
Abstract
Background: The increasing prevalence and incidence of diabetes brings challenges to the healthcare delivery system and raises questions about the provision of high-quality care. Inappropriate care of diabetes leads to adverse outcomes such as comorbidities or hospitalizations and is associated with high costs. However, adverse outcomes can be avoided in many cases with improving adherence to diabetes guidelines. In Switzerland, an incentive scheme was implemented in established contracts between a large basic mandatory health insurance and physician networks in 2018 to improve the quality of diabetes care. The aim of this study was to evaluate the association between this implementation and adherence to diabetes guidelines among patients with diabetes enrolled in a family physician model.Methods: We performed a retrospective cohort study, using anonymized claims data of patients with diabetes who chose a family physician model as their mandatory healthcare coverage. Incentive scheme included a non-financial and a financial element for the treating network-physician. Adherence to diabetes guidelines was assessed by evidencebased diabetes tests and hierarchically constructed adherence levels. Generalized multilevel models were used to investigate the association between the incentive scheme and adherence to diabetes guidelines.
Results: Over 6’000 patients with diabetes were included in this study. The study showed that patients had a statistically significant higher chance to receive guideline-based diabetes tests after implementation of the incentive scheme. Full adherence to diabetes guidelines was more likely after implementation of the incentive scheme.
Conclusion: The evidence suggests that incentive schemes can significantly improve adherence to diabetes guidelines in patients with diabetes enrolled in a family physician model and are promising to increase quality of diabetes care.
Title
Cigarettes électroniques jetables « puffs » et nouveaux produits du tabac chez les jeunes
Name
Yara Barrense-Dias
Affiliation
Unisanté
Abstract
Les cigarettes électroniques (ou e-cigarettes), apparues sur le marché autour de 2008-2009, ont particulièrement intéressé la recherche et la prévention, notamment par rapport à leur utilisation chez les jeunes. Parmi elles, un nouveau produit est arrivé sur la marché suisse depuis 2020 : les e-cigarettes jetables, ou puffs, des dispositifs colorés ressemblant à des surligneurs ou des clés USB. Les puffs soulèvent de nombreuses inquiétudes pour la protection des jeunes, en particulier car elles présentent souvent de fortes teneurs en nicotine et possèdent donc un potentiel addictif très élevé. En août 2022, une étude menée par Unisanté et Promotion Santé Valais auprès des jeunes (14-25 ans) en Suisse romande a permis d’obtenir les premières données en Suisse sur l’usage et les représentations des puffs. Cette présentation orale présentera donc les résultats de cette étude et les recommandations, notamment quant à la réglementation sur les cigarettes électroniques et les produits du tabac en Suisse (romande).Title
Frühzeitige Prävention chronischer Krankheiten – am Beispiel von chronischem Nierenleiden
Name
Michaela Metz
Affiliation
Die Präsentation wird freundlicherweise unterstützt von AstraZeneca AG
Abstract
Früherkennung und Behandlung von Nierenerkrankten steigert Lebensqualität und senkt Kosten
Die wenigsten Menschenkennen die Funktionsfähigkeit ihrer Nieren. Das ist gefährlich, denn eine chronische Nierenerkrankung (engl. Chronic, Kidney Disease, CKD) kann sich langsam und symptomlos entwickeln. In der Schweiz leidet jede zehnte erwachsene Person an einer Nierenerkrankung (1,2).
Aufgrund der älter werdenden Bevölkerung und dem zunehmenden Auftreten von Krankheiten, welche die Niere belasten und schädigen (z. B. Diabetes, Bluthochdruck), ist die Prävalenz der chronischen Nierenerkrankung zudem stark steigend. Eine Nierenerkrankung verschlimmert sich oft unbemerkt.
Eine letztjährige Studie der Universität Zürich fand heraus, dass bei der Früherkennung und Behandlung von chronischen Nierenleiden in der Schweiz jedoch Schwachstellen bestehen. Es wird davon ausgegangen, dass zwei Drittel der Nierenpatient:innen keine Diagnose erhalten.3 Oft versäumt wird die Überwachung des Bluteiweisses im Urin (Albuminurie) sowie die gezielte Untersuchung von Risikopatient:innen. Eine optimierte Früherkennung und Behandlung ist jedoch eminent wichtig: Dadurch kann eine Blutwäsche (Dialyse) oder eine Nierentransplantation länger vermieden werden. Zudem steigert sie die Lebensqualität der Betroffenen und führt zu signifikanten Kosteneinsparungen von bis zu 250'000 Franken pro Jahr und Patient:in (4).
Mithilfe von Aufklärungsmassnahmen können die identifizierten Schwachstellen in den Arztpraxen verringert werden, damit Früherkennung und Behandlung künftig optimal ineinander greifen. Informationsportale wie nieren-leiden-leise.ch (4) und diagnose-niereninsuffizienz.ch (5) versuchen die Aufklärung in der Öffentlichkeit voranzutreiben und Orientierungshilfen anzubieten. Die Schweizerische Gesellschaft für Nephrologie (swissnephrology.ch) hat zudem Leitlinien erarbeitet, um die medizinische Praxis bei der Identifikation, Früherkennung und Behandlung zu unterstützen.
Es sind verschiedene Test- und mittlerweile auch effektive Behandlungsoptionen verfügbar. So kann beispielsweise Albuminurie präzise getestet werden. Bei Patient:innen, die ein erhöhtes Risiko für eine Nierenschädigung aufweisen, empfiehlt sich einmal jährlich die Nierenfunktion zu kontrollieren.
Fachpersonen und Patientenorganisationen sind sich einig: Die Früherkennung von Nierenerkrankungen ist zentral, um den Krankheitsverlauf positiv zu beeinflussen und die Lebensqualität der Betroffenen zu verbessern.
Referenzen:
1. Ogna VF, et al., Prevalence and determinants of chronic kidney disease in the Swiss population. Swiss Med Wkly. 2016;146:w14313.
2. Ponte B. et al. Determinants and burden of chronic kidney disease in the population-based CoLaus study: a cross-sectional analysis. Nephrol Dial Transplant. 2013 Sep;28(9):2329-39.
3. Sundström J, et al. Prevalence, outcomes, and cost of CKD in a contemporary population of 2.4 million patients from 11 countries: the CaReMe CKD Study. The Lancet Regional Health – Europe 2022;00: 100438. Published online 30 June 2022. Available from: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00132-6/fulltext
4. Pierre-Yves Martin. Fortschritte in der Nephrologie: Vorteilhaft für Patienten und Kosten. Schweizerische Ärztezeitung. 2017; 98(45):1484–1486.
5. nieren-leiden-leise.ch (Stand: 31.08.23)
6. diagnose-niereninsuffizienz.ch (Stand: 31.08.23)
Title
Patient-reported Complementary and Alternative Medicine Use in IBD
Name
Valérie Pittet
Affiliation
Unisanté-DESS
Abstract
Background: Complementary and alternative medicines (CAM) may be defined as treatments that fall outside of conventional healthcare. Patients with IBD often turn to CAM, mainly without discussing it with their physician. We repetitively collect information on patient-reported CAM use between 2007 and 2016. Aims: 1) to assess main categories of patient-reported CAM used by year, 2) to assess factors associated with CAM use in 2016.Methods: The Swiss IBD cohort started in November 2006. At enrollment and annually, patients were asked to complete self-reported questionnaires. Cohort data was used to characterize CAM users. We classified CAM using recommendations of the US National Center for Complementary and Integrative Health. Changes in life habits (e.g. diet) was taken as an additional category. Multivariate logistic regressions were performed to search for factors associated with CAM use (i.e. >=1 CAM reported from 2007-2016).
Results: 3334 patients were included since Nov 2006. Overall, CAM were used by 21.7% to 29.3% of patients over years. Types of CAM were natural products and biologically based therapies (range: 6.9% to 11.9%), change in life habits (6.2% to 11.2%), whole medical systems and traditional medicines (5.8% to 9.6%), mind-body interventions (3.2% to 7.7%), body-based interventions (3.5% to 6.9%) and energy therapies (1.9% to 4.6%). When looking to CAM use by patients in 2016, we found that 41.9%/44.4% of CD/UC patients used >=1 CAM; the most frequent were “change in life habits” (20.6%/18.7%), homeopathy (12.5%/14.5%) and acupuncture (9.2%/10.5%). No significant CAM differences were observed by type of disease, except for bio-electromagnetic therapies (3.5% for UC, 1.9% for CD; p=0.010). CAM use in CD was significantly higher among women (OR=1.9; p<0.001), French-speakers (OR=1.5; p=0.002), patients with arthritis complications (OR=1.5; p=0.001) and lower among smokers, patients with higher SF-36 mental scores, higher age at diagnostic and B1p disease behavior profiles. CAM use in UC was significantly higher among women (OR=2.3; p<0.001), patients with arthritis complications (OR=1.4; p=0.017), aged 36 to 45, and lower with increased IBD QoL score.
Conclusions: Each year, > ¼ of IBD patients used CAM, with no major changes in CAM types. On average, 43% of patients reported a history of CAM use in 2016. Factors associated with CAM use differed between UC and CD and extraintestinal symptoms.