Services In Switzerland Research Articles

Monitoring equity in the delivery of health services: a Delphi process to select healthcare equity indicators.

Health equity is a key component of quality of care and an objective for a growing number of quality improvement projects for deontological, ethical, public health and economic reasons. To monitor equity in the delivery of health services in Switzerland, there is a need to implement valid, measurable and actionable equity indicators, along with vulnerability stratifiers such as migrant status, which could lead to differences in quality of care. The aim of this study was to develop a set of healthcare equity indicators and stratifiers targeting inpatient and outpatient populations and to test their feasibility. A scoping literature review and inputs from a national interprofessional expert taskforce provided a set of indicators and vulnerability stratifiers. The most valid and measurable indicators and stratifiers were retained using a Delphi process. They were then operationalised, and their implementation tested in three Swiss hospitals from the three language regions. A taskforce of 18 experts, including a patient representative, selected 11 indicators that evaluate structures, processes and outcomes, and five vulnerability stratifiers. Although most indicators and stratifiers could be implemented in all three hospitals, data availability was limited for some variables, including patient satisfaction and access to interpreters for foreign-language patients. The equity indicators and stratifiers identified by this two-stage process have content validity, wide patient coverage and are focused on inequities in the healthcare system that are actionable through improvement projects. Both the indicators and the project methodology could be replicated in institutions aiming for more equitable care.

Ethical concerns in caring for persons with anorexia nervosa: content analysis of a series of documentations from ethics consultations

BackgroundCaring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce.MethodsWe identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns.FindingsThe ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case.ConclusionsEthical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption.

Noncompressible Chest Wall in Critically Buried Avalanche Victims with Cardiac Arrest: A Case Series.

David Eidenbenz, Alexandre Kottmann, Ken Zafren, Pierre-Nicolas Carron, Roland Albrecht, and Mathieu Pasquier. Noncompressible chest wall in critically buried avalanche victims with cardiac arrest: a case series. High Alt Med Biol. 00:00-00, 2024. Introduction: In avalanche victims with cardiac arrest, a noncompressible chest wall or frozen body is a contraindication to initiating cardiopulmonary resuscitation. The evidence sustaining this recommendation is low. Objective: To describe the characteristics and prehospital management of critically buried avalanche victims declared dead on site, with and without noncompressible chest walls. Methods: Retrospective study including all critically buried avalanche victims declared dead on site by physicians of a helicopter emergency medical service in Switzerland, from 2010 to 2019. The primary outcome was the proportion of victims with a noncompressible chest wall reported in medical records. Secondary outcomes included victims' characteristics and the relevance of the criterion, noncompressible chest wall, for management. Results: Among the 53 included victims, 12 (23%) had noncompressible chest walls. Victims with noncompressible chest walls had significantly longer burial durations (median 1,125 vs. 45 minutes; p < 0.001) and lower core temperatures (median 14 vs. 32°C; p = 0.01). The criterion, noncompressible chest wall, assessed in six victims, was decisive for declaring death on site in four victims. Conclusion: The presence of a noncompressible chest wall does not appear to be a sufficient criterion to allow to declare the death of critically buried avalanche victims. Further clinical information should be sought.

Overview and current challenges at the Calibration Laboratory of the Paul Scherrer Institute

The Calibration Laboratory of the Paul Scherrer Institute (PSI) is a secondary calibration laboratory accredited by the Swiss Accreditation Service (SAS) in accordance with ISO 17025. It also acts as a verification body authorized by the Swiss Federal Institute of Metrology (METAS). The Laboratory is equipped with X-ray, gamma and neutron irradiation facilities, providing characterized reference radiation fields for gamma 137Cs, 60Co, narrow spectrum X-rays from N-15 to N-300 and neutron radionuclide sources 252Cf, 252Cf (D2O-moderated) and 241Am-Be. The laboratory performs routine calibrations, organizes intercomparison measurements for individual monitoring services in Switzerland, and participates in various research projects, e.g., by performing irradiations in reference fields. For this reason, the proper characterization of reference radiation fields is of utmost importance for ensuring high quality irradiations and calibrations of personal dosemeters and radiation protection instruments. In this contribution, we provide an overview of the irradiation facilities at the Calibration Laboratory at PSI and discuss the challenges of characterizing reference radiation fields. In particular, we will discuss the factors affecting the determination of the distance between the source and irradiated dosemeters and detectors, as well as issues related to 252Cf decay and contribution of 250Cf. We will also demonstrate the use of Monte-Carlo simulations in determining the optimal position of the source and irradiation facility within the irradiation room.

Fluoroscopic-Guided vs. Multislice Computed Tomography (CT) Biopsy Mode-Guided Percutaneous Radiologic Gastrostomy (PRG)-Comparison of Interventional Parameters and Billing.

This study investigated and compared the efficacy, safety, radiation exposure, and financial compensation of two modalities for percutaneous radiologic gastrostomy (PRG): multislice computed tomography biopsy mode (MS-CT BM)-guided and fluoroscopy-guided (FPRG). The aim was to provide insights into optimizing radiologically assisted gastrostomy procedures. We conducted a retrospective analysis of PRG procedures performed at a single center from January 2018 to January 2024. The procedures were divided into two groups based on the imaging modality used. We compared patient demographics, intervention parameters, complication rates, and procedural times. Financial compensation was evaluated based on the tariff structure for outpatient medical services in Switzerland (TARMED). Statistical differences were determined using Fisher's exact test and the Mann-Whitney U test. The study cohort included 133 patients: 55 with MS-CT BM-PRG and 78 with FPRG. The cohort comprised 35 women and 98 men, with a mean age of 64.59 years (±11.91). Significant differences were observed between the modalities in effective dose (MS-CT BM-PRG: 10.95 mSv ± 11.43 vs. FPRG: 0.169 mSv ± 0.21, p < 0.001) and procedural times (MS-CT BM-PRG: 41.15 min ± 16.14 vs. FPRG: 28.71 min ± 16.03, p < 0.001). Major complications were significantly more frequent with FPRG (10% vs. 0% in MS-CT BM-PRG, p = 0.039, φ = 0.214). A higher single-digit number of MS-CT BM-guided PRG was required initially to reduce procedure duration by 10 min. Financial comparison revealed that only 4% of MS-CT BM-guided PRGs achieved reimbursement equivalent to the most frequent comparable examination, according to TARMED. Based on our experience from a retrospective, single-center study, the execution of a PRG using MS-CT BM, as opposed to FPRG, is currently justified in challenging cases despite a lower incidence of major complications. However, further well-designed prospective multicenter studies are needed to determine the efficacy, safety, and cost-effectiveness of these two modalities.

Overcoming Barriers: Strategies for Implementing Pharmacist-Led Pharmacogenetic Services in Swiss Clinical Practice.

There is growing evidence that pharmacogenetic analysis can improve drug therapy for individual patients. In Switzerland, pharmacists are legally authorized to initiate pharmacogenetic tests. However, pharmacogenetic tests are rarely conducted in Swiss pharmacies. Therefore, we aimed to identify implementation strategies that facilitate the integration of a pharmacist-led pharmacogenetic service into clinical practice. To achieve this, we conducted semi-structured interviews with pharmacists and physicians regarding the implementation process of a pharmacist-led pharmacogenetic service. We utilized the Consolidated Framework for Implementation Research (CFIR) to identify potential facilitators and barriers in the implementation process. Additionally, we employed Expert Recommendations for Implementing Change (ERIC) to identify strategies mentioned in the interviews and used the CFIR-ERIC matching tool to identify additional strategies. We obtained interview responses from nine pharmacists and nine physicians. From these responses, we identified 7 CFIR constructs as facilitators and 12 as barriers. Some of the most commonly mentioned barriers included unclear procedures, lack of cost coverage by health care insurance, insufficient pharmacogenetics knowledge, lack of interprofessional collaboration, communication with the patient, and inadequate e-health technologies. Additionally, we identified 23 implementation strategies mentioned by interviewees using ERIC and 45 potential strategies using the CFIR-ERIC matching tool. In summary, we found that significant barriers hinder the implementation process of this new service. We hope that by highlighting potential implementation strategies, we can advance the integration of a pharmacist-led pharmacogenetic service in Switzerland.

Cost and financing of paratransit services and their effect on dissatisfaction with participation in daily activities of persons with disabilities

IntroductionTransportation use affects participation in daily activities, health and well-being. Persons with disabilities rely on paratransit services if they are not able to use public transport. The per-trip costs of paratransit services in Switzerland are high, and the responsibility for financing these trips (e.g., social insurance, canton) varies depending on the purpose of travel. We hypothesized that cost and financing factors of paratransit services increase dissatisfaction with participation in daily activities of persons with disabilities in Switzerland. The study's objective is to investigate which cost and financing factors affect dissatisfaction with participation in daily activities. MethodsUsing a cross-sectional study design, we conducted a self-administered online questionnaire. We included paratransit service users or relatives of paratransit service users aged 18 years or older. We analyzed the data using the multiple correspondence-, lasso- and regression analysis. ResultsA statistically significant effect on lower levels of dissatisfaction with participation in daily activities had high costs of paratransit services (Odds ratio (OR) = 3.45, 95% Confidence interval (CI) [1.41, 8.36]), not using paratransit services to leisure activities (OR = 2.39, 95% CI [1.28, 4.58]) and work (OR = 4.11, 95% CI [1.22, 20.89]), and getting trips financed to leisure activities by social insurances and benefits (OR = 3.06, 95% CI [1.08, 8.42]). ConclusionConcerning the influence of transportation on health and wellbeing, policy-makers and transportation planners may reflect on the effect of cost and financing factors of paratransit services on dissatisfaction with participation in daily activities of persons with disabilities. This is particularly important when the dissatisfaction stems from reduced use of paratransit services for leisure activities, due to high costs.

Search Engine for Open Geospatial Consortium Web Services Improving Discoverability through Natural Language Processing-Based Processing and Ranking

The improvement of search engines for geospatial data on the World Wide Web has been a subject of research, particularly concerning the challenges in discovering and utilizing geospatial web services. Despite the establishment of standards by the Open Geospatial Consortium (OGC), the implementation of these services varies significantly among providers, leading to issues in dataset discoverability and usability. This paper presents a proof of concept for a search engine tailored to geospatial services in Switzerland. It addresses challenges such as scraping data from various OGC web service providers, enhancing metadata quality through Natural Language Processing, and optimizing search functionality and ranking methods. Semantic augmentation techniques are applied to enhance metadata completeness and quality, which are stored in a high-performance NoSQL database for efficient data retrieval. The results show improvements in dataset discoverability and search relevance, with NLP-extracted information contributing significantly to ranking accuracy. Overall, the GeoHarvester proof of concept demonstrates the feasibility of improving the discoverability and usability of geospatial web services through advanced search engine techniques.

Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem.

Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.

Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses

PurposeIn end-of-life cancer care, 10–20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. Methods81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. ResultsService specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. ConclusionsWhile several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.

236 Favourable neurological survival following out-of-hospital cardiac arrest in children treated by helicopter emergency medical service in Switzerland: a retrospective observational study

236 Favourable neurological survival following out-of-hospital cardiac arrest in children treated by helicopter emergency medical service in Switzerland: a retrospective observational study

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

ObjectiveRunning an emergency general surgery (EGS) service is challenging and requires significant personnel and institutional resources. The aim of this study was to achieve a nationwide overview of the individual EGS service organizations in public hospitals in Switzerland.MethodsAll Swiss public hospitals with a surgical and emergency department were included and contacted by telephone. General surgeons were interviewed between December 2021 and January 2022 using a standardized questionnaire.ResultsSeventy-two out of 79 public hospitals in Switzerland (91.1%) agreed to the survey. They employed 1,581 surgeons in 19 (26.4%) hospitals with < 100 beds, 39 (54.2%) hospitals with 100–300 beds, 7 (9.7%) with 300–600 beds, and 7 (9.7%) with > 600 beds. The median number of surgeons per hospital was 20.5 (IQR 13.0–29.0). Higher level of care (intermediate or intensive care unit) was significantly less available in small hospitals (< 100 beds). The median hour of designated emergency operating room capacity per day was 14 h (IQR 14–24) for all hospitals with < 600 beds and 24 h (IQR 14–24) for the largest hospitals (> 600 beds). With increasing hospital size, there was a significant increase in the number of surgical units where EGS and orthopedic trauma surgery were covered by two separate teams (21.1% vs. 43.6% vs. 85.7% vs. 100%, p = 0.035). The median number of surgeons on-call per hospital and per 24 h was 5.0 (IQR 3.3–6.0).ConclusionLack of higher level of care in small hospitals, limited emergency OR capacity and short rotations of on-call teams are major drawbacks of many current EGS systems in Switzerland. Centralization of critically ill EGS patients and reorganization of surgical on-call systems to designated acute care surgery teams should be considered.

Heterogeneity in the exchange rate pass-through to consumer prices: the Swiss franc appreciation of 2015

This paper analyzes the exchange rate pass-through to consumer prices for 85 categories of goods and services in Switzerland. The pass-through estimates are computed using a synthetic difference-in-differences approach that exploits the large Swiss franc appreciation that followed the unexpected removal of the Swiss franc-Euro floor in January 2015. The overall 1-year all-items pass-through is 0.12, which shows that the pass-through is highly incomplete. There is an important heterogeneity across product categories, where pass-through can be as high as 0.80. These variations are linked to the international trade characteristics of the products, as the prices of goods with a high degree of international tradability, with a high import share, or that depend on tourism are shown to be more sensitive to the exchange rate.

On the correlation between a sub-level qualifier refining the danger level with observations and models relating to the contributing factors of avalanche danger

Abstract. Forecasting avalanche danger at a regional scale is a largely data-driven yet also experience-based decision-making process by human experts. In the case of public avalanche forecasts, this assessment process terminates in an expert judgment concerning summarizing avalanche conditions by using one of five danger levels. This strong simplification of the continuous, multi-dimensional nature of avalanche hazard allows for efficient communication but inevitably leads to a loss of information when summarizing the severity of avalanche hazard. Intending to overcome the discrepancy between determining the final target output in higher resolution while maintaining the well-established standard of assessing and communicating avalanche hazard using the avalanche danger scale, avalanche forecasters at the national avalanche warning service in Switzerland used an approach that combines absolute and relative judgments. First, forecasters make an absolute judgment using the five-level danger scale. In a second step, a relative judgment is made by specifying a sub-level describing the avalanche conditions relative to the chosen danger level. This approach takes into account the human ability to reliably estimate only a certain number of classes. Here, we analyze these (yet unpublished) sub-levels, comparing them with data representing the three contributing factors of avalanche hazard: snowpack stability, the frequency distribution of snowpack stability, and avalanche size. We analyze both data used in operational avalanche forecasting and data independent of the forecast, going back 5 years. Using a sequential analysis, we first establish which data are suitable and in which part of the danger scale they belong by comparing their distributions at consecutive danger levels. In a second step, integrating these findings, we compare the frequency of locations with poor snowpack stability and the number and size of avalanches with the forecast sub-level. Overall, we find good agreement: a higher sub-level is generally related to more locations with poor snowpack stability and more avalanches of larger size. These results suggest that on average avalanche forecasters can make avalanche danger assessments with higher resolution than the five-level danger scale. Our findings are specific to the current forecast set-up in Switzerland. However, we believe that avalanche warning services making a hazard assessment using a similar temporal and spatial scale as currently used in Switzerland should also be able to refine their assessments if (1) relevant data are sufficiently available in time and space and (2) a similar approach combining absolute and relative judgment is used. The sub-levels show a rank-order correlation with data related to the three contributing factors of avalanche hazard. Hence, they increase the predictive value of the forecast, opening the discussion on how this information could be provided to forecast users.

Characteristics of emergency general surgery services in Switzerland: A nationwide survey

Abstract Objective Running emergency general surgery (EGS) services is challenging and requires significant personnel and institutional resources. In addition, increasing specialization of surgeons has made the provision of EGS services more problematic. The aim of this study was to elaborate a nationwide overview of the individual hospital organization systems of EGS services in Switzerland and to find related challenges and difficulties. Methods Telephone based standardized survey of all Swiss hospitals with a state medical treatment contract of the Swiss Federal Office of Public Health (FOPH) including a surgical and emergency unit (ER). The telephone interviews were conducted between December 2021 and January 2022. A corresponding junior, senior consultant or attending surgeon was interviewed per hospital by one of four interviewers. Descriptive and univariate analysis was performed using SPSS Version 28. Results A total of 72 of 79 (91.1%) surgical clinics participated in the telephone survey. There were 19 (26.4%) hospitals with &amp;lt;100 beds, 37 (54.2%) hospitals with 100–300 beds, 7 (9.7%) with 300–600 beds, and 7 (9–7%) with &amp;gt;600 beds. 57 (79.2%) hospitals have both, an ER and an intensive care unit (ICU). Eight (11.1%) hospitals have solely an intermediate care unit (IMC), 7 (9.7%) solely an ER. The average number of surgeons per hospital was proportional to the size of the hospital: 11.1±4.1 surgeons in hospitals &amp;lt;100 beds, 23.1±8.8 surgeons in hospitals with 100–300 beds, 29.1±10 surgeons in hospitals with 300–600 beds, and 37.7±9.4 surgeons in hospitals &amp;gt;600 beds. The percentage of surgical staff on EGS service per hospital was significantly higher in smaller hospitals (&amp;lt;100 beds), however, with a smaller number of surgeons on service per day. Regarding personal resources to run the EGS services, for hospitals with &amp;gt;300 beds similar person-days per month were found (159.7±24.7). Conclusion This study elaborates and characterises for the first time EGS services in Switzerland. Different EGS systems are in place and are related to the size of the hospitals. The individual EGS systems have been discussed regarding (1) surgical expertise, (2) continuity of treating surgical teams, (3) teaching and (4) optimization of personnel hospital resources. Moreover, based on these results, recommendations have been made to optimize EGS services.

Job Demands, Job Resources and Well-Being of Staff in Extended Education Services in Switzerland: A Longitudinal Study

Extended education services are expanding in Switzerland. Their quality depends on the working conditions and well-being of staff. This study examined the relationships between job demands, job resources and well-being using the job demands-resources ( JD-R) model. 655 staff members from 113 extended education services from three Swiss cantons participated in the three-wave study. Overall, staff reported low levels of job demands and high levels of resources except for autonomy. Results provided support for the motivational and health impairment processes proposed by the JD-R model, although not consistently for both measurement intervals. The findings highlight the importance of focussing on working conditions, especially when extended education services expand in the future.

Evidence-based indicators for the measurement of quality of primary care using health insurance claims data in Switzerland: update of the SQUIPRICA working group

BackgroundThe level of quality of care of ambulatory services in Switzerland is almost completely unknown. Since health insurance claims are the only nationwide applicable and available data source for this purpose, a set of 24 quality indicators (QI) for the measurement of quality of primary care has been previously developed and implemented. The present paper reports on an evidence-based update and extension of the initial QI set.MethodsEstablished pragmatic 6-step process based on informal consensus and potential QI extracted from international medical practice guidelines and pre-existing QI for primary care. Experts rated potential QI based on strength of evidence, relevance for Swiss public health, and controllability in the Swiss primary care context. Feasibility of a preliminary set of potential new QI was tested using claims data of persons with basic mandatory health insurance at one of the largest Swiss health insurers. This test built the basis for expert consensus on the final set of new QI. Additionally, two diabetes indicators included in the previous QI set were re-evaluated.ResultsOf 23 potential new indicators, 19 of them were selected for feasibility testing. The expert group consented a final set of 9 additional QI covering the domains general aspects/efficiency (2 QI), diagnostic measures (1 QI), geriatric care (2 QI), osteoarthritis (1 QI), and drug safety (3 QI). Two pre-existing diabetes indicators were updated.ConclusionsAdditional QI relating to overuse and intersectoral care aspects extend the options of measuring quality of primary care in Switzerland based on claims data and complement the initial QI set.

Assessment of minor health disorders with decision tree-based triage in community pharmacies.

Triaging in community pharmacies can lower the burden of minor health disorders on other primary health care settings. The netCare service, introduced in 2012 by the Swiss association of pharmacists, provides community pharmacists with 27 decision trees for the triage of minor health disorders. (1) to describe the utilization and symptom resolving rate of decision trees in community pharmacies; (2) to identify the need for additional decision trees. A descriptive, explorative analysis was conducted of netCare consultations between January 2019 and March 2020, as documented in phS-net, a service platform for public pharmacies. Client characteristics, weekdays, recommended course of action, availability of a general practitioner, and hypothetical course of action if netCare would not have been available were investigated. Follow-up information was assessed for resolution of symptoms and prevention of needing additional services. Data from consultations with empty assessment forms were used to identify minor health disorders in need of an additional decision tree. Information on 4256 performed netCare consultations were identified over a 14-month observation period, resulting in an average of 284 decision tree consultations per month in Switzerland. Customers were mainly female (n=3253, 76.4%) with a mean age of 40.7 years (±18.5 years). Cystitis (39.5%), conjunctivitis (19.5%), and pharyngitis (10.9%) were the primary reasons for consultation. Minor health disorders were managed by pharmacists themselves (88.2%) and achieved a resolution rate of 84.7%. Eyelid inflammations were identified as in need for an additional decision tree. Pharmacist-led structured triaging services in Switzerland led to an 84.7% resolution rate of minor health disorders, thereby identifying the potential for pharmacists to minimize the demand on other primary health care providers.

Frequency of Eye Diseases in Residents of Nursing Homes - 1-Year Results of a Novel Telemedicine Service in Switzerland.

For the elderly in nursery homes, a visit to the ophthalmologist is a burden, which might lead to undertreatment. We have recently started offering a novel ophthalmological service combining onsite examination and telemedical interpretation for patients with limited access to ophthalmological care. This study summarises the frequency of findings of treatable eye diseases after the first year of operation in participants who dropped out from regular ophthalmological control. Participants' clinical characteristics, frequency of service utilisation, and findings were extracted from the system and analysed. Of 1946 residents approached, 540 (27.7%; 1080 eyes) signed up for the service. A complete examination was possible in 412 persons (813 eyes) and partially possible in the remaining 128. The mean age of the examined participants mean age was 83.9 years (SD 9.7), and they were predominantly female (69.8%). The majority had a diagnosis of dementia (54.5%) and 20.2% had diabetes mellitus requiring treatment. The median care level (ranging from 0 - 12) was 7(interquartile range 6 - 9), corresponding to a care need of 121 - 140 min/d. The mean best-corrected decimal visual acuity was 0.55 (SD 0.24). For 164 eyes (15.2%), the current spectacle correction was insufficient. An untreated cataract was present in 145 eyes (13.4%), 89 eyes (8.2%) were receiving glaucoma treatment, and 7 eyes had a decompensated glaucoma. Dry age-related macular degeneration (AMD) appeared in 276 eyes (25.6%), 12 eyes (1.1%) had wet AMD, and 24 eyes (11.0%) among patients with diabetes showed signs of diabetic retinopathy. Other pathologies were uncommon. Residents of nursery homes, who are unable to attend regular ophthalmological control, show various treatable ophthalmological conditions, including cataracts, glaucoma, and retinal pathologies. Screening with a novel telemedicine service allows for the identification of treatable conditions and careful planning and referral of patients to appropriate clinics having the necessary infrastructure for this particular population.

Characteristics of low-acuity paediatric emergency department consultations in two tertiary hospitals in Switzerland: a retrospective observational study

BackgroundLow-acuity paediatric emergency department (PED) visits are common in high-income countries and are an increasing burden for the healthcare system and quality of care. Little is known about low-acuity PED...