Room
Paternot salle n° 30 ( à côté de l'auditoire PATERNOT )
Theme
Primary care - The future of primary care and health professions
Chair
Isabelle Peytremann-Bridevaux
Title
eHealth in ambulatory primary care: Recent developments before and after the pandemic outbreak.
Name
Olivier Pahud
Affiliation
Swiss Health Observatory
Abstract
Digital transformation is a critical basis for integrated care, helping to improve quality, safety, and efficiency across the healthcare continuum. However, digital transformation of primary care is known to progress slowly in Switzerland. The use of eHealth by general practitioners (GPs) is still relatively low compared to other countries. Recently, digital drivers such as the outbreak of the coronavirus, the revision of the Swiss health insurance law as well as the nationwide implementation of reference communities may have had a boosting effect on the digitalization of primary care. To analyze potential effects, the Swiss Health Observatory is using data from the International Health Policy Surveys to monitor digital progress before and after the outbreak of the pandemic (i.e., 2012, 2015 and 2019 versus 2022). In addition, the national results are compared with five European (France, Germany, the Netherlands, Sweden and the United Kingdom) and four overseas countries (Australia, Canada, New Zealand and the United States of America) in order to determine the level of digital development in Switzerland. This presentation shows where Swiss GPs stand internationally and how eHealth evolved in terms of electronic documentation of medical records, communication with other health care providers (i.e., hospitals or specialists) and – more importantly – with their patients. Finally, it shows which eHealth-services GP practices offer to patients and how remote consultations have affected their work before, during and after the pandemic.Title
Primary care’s public health role as a motivator for students’ career choice: Avenues for action
Name
Eva Pfarrwaller
Affiliation
University Institute for Primary Care, Faculty of Medicine, University of Geneva
Abstract
In the context of primary care physician shortages, research on medical students’ career choice has suggested how medical schools may contribute to a workforce aligned with population health needs. Career choice is dynamic and involves numerous internal and external influences. We developed a conceptual framework representing this complex process. In this framework, public health-related elements, such as physician shortages or population health needs, were expected to influence career choices. This presentation focuses on selected results from a qualitative study to discuss whether students’ image of primary care reflects the public health role of primary care physicians.Fourteen young physicians were interviewed, using a semi-structured approach to explore the development of their career preferences during medical school, focusing on primary care (defined as the specialties of general internal medicine or pediatrics). Interviews were analyzed using an inductive approach and based on the previously developed conceptual framework.
Participants’ career choices were mostly driven by individual needs, such as the need for work-life balance. Relationships with patients and continuity of care were highly valued, mostly as a source of personal satisfaction. Participants were aware of primary care workforce shortages but did not think that this influenced their career decisions. The prevailing image of primary care was that of a specialty offering deep and long-lasting relationships with patients, but many participants also thought that primary care physicians could not truly help their patients. The social aspect of primary care practice was often considered negatively.
Many activities of primary care physicians are at the interface with public health and contribute substantially to population health. However, these aspects do not seem to be predominant in future physicians’ considerations about career choices, which, in our study, were mostly driven by personal needs. Medical education is still heavily influenced by the traditional training model focusing on a reactive approach to solve specific clinical problems in the individual patient. This may contribute to students’ insufficient understanding of primary care’s role in society. We will discuss avenues to drive change within medical education to ensure that the future physician workforce is prepared to embrace a population-health based role.
Title
Impact of primary care physicians working part-time on patient care: A scoping review
Name
Stefan Essig
Affiliation
University of Lucerne
Abstract
BackgroundIncreasing numbers of general practitioners (GPs) are reducing their working hours. A recent survey of the Swiss GP workforce has shown that the working hours of Swiss GPs have declined continuously since 2005 from an average of 50 hours per week to an average of 43.4 hours per week in 2020. This decline affects the workforce and the care provided to patients.
Aim and Methods
To explore how GPs working part-time influence patient care, we are currently conducting a scoping review by searching the databases PubMed, CINAHL, Embase, and the Cochrane Library. Peer-reviewed, original articles with either quantitative or qualitative designs are considered.
Results
The initial search resulted in 2070 unique studies. Abstracts were screened, and relevant information from full texts was extracted. In the final dataset, 15 studies could be included that have examined the impact of GPs working part-time on patient care. Most studies suggest that working part-time may affect patients’ satisfaction and access to care. However, some studies show that the availability of alternative GPs can counteract adverse effects. Further, alternative GPs may be able to ensure continuity of care, as long as the patients’ medical records are easily accessible.
Conclusion
On the one hand, there is evidence on undesirable effects of GPs working part-time on patient care. On the other hand, potential adverse effects can be overcome with organizational efforts.
Title
Integrating the role of Advanced Nurse Practitioners in primary care: APN Lucerne Model
Name
Charlotte Müller
Affiliation
Center for Primary and Community Care, University of Lucerne
Abstract
How can the public health problem of general practitioners (GPs) shortage, especially in rural Switzerland, be tackled? How can complex social and health-related needs be met in primarycare? Advanced Practitioner Nurses (APNs) complete higher education and can work autonomously with patients to support and complement GPs in their primary care practices.
Various pilot studies show that APNs can be integrated into primary care in Switzerland. To go one step further, the canton of Lucerne has initiated a project to develop the “APN Lucerne Model” from 2023-2025. The project is a joint effort from the cantonal health department, the University of Lucerne, and a multidisciplinary sounding board. The project should result in a model that includes a mutual understanding of the role of APNs in primary care and suggestions for financial reimbursement for APN services. The project will be built on previous pilot studies and four new primary care practices with APNs in the canton of Lucerne.
The landscape of APNs in Switzerland and the outline of the APN Lucerne Model will be introduced in form of an input talk by a Ph.D. student (Charlotte Müller). Based on this presentation, the workshop will discuss the lack of tariffs to reimburse APN services and the upcoming role of APNs in primary care. The interactive workshop aims at receiving critical feedback and developing recommendations to further research and implement the APN role in Switzerland. We will invite APNs and GPs with first-hand experience as well as policymakers in health care to facilitate meaningful results.
Title
Health2040: Aligning outpatient care with the population’s and professionals’ preferences
Name
Cinzia Zeltner
Affiliation
Universität Luzern
Abstract
Which health professionals would patients prefer to receive treatment from in the future? What are the characteristics of care models in which health professionals would like to work with each other? And how can institutions meet these preferences? These and further questions are addressed by “Health2040”, a cooperative project by the Faculty of Health Sciences and Medicine at the University of Lucerne and Interface Policy Studies Consulting Lucerne. The overarching goal of “Health2040” is to identify which prerequisites future outpatient healthcare in Switzerland must fulfil in order to meet the preferences of various stakeholder groups. A steering group consisting of representatives from professional associations, patient and educational organisations, insurance companies as well as policy makers ensures the practical relevance of the project.Over the past three years, a representative online survey of the general population (n=5’000) as well as a survey of health professionals from the five biggest professional groups in the outpatient sector (n=4’000) have been conducted based on a cross-sectional study design. In addition, a qualitative study on task shifting in general practitioners’ surgeries using a grounded theory approach is currently being designed.
The results of “Health2040” will be presented in three input talks by PhD students. (1) Zora Föhn – Preferences of the general population regarding future healthcare; (2) Sophie K. Brandt – Preferences and attitudes of health professionals regarding their future practice; (3) Cinzia Zeltner – Successful implementation of task shifting in outpatient healthcare and implications for decision-makers.
The focus will lie on the presentation of the final results from projects (1) and (2). Commonalities and differences in the respective preferences and attitudes will be discussed. Additionally, first insights from project (3) will be highlighted.
On the basis of these presentations, the workshop will give participants the opportunity to develop, together with decision-makers in healthcare, which prerequisites need to be met for outpatient healthcare to align with both the preferences of the general population and those of health professionals. The discussion will be centred around the themes of “professional profiles”, “care models” and “health policy” with the aim to develop specific and realistic recommendations for decision-makers in healthcare.