General Practitioners In Switzerland Research Articles

Lost in translation? A qualitative study of representations and management of chronic depression in general practice

BackgroundGPs are on the front line for the identification and management of chronic depression but not much is known of their representations and management of chronic depression.ObjectivesTo analyze GPs’ representations of chronic depression and to explore how they manage it.MethodsThree focus groups were conducted with 22 French-speaking general practitioners in Switzerland. The focus groups were transcribed and coded with MaxQDA. A detailed content analysis was carried out and the results were synthesized into a conceptual map.ResultsGPs form representations of chronic depression at the intersection of expert and lay knowledge. When talking about patients suffering from chronic depression, GPs mention middle-aged women with complex psychosocial situations and somatic complaints. GPs’ management of chronic depression relies on the relationship with their patients, but also on taking care of them as a whole: psyche, body and social context. GPs often feel helpless and lonely when confronted with a patient with chronic depression. They insist on the importance of collaboration and supervision. As regards chronic depression management, GPs remain alone with patients suffering from complex biopsychosocial situations. In other situations, GPs seek the help of a psychiatrist, sometimes quickly, sometimes after a long approach. In each situation, GPs have to develop skills for translating patients’ complaints.ConclusionGPs endorse a role of interpreter, making the physical presentation of their patient complaints move towards a psychological appreciation. Our results call for a renewed interest in GPs’ role as interpreters and the means to achieve it.

Attractiveness of medical disciplines amongst Swiss first-year medical students allocated to different medical education tracks: cross-sectional study

BackgroundAs most countries, Switzerland is experiencing a shortage of physicians especially in general practice and new medical education tracks with respective focusses have been started in response. This study investigated Swiss medical students’ career openness and attractiveness of different medical disciplines as well as the concordance of students’ career intentions with assigned medical education tracks.MethodsCross-sectional study surveying first year medical students assigned to four different Swiss medical education tracks with distinctive additional education focuses (ETH Zurich: medical technology and engineering, University of St. Gallen and University of Lucerne: primary healthcare and University of Zurich: no distinctive focus).ResultsWe surveyed 354 medical students (response rate across all included medical education tracks 71.1%), 64.8% female, mean age 20 years. Regarding career openness, we found that 52.8% of medical students had neither a strong commitment nor a strong reservation for any of the proposed career options and 17.0% had a strong commitment. Among medical disciplines, medical subspecialties were attractive to the largest part of students (inpatient subspecialties attractive for 71%, outpatient for 58%), attractiveness of general practice was moderate (30%), academic (22%) and industrial sector (17%) careers were least attractive. Proportions of medical students attracted to general practice were similar at medical education tracks with focus on primary healthcare compared to other medical education tracks (32.2% vs. 25.8%, p = 0.391). Conversely, proportions of medical students attracted to academic or industry careers were significantly higher at the ETH Zurich compared to other medical education tracks (37.2%, vs. 13.1%, p < 0.001 and 31.9%, vs. 8.8%, p < 0.001 respectively).ConclusionWhile most first-year medical students were open to careers in many medical disciplines, attractiveness of disciplines varied strongly. Students attracted to academic or industrial careers accumulated at the medical education track with concordant teaching focus but students attracted to general practice did not accumulate at medical education tracks focused on primary healthcare. For medical education tracks with primary care teaching focus this is both a challenge and an opportunity to specifically counteract the shortage of general practitioners in Switzerland.

Impact of the COVID-19 pandemic on the intensity of health services use in general practice

Abstract Background The COVID-19 pandemic affects non-COVID-19-related health services use due to shutdown measures and fears of potential coronavirus infection or fears of overwhelmed health systems. We aimed to explore the impact of the shutdown in spring 2020 on the intensity of health services use (consultation counts, chronic disease measurement counts) in Swiss general practice. Methods Based on electronic medical records from 278 general practitioners in Switzerland, we built two patient cohorts: (1) Jan-Jun 2019 (173,523 patients); (2) Jan-Jun 2020 (179,086 patients). We used linear regression analysis to model weekly consultation counts, as well as weekly blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts, per 100 patients. We calculated expected values in absence of a shutdown and compared them to actual observed values in 2020. The analyses were repeated for selected at-risk groups (patients with hypertension, diabetes, or cardiovascular disease) and different age groups (&amp;lt;60 years, 60-80 years, and &amp;gt;80 years). Results During the shutdown period (calendar weeks 13-19 in 2020), weekly consultation counts were lower than non-shutdown models predicted. Consultation rates reduced by 17.2% for the total population, 16.5% for patients with hypertension, 17.5% for patients with diabetes, and 17.6% for patients with cardiovascular disease. Between different age groups, consultation counts reduced by 15.7% for patients aged &amp;lt;60 years, 20.4% for patients aged 60-80 years, and 14.5% for patients aged &amp;gt;80 years. Weekly BP counts reduced by 35.3% in the total population and by 35.0% for patients with hypertension. Weekly HbA1c counts reduced by 33.2% in the total population and by 29.8% for patients with diabetes. P-values were &amp;lt;0.001 for all reported estimates. Conclusions We found a significant decrease in the intensity of health services use in Swiss general practice during the shutdown in spring 2020. Key messages We demonstrate that the intensity of health services use in general practice decreased during the first Swiss shutdown in spring 2020, overall and among patients with chronic conditions. It is crucial that health systems remain able to meet the non-COVID-19-related health care needs of patients during shutdowns, especially for patients with chronic conditions who require regular care.

Antibiotic prescription monitoring and feedback in primary care in Switzerland: Design and rationale of a nationwide pragmatic randomized controlled trial

IntroductionAntibiotic consumption is highest in primary care, and antibiotic overuse furthers antimicrobial resistance. In our recently published pilot-RCT, we used monthly aggregated claims data to provide personalized antibiotic prescription feedback to general practitioners (GPs). The pilot-RCT has shown that personalized prescription feedback is a feasible and promising low-cost intervention to reduce antibiotic prescribing. Here, we describe the rationale and design of the follow-up RCT with 3426 GPs in Switzerland. We now have access to pseudonymized patient-level data from routinely collected health insurance data of the three largest health insurers in Switzerland. Methods and analysis1713 GPs randomized to the intervention group received once evidence-based treatment guidelines at the beginning, including region-specific antibiotic resistance information from the community and personalized feedback of their antibiotic prescribing, followed by quarterly personalized prescription feedback for two years. The first and the last mailings were sent out in December 2017 and September 2019, respectively. The 1713 GPs randomized to the control group were not notified about the study and they received no guidelines and no prescription feedback. The personalized prescription feedbacks and the analyses of the primary and secondary outcomes are entirely based on pseudonymized patient-level data from routinely collected health insurance data. The primary outcome is prescribed antibiotics per 100 patient consultations during the second year of intervention. The secondary outcomes include antibiotic use during the entire two-year trial period, use of broad-spectrum antibiotics, hospitalization rates (all-cause and infection-related), and antibiotic use in different age groups. If the feedback intervention proves to be efficacious, the intervention could be continued systemwide. Ethics and disseminationThe trial is publicly funded by the Swiss National Science Foundation (SNSF, grant number 407240_167066). The trial was approved by the ethics committee "Ethikkommission Nordwest-und Zentralschweiz" (EKNZ Project-ID 2017-00888). Results will be disseminated in peer-reviewed journals and international conferences.

Treatment Quality through Advanced Practice Nurses (APN) and Clinical Nurses (CN) in Ambulatory Primary Health Care – a retrospective study / Behandlungsqualität durch Advanced Practice Nurses (APN) und Clinical Nurses (CN) in der ambulanten Gesundheitsversorgung – eine retrospektive Studie

Abstract Introduction The shortage of general practitioners in Switzerland requires new ways to ensure primary outpatient health care. The group practice Medbase Winterthur Neuwiesen has been testing the use of Advanced Practice Nurses (APN) and Clinical Nurses (CN) for the treatment of clearly defined cases with minor illnesses for the past two years. In the context of quality assurance, this study examines the quality of treatment and outcome in 60 patients with symptoms of an acute upper respiratory tract infection, half of whom were assigned to a physician and half to an APN/CN Methods Analysis of the treatment and the outcome of 60 patient files, half of which were randomly assigned to a physician and half to an APN/CN. Results APN/CN treated significantly more often according to standardized guidelines than physicians; the outcome in patients treated by APN/CN was slightly better, the difference is not significant, though. Discussion The use of APN and CN in outpatient primary care is possible without compromising the quality of treatment in cases with minor illnesses and clearly defined guidelines for treatment.

Cardiovascular risk stratification in primary care patients with arterial hypertension: Results from the Swiss Hypertension Cohort Study (HccH).

Few data are available on cardiovascular risk stratification in primary care patients treated for arterial hypertension. This study aimed at evaluating the cardiovascular risk profile of hypertensive patients included into the Swiss Hypertension Cohort Study according to the 2013 European Society of Hypertension/European Society of Cardiology Guidelines. The Swiss Hypertension Cohort Study is a prospective, observational study conducted by the Centre for Primary Health Care of the University of Basel from 2006 to 2013. Patients with a diagnosis of arterial hypertension (office blood pressure measurement ≥140/90 mmHg) were enrolled. Office blood pressure measurement, cardiovascular risk factors, subclinical organ damage, diabetes mellitus, and established cardiovascular and renal disease were recorded at baseline and at an annual interval during routine consultations by general practitioners in Switzerland. In total, 1003 patients were eligible for analysis (55.6% male, mean age: 64.0 ± 13.2 years). At baseline, 78.5% of patients presented with either more than three additional cardiovascular risk factors, diabetes mellitus or subclinical organ damage, while 44.4% of patients had a high or very high overall cardiovascular risk. Cardiovascular risk factors and information about diabetes mellitus, established cardiovascular disease and renal disease were recorded mostly completely, whereas substantial gaps were revealed regarding the assessment of subclinical organ damage. The present findings demonstrate that the majority of primary care patients with arterial hypertension bear a substantial number of additional cardiovascular risk factors, subclinical and/or established organ damage. This emphasizes the need for continuous cardiovascular risk stratification and adequate treatment of arterial hypertension in Switzerland.

Prevalence of Actinic Keratosis in Patients Attending General Practitioners in Switzerland

Background: Most of the data concerning the prevalence of actinic keratosis (AK) originate from the USA and Australia, and recently from Austria and Spain, but are based on populations in dermatology practices. Switzerland is the leading country with skin cancer incidence in Europe. AK prevalence among the Swiss population is therefore an important public health issue. Objective: To assess the prevalence of AK in the outpatient Swiss population in general practice. Methods: General practitioners captured AK diagnosis stage and localization in consecutive patients, who attended the physician for any reason. Results: A total of 2,844 consecutive patients (55.7% female) were enrolled in 59 general practitioners’ offices. AK prevalence was 25.3% and increased steadily with age; 33% of men and 19% of women were diagnosed with AK. Every second AK patient declared leisure-related UV exposure, while only 23% were exposed to UV occupationally; 16% of the patients were UV exposed both occupationally and during leisure. AK distribution among sun-exposed body sites and extent of disease varied by sex. Conclusion: In Switzerland AK is a common diagnosis in dermatology practices. Since up to 5% of AK may progress to invasive squamous cell carcinoma (SCC), prevention of AK, as well as education of patients and general practitioners, may play a critical role for subsequent SCC development. This is the first study on AK prevalence in Switzerland identifying patients most affected by AK. These results will help to define future approaches to target general practitioners for education, screening, and specific intervention in patients with AK.

Patient-provider concordance in the perception of illness and disease: a cross-sectional study among multimorbid patients and their general practitioners in Switzerland

BackgroundMultiple chronic health conditions are leading to multiple treatment procedures and polypharmacy. Prioritizing treatment according to patients’ needs and preferences may be helpful for deprescribing. Thus, for improving health care, it is crucial for general practitioners (GPs) to perceive the chief complaints (CCs) of patients. The primary aim of this study was to investigate the patient–provider concordance of CCs and the secondary aim was to investigate the concordance between CCs and diagnosis, in a sample of Swiss multimorbid patients.Materials and methodsA cross-sectional analysis based on a cluster randomized controlled trial (RCT) among 46 GPs, recruited between March 2015 to July 2016, and 334 multimorbid patients (≥60 years taking ≥5 drugs for at least 6 months) in Northern Switzerland was performed. CCs listed by GPs and by patients (n=128) were classified according to the International Classification of Primary Care, version 2 (ICPC-2) coding system on chapter and component level and defined as concordant if ICPC-2 codes of patients and GPs were identical. Concordance was classified into full, moderate or low, depending on the ranking of patients’ CCs on GPs’ list. As secondary outcome, we compared patients’ CCs to GPs’ diagnosis. Statistics included descriptive measures and a multivariate regression analysis of factors that are modifying concordance.ResultsThe mean age of patients was 76.9 (SD 8.1) years, where 38% were male, taking 7.9 (SD 2.6) drugs on the long term. The most frequent complaint was pain. Concordance of the CC was given in 101/128 (78.9%) on the ICPC-2 chapter level, whereby 86/128 (67.2%) showed full, 8/128 (6.3%) moderate and 7/128 (5.5%) low concordance; 27/128 (21.1%) were discordant. Concordance between CCs and diagnosis was 53.6%. Concordance increased with the intensity of the CC rated by patients (OR 1.48, CI 1.13–1.94, P<0.001). The younger age and higher intake of drugs were significantly associated with an increased concordance between CCs and diagnosis.ConclusionA majority of GPs perceive the CCs of the multimorbid patients correctly, but there is room for improvement.

Rates, Delays, and Completeness of General Practitioners' Responses to a Postal Versus Web-Based Survey: A Randomized Trial.

BackgroundWeb-based surveys have become a new and popular method for collecting data, but only a few studies have directly compared postal and Web-based surveys among physicians, and none to our knowledge among general practitioners (GPs).ObjectiveOur aim is to compare two modes of survey delivery (postal and Web-based) in terms of participation rates, response times, and completeness of questionnaires in a study assessing GPs’ preventive practices.MethodsThis randomized study was conducted in Western Switzerland (Geneva and Vaud) and in France (Alsace and Pays de la Loire) in 2015. A random selection of community-based GPs (1000 GPs in Switzerland and 2400 GPs in France) were randomly allocated to receive a questionnaire about preventive care activities either by post (n=700 in Switzerland, n=400 in France) or by email (n=300 in Switzerland, n=2000 in France). Reminder messages were sent once in the postal group and twice in the Web-based group. Any GPs practicing only complementary and alternative medicine were excluded from the study.ResultsAmong the 3400 contacted GPs, 764 (22.47%, 95% CI 21.07%-23.87%) returned the questionnaire. Compared to the postal group, the participation rate in the Web-based group was more than four times lower (246/2300, 10.70% vs 518/1100, 47.09%, P<.001), but median response time was much shorter (1 day vs 1-3 weeks, P<.001) and the number of GPs having fully completed the questionnaire was almost twice as high (157/246, 63.8% vs 179/518, 34.6%, P<.001).ConclusionsWeb-based surveys offer many advantages such as reduced response time, higher completeness of data, and large cost savings, but our findings suggest that postal surveys can be still considered for GP research. The use of mixed-mode approaches is probably a good strategy to increase GPs’ participation in surveys while reducing costs.

OP.6C.07] COMPLIANCE WITH ESH/ESC GUIDELINES FOR ARTERIAL HYPERTENSION IN SWISS PRIMARY CARE

Objective: Elevated blood pressure is a major cardiovascular risk factor, affecting approximately 35% of the population worldwide. Effective antihypertensive therapy is crucial for cardiovascular risk reduction. Nevertheless, blood pressure control appears to be low in Switzerland. The goal of this study was to investigate the compliance of Swiss general practitioners with European and national guidelines for the treatment of arterial hypertension with focus on pharmacological therapy. Design and method: Data from the Swiss Hypertension Cohort Study (HccH) was analyzed. From 2005 to 2013 1004 patients were recruited. A follow up of up to six years was performed by 91 general practitioners in Switzerland. Results: Data on adherence with antihypertensive drug therapy according to ESH/ESC guidelines are given in the following figure.Conclusions: Overall, compliance with European and national guidelines on treatment of arterial hypertension in Swiss primary care appears to be low. Because blockers of the renin angiotensin aldosterone system (RAAS) are widely used, recommendations to use these agents are well implemented while compliance is low in situations where guidelines recommend avoiding these drug classes. Thiazide diuretics (T) are the most frequently used drug class in our cohort. This may be due to the broad usage of fixed dose combinations (FDC) in Switzerland, which mostly contain T. Usage of FDC is recommended in guidelines to improve adherence which is well implemented in Swiss primary care. Combination therapy as well as lifestyle interventions are not as widely used as recommended in guidelines. Especially patients with uncontrolled blood pressure often do not have a fully escalated therapy. Therefore, our study suggests that implementation of guidelines in daily practice is low.

The influence of patients’ immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland

This study examines the influence of patients’ immigration background and residence permit status on physicians’ willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians’ time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care.

PP.30.13

Objective: Cardiovascular (CV) risk stratification in patients with arterial hypertension is essential for tailoring adequate antihypertensive treatment. Only few data is available on CV risk stratification in primary care patients with arterial hypertension. The aim of this subanalysis from the Swiss Hypertension Cohort Study (HccH) was to evaluate the compliance of general practitioners with the ESH/ESC guidelines on CV risk stratification in arterial hypertension as well as potential gaps in the risk stratification process. Design and method: HccH is an ongoing prospective observational study which has been initiated in 2005 by the Institute for Primary Care of the University of Basel, Switzerland. Data collection is conducted by general practitioners in Switzerland. Eligible patients are adult men and women (age > = 18 years) with arterial hypertension. Inclusion criteria are antihypertensive treatment respectively a mean through sitting office blood pressure (OBPM) > = 140/90mmHg. Patient characteristics, OBPM, ambulatory blood pressure (ABPM), CV risk factors, asymptomatic target organ damage (OD), diabetes mellitus (DM), chronic kidney disease (CKD) and symptomatic CV and renal disease are recorded on an annual basis and CV risk analyzed according to the 2013 ESH/ESC Guidelines. Results: Baseline data from 1005 patients included into HccH are given in the following table:BMI: Body Mass Index; CHD: Coronary Heart Disease; CHF: Congestive Heart Failure; CKD: Chronic Kidney Disease; GFR: Glomerular Filtration Rate; PAD: Peripheral Artery Disease; TIA: Transitory Ischemic Attack; Smoking Status: Y: active smoker, N: never smoked, Ex: former smoker. Data given as mean ± SD or absolute numbers (% of recorded data) where applicable. Conclusions: Decisions about treatment and optimal therapy in hypertensive patients should be based on an individual overall CV risk. Therefore a complete performance of risk stratification is very important. Our preliminary analysis from HccH demonstrates that CV risk factors from medical history and clinical data, with the exception of ABPM, appear to be comprehensively recorded in primary care. Substantial gaps were revealed with regards to the assessment of asymptomatic OD, particularly microalbuminuria and left ventricular hypertrophy, indicating that overall CV risk may be significantly underestimated in primary care patients with arterial hypertension.

How do GPs in Switzerland perceive their patients’ satisfaction and expectations? An observational study

ObjectivesTo assess doctors’ perceptions of their patients’ satisfaction and expectations in primary care.Study designCross-sectional study using questionnaires completed by general practitioners (GPs) and their patients.SettingPrimary care practices in Geneva, Switzerland.Participants23...

How do Swiss family physicians treat subclinical hypothyroidism?

Subclinical hypothyroidism is a common condition, and its prevalence increases with age. Currently, guidelines regarding the screening and treatment of subclinical hypothyroidism are controversial. An international survey of general practitioners (GPs), to which Swiss GPs also contributed, showed large inter-country variations in treatment strategies for subclinical hypothyroidism. These differences are mainly explained by the lack of strong evidence for the management of this condition. The European randomized-controlled clinical trial TRUST should help clarify recommendations for screening and thyroxin replacement for the elderly with subclinical hypothyroidism. Working in close collaboration with GPs in Switzerland for the recruitment of patients will ensure that the findings from this study will be applicable to primary care settings.

General practitioner's adherence to the COPD GOLD guidelines: baseline data of the Swiss COPD Cohort Study

PRINCIPLES: Chronic obstructive pulmonary disease (COPD) is a major burden on patients and healthcare systems. Diagnosis and the management of COPD are often administered by general practitioners (GPs). This analysis investigated the adherence of GPs in Switzerland to the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guidelines. METHODS: As part of an ongoing investigation into the effect of GPs prescriptions on the clinical course of COPD, 139 GPs submitted a standardised questionnaire for each COPD patient recruited. Information requested included spirometric parameters, management and demographic data. Participating GPs were provided with and received instruction on a spirometer with automatic feedback on quality. Patients were grouped by the investigators into the GOLD COPD severity classifications, based on spirometric data provided. Data from the questionnaires were compared between the groups and management was compared with the recommendations of GOLD. RESULTS: Of the 615 patients recruited, 44% did not fulfil GOLD criteria for COPD. Pulmonary rehabilitation was prescribed to 5% of all patients and less than one-third of patients exercised regularly. Less than half the patients in all groups used short-acting bronchodilators. Prescribing long-acting bronchodilators or inhaled corticosteroids conformed to GOLD guidelines in two-thirds of patients with GOLD stage III or IV disease, and approximately half of the less severe patients. Systemic steroids were inappropriately prescribed during stable disease in 6% of patients. CONCLUSIONS: Adherence to GOLD (COPD) guidelines is low among GPs in Switzerland and COPD is often misdiagnosed or treated inappropriately. This is probably due to poor knowledge of disease definitions.

ICE COLD ERIC – International collaborative effort on chronic obstructive lung disease: exacerbation risk index cohorts – Study protocol for an international COPD cohort study

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a systemic disease; morbidity and mortality due to COPD are on the increase, and it has great impact on patients' lives. Most COPD patients are managed by general practitioners (GP). Too often, GPs base their initial assessment of patient's disease severity mainly on lung function. However, lung function correlates poorly with COPD-specific health-related quality of life and exacerbation frequency. A validated COPD disease risk index that better represents the clinical manifestations of COPD and is feasible in primary care seems to be useful. The objective of this study is to develop and validate a practical COPD disease risk index that predicts the clinical course of COPD in primary care patients with GOLD stages 2–4.Methods/DesignWe will conduct 2 linked prospective cohort studies with COPD patients from GPs in Switzerland and the Netherlands. We will perform a baseline assessment including detailed patient history, questionnaires, lung function, history of exacerbations, measurement of exercise capacity and blood sampling. During the follow-up of at least 2 years, we will update the patients' profile by registering exacerbations, health-related quality of life and any changes in the use of medication. The primary outcome will be health-related quality of life. Secondary outcomes will be exacerbation frequency and mortality. Using multivariable regression analysis, we will identify the best combination of variables predicting these outcomes over one and two years and, depending on funding, even more years.DiscussionDespite the diversity of clinical manifestations and available treatments, assessment and management today do not reflect the multifaceted character of the disease. This is in contrast to preventive cardiology where, nowadays, the treatment in primary care is based on patient-specific and fairly refined cardiovascular risk profile corresponding to differences in prognosis. After completion of this study, we will have a practical COPD-disease risk index that predicts the clinical course of COPD in primary care patients with GOLD stages 2–4. In a second step we will incorporate evidence-based treatment effects into this model, such that the instrument may guide physicians in selecting treatment based on the individual patients' prognosis.Trial registrationClinicalTrials.gov Archive NCT00706602

Optimierung der glykämischen Kontrolle und Dosistitration mit Insulin Glargine (Lantus®) durch frei praktizierende Ärzte in der Schweiz: Resultate des OPTI-LAN Praxiserfahrungsberichtes

National and international societies have published guidelines regarding glycaemic control in type-2 diabetes mellitus. Clinical studies have shown that glycaemic control of type-2 diabetes mellitus can be improved using simple algorithms for titration of insulin Glargine (Lantus). It is unclear, to what degree published guidelines are adopted in daily practice in Switzerland. We performed a postmarketing study on the adoption of published guidelines regarding glycaemic control and the use of algorithms for titration of insulin Glargine doses by 77 general practitioners in Switzerland. Data collection was done prospectively over 6 months from September 2005 to September 2007. A total of 317 patients were included with a mean age of 63 +/- 11 years, 137 (43%) were female and 298 (94%) had type-2 diabetes. Average diabetes duration was 8 +/- 6 years. The initial average HbA1C and fasting plasma glucose were 8.9 +/- 1.6% and 10.1 +/- 3.2 mmol/l respectively. This, despite treatment with at least one oral hypoglycaemic agent (83% of patients) and/or insulin (47% of patients). As target the treating physicians chose an HbA1C < or = 7% for 284 patients (90%) and a fasting plasma glucose < or = 7 mmol/l for 245 patients (77%); thresholds that correspond to the guidelines of the Swiss Society of Endocrinology and Diabetes (SSED). The algorithm developed Riddle et al. was used by 33% of treating physicians; whereas 17% of physicians used a schedule proposed by the American Diabetes Association (ADA) and by the European Association for the Study of Diabetes (EASD) that is generally adapted by the patients themselves. During the 6-month treatment with insulin Glargine (Lantus) 196 patients (62%) achieved the SSED guidelines for glycaemic control. On average HbA1C was reduced by 2.1% (8.9 vs. 6.8%) and fasting plasma glucose by 3 mmol/l (10.1 vs. 7.1 mmol/l). On average insulin dose was increased by 14 IU (from 16 to 30 IU). Overall 91% of patients were satisfied with the way insulin doses were adapted. In 64% general wellbeing improved during the treatment period and in 27% it was unchanged. In daily practise in Switzerland the recommendations of the SSED are implemented to a high degree. Using insulin Glargine (Lantus) recommended goals of glycaemia can be rapidly and adequately achieved and patient satisfaction can be improved.

Dringliche Konsultationen und Notfälle im Notfalldienstkreis Möhlin-Wegenstettertal

The upcoming shortage of general practitioners in Switzerland will be a big challenge for medical out-of-hours services. Regionally ver different exists only few datas about organisational matters of and problems seen in "out-of-hours" care and "urgent consultations". Our Pilot present the prevalence of "out-of-hours care" in a general practitioner setting describes and classifies the problems seen using ICPC-2.

Consultations in primary care for symptoms attributed to electromagnetic fields – a survey among general practitioners

BackgroundFive percent of the Swiss population attribute symptoms to electromagnetic fields (EMF). General practitioners (GPs) might play a key role in recognising an emerging health risk, since they are the first to observe and follow up persons who attribute symptoms to EMF. It is unclear to what extent EMFs have become an issue in general practice and which experiences GPs report from the consultations.MethodsWe conducted telephone interviews in a random sample of GPs in Switzerland in order to assess the frequency of consultations in primary care due to EMF and the GPs' experience with these patients.Results342 general practitioners were interviewed, corresponding to a response rate of 28.2%. 69% of the GPs reported at least one consultation due to EMF, but GPs with a certificate in complementary medicine were much more likely to report EMF consultations. The median of EMF consultation numbers within one year was three. An overview of the most recent EMF-related consultation per GP yielded sleep disorders, headaches and fatigue as the most often reported symptoms and mobile phone base stations, power lines and the own use of mobile phones as the main EMF sources suspected to be associated to symptoms. GPs judged the association between EMF and the symptoms to be plausible in 54% of the cases. There was no combination of symptoms and EMF sources that was remarkably and consistently judged to be a plausible cause of the symptoms.ConclusionIn our survey, GPs often judged the association between the health problems and the suspected exposure to be plausible. This plausibility assessment seems to be based on grounds of preventive positions in a situation of scientific uncertainty. More research effort is needed to obtain more insight on a potential association between long term EMF exposure and unspecific symptoms.

36: Management of Patients with Elevated Prostate Specific Antigen Level among General Practitioners in Switzerland

36: Management of Patients with Elevated Prostate Specific Antigen Level among General Practitioners in Switzerland