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To describe the prevalence and determinants of potentially inappropriate medication (PIM) use and association with hospitalizations in an elderly managed care population in Switzerland. Using health care claims data of four health insurers for a sample of managed care patients 65 years of age and older to compare persons on PIM with persons not on PIM. Beers' 2012 and PRISCUS criteria were used to determine the potential inappropriateness of prescribed medications. The sample included 16'490 elderly patients on PIM and 33'178 patients not on PIM in the time period of January 1, 2008 through December 31, 2012. Prevalence estimates are standardized to the population of Switzerland. Associations between PIM and hospitalizations were examined by multivariate Cox regression analyses controlling for possible confounding variables. The estimated prevalence of PIM use in our managed care sample was 22.5%. Logistic regression analysis showed that number of different medications used in the previous year, total costs in the previous year and hospitalization in the previous year all significantly increased the likelihood of receiving PIM. Multiple Cox regression analysis revealed that those on cumulative levels of PIM use acted significantly as a factor related to greater hospitalization rates: the adjusted HR was 1.13 (95% CI 1.07-1.19) for 1 PIM, 1.27 (95% CI 1.19-1.35) for 2 PIM, 1.35 (95% CI 1.22-1.50) for 3 PIM, and 1.63 (95% CI 1.40-1.90) for more than 3 PIM compared to no PIM use. The prevalence of PIM in managed care health plans are widely found but seem to be much lower than rates of non-managed care plans. Furthermore, our study revealed a significant association with adverse outcomes in terms of hospitalizations. These findings stress the need for further development of interventions to decrease drug-related problems and manage patients with multiple chronic conditions.

Interactive audit and feedback dashboards, which summarize performance using quality indicators, are increasingly used to enhance care processes and outcomes, but their effectiveness in primary care remains underexplored. This systematic review aimed to evaluate the impact of these dashboards in primary care settings by analyzing studies that compared their use to usual care or similar interventions without dashboards. A comprehensive search across MEDLINE (via Ovid), Embase, Cochrane Library, Scopus, and Web of Science through November 2024 was conducted. Risk of bias was assessed using Cochrane tools, and evidence quality was evaluated with GRADE. Relevant data, including features of the interactive dashboards, were extracted, and findings were synthesized narratively and visualized with forest plots. Six studies met the inclusion criteria, comprising five randomized controlled trials and one non-randomized trial, all with low or moderate risk of bias. Four studies incorporating dashboards into multifaceted interventions showed improvements in at least one primary outcome, while two studies using standalone dashboards reported mixed results. Significant heterogeneity in dashboard design, study settings, targeted health conditions, and quality indicators limits the generalizability of these findings. Nonetheless, the results highlight the potential of interactive dashboards to improve quality indicators performance in primary care, particularly as part of broader intervention strategies. Standardized evaluation frameworks and rigorous, consistent reporting are needed in future research to better isolate the effects of interactive dashboards and enhance the robustness and applicability of the evidence in varied primary care contexts.

Increasing oncological treatment costs are a major global concern with the risk of entailing two-tiered health care. Among cost determining factors is the price of individual drugs. In recognition of the central role of this factor, we present a comprehensive overview of the development of monthly prices of oncological drugs introduced over the last 15 years in Switzerland. We identified all oncological drugs newly reimbursed by mandatory health insurance in 2005–2019, and searched public repositories for their package prices, indications with approval dates, and treatment regimens for the calculation of (indication-specific) monthly prices. We found 81 products covering 77 different substances (39.5% protein kinase inhibitors, 21.0% monoclonal antibodies). Most indications related to the topography “blood”, followed by “lung and thorax” and “digestive tract”. From 2005–2009 to 2015–2019, the median monthly product price over all distinct indications of all products decreased by 7.56% (CHF 5,699 [interquartile range 4,483–7,321] to CHF 5,268 [4,19–6,967]), whereas it increased by 73.7% for monoclonal antibodies. In December 2019, six products had monthly prices over CHF 10,000, all approved for hematological or dermatological cancers. Our analysis suggests that individual price developments of oncological drugs are presently not the major driver of rising cancer treatment costs. However, rising launch prices of some new, mostly hematological drugs are of concern and require continued monitoring.

In autosomal dominant polycystic kidney disease (ADPKD), aberrant activation of the mammalian target of rapamycin (mTOR) pathway is associated with progressive kidney enlargement. Sirolimus (rapamycin) suppresses mTOR signaling and was studied in this 18-month open-label, randomized, controlled trial involving adults with ADPKD and early chronic kidney disease. Sirolimus at a daily target dose of 2 mg did not halt polycystic kidney growth. Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent hereditary kidney disease and the cause of end-stage renal disease in 7 to 10% of all patients undergoing dialysis. 1 – 3 The disease is characterized by the growth of numerous kidney cysts, which leads to progressive destruction of the adjacent renal parenchyma and massive enlargement of the kidneys. 4 Renal function is often preserved until the age of 40 years because functioning nephrons undergo compensatory hypertrophy. 5 Subsequently, the glomerular filtration rate (GFR) decreases, and end-stage renal disease ensues in many patients by the fifth decade. As yet, no treatment is available to . . .

Background The use of anabolic androgenic steroids (AAS) among male recreational gym users has become a global substance use concern. A substantial black market for these substances exists with possibly extensive counterfeiting. Drug checking services (DCS) are established harm reduction services for people who consume illicit substances. To evaluate the feasibility of implementing a novel specialized DCS for AAS, a pilot study was conducted within a pre-existing DCS in Zurich (Switzerland). Methods The reporting of this pilot study follows an adapted CONSORT statement. Further aims were to characterize AAS use as well as the chemical properties of customer-provided substance samples analysed through the DCS in a Swiss context. Customers could access DCS in Zurich from August 2023 onwards by providing a voluntary user questionnaire and dispense samples of AAS. Primary feasibility outcomes for this study were customer satisfaction metrics with the DCS received (i.e., customer satisfaction score (CSAT); net promoter score (NPS)). The chemical analytical method utilized was gas chromatography–mass spectrometry (GC–MS). Descriptive statistics were used. Results Overall, 52 clients accessed DCS over the pilot period and 71 samples were chemically assessed. Excellent results regarding customer satisfaction metrics towards DCS for AAS were achieved (NPS: 97 (integer); CSAT: 93%). The typical clients were males partaking in recreational sports, between 22 and 40 years old, working, and with a higher education. The main motivation for using AAS was for aesthetic purposes. Patterns of AAS use were complex with frequent extensive concomitant substances use. Most AAS in this sample were acquired from non-medical sources. The sample analysis revealed that over half (52%) of the user-provided samples of AAS were fake. Conclusions We demonstrate that the implementation of DCS for AAS was feasible with high acceptance among clients. Those clients may engage in many high-risk behaviors and the use of substances with low chemical properties may expose them to additional unexpected health risks. As a harm reduction tool, DCS for these clients and substances appears to be feasible and it may further serve as monitoring tool for public health purposes. Upon the initial study results, DCS for AAS were continued with close monitoring.

Chronic kidney disease (CKD) is a common condition in general practice. Data about quality and physician-level variation of CKD care provided by general practitioners is scarce. In this study, we evaluated determinants and variation of achievement of 14 quality indicators for CKD care using electronic medical records data from Swiss general practice during 2013-2019. We defined two patient cohorts from 483 general practitioners, one to address renal function assessment in patients with predisposing conditions (n = 47,201, median age 68 years, 48.7% female) and one to address care of patients with laboratory-confirmed CKD (n = 14,654, median age 80 years, 57.5% female). We investigated quality indicator achievement with mixed-effect logistic regression and expressed physician-level variation as intraclass correlation coefficients (ICCs) and range odds ratios (rORs). We observed the highest quality indicator achievement rate for withholding non-steroidal anti-inflammatory drug prescription in patients with CKD staged G2-3b within 12 months of follow-up (82.6%), the lowest for albuminuria assessment within 18 months of follow-up (18.1%). Highest physician-level variation was found for renal function assessment during 18 months of follow-up in patients with predisposing conditions (diabetes: ICC 0.31, rOR 26.5; cardiovascular disease: ICC 0.28, rOR 17.4; hypertension: ICC 0.24, rOR 17.2). This study suggests potentially unwarranted variation in general practice concerning RF assessment in patients affected by conditions predisposing for CKD. We further identified potential gaps in quality of CKD monitoring as well as lower quality of CKD care for female patients and patients not affected by comorbidities.

Pain therapies are prescribed to a significant proportion of the population but also associated with adverse drug reactions (ADRs). The prescription of pain therapies requires careful consideration of their safety profiles in the context of patient-specific characteristics, such as age-specific vulnerabilities, which are, however, still understudied so far. The aim of this study was to describe ADRs reported for drugs used in pain therapies and investigate age disparities. We conducted a descriptive comparative analysis of individual case safety reports (ICSRs) of drugs used in pain therapies from the global ADR database VigiBase between September 29, 1991, and December 31, 2022, from Switzerland. Comparisons were drawn between younger and older adults (18–74 years vs. 75 + years). Disproportionality (reporting odds ratio, ROR) of serious ADRs was assessed between age groups. A total of 17,228 ICSRs were analysed (58% female, 24% age 75 +). Across both age groups, the most frequently reported ADRs were related to the nervous system (23%), gastrointestinal system (20%), and general health and administration site conditions (20%). Serious ADRs were more common in the older population compared to younger adults (69% vs. 54%) with an ROR of 1.9. Fatal ADRs were also disproportionally higher in older adults (ROR 1.9). Hemorrhage was the most frequent fatal reaction. Commonly used pain therapies can lead to ADRs with a pronounced impact, especially in older adults. A deeper understanding of the safety profiles of these drugs should aid healthcare professionals in making more informed, safer treatment decisions.

During the first year of the COVID-19 pandemic, healthcare facilities worldwide struggled to adequately care for the increasing number of COVID-19 patients while maintaining quality of care for all other patients. The aim of this study was to investigate the displacement and underuse of non-COVID-19 patient care in a medical department of a tertiary hospital in Switzerland. In this retrospective cross-sectional study, internal medicine admissions from 2017 to 2020, emergency outpatient visits from 2019 to 2020 and COVID-19 admissions in 2020 were analyzed and compared using a regression model. Internal medicine admissions were also stratified by diagnosis. A questionnaire was used to assess the pandemic experience of local general practitioners, referring hospitals, and nursing homes. The total number of admissions decreased during the 1st and 2nd waves of the pandemic but increased between the two waves. Elective admissions decreased in 2020 compared to pre-pandemic years: they represented 25% of total admissions in 2020 versus 30% of the total admissions during 2017–2019, p <0.001. Admissions for emergency reasons increased: 71% in 2020 versus 65% in 2017–2019, p < 0.001. Emergency outpatient consultations decreased in 2020 compared to 2019, 62.77 (14.70), mean (SD), weekly visits in 2020 versus 74.13 (13.98) in 2019, p<0.001. Most general practitioners and heads of referring hospitals also reported a decrease in consultations, especially during the 1st wave of the pandemic. Mental illnesses, anxiety or burn-out were perceived in both patients and staff in general practices and nursing homes. In conclusion, the COVID-19 pandemic negatively affected the care of non-COVID-19 patients, particularly those with chronic illnesses. A shift of health care resources from non-COVID patients to COVID patients was observed. These findings could help institutions better manage such a situation in the future.

Chronic conditions are a significant public health concern due to their rising prevalence, association with high mortality, and substantial healthcare costs. General practitioners play a crucial role in managing these conditions, and quality indicators are essential tools for assessing the quality of care. Electronic feedback reports incorporating quality indicator performance have shown promise in improving care quality. However, most studies have focused on single conditions or link feedback to financial incentives, which may not sustain long-term practice changes. This study aims to evaluate the effectiveness of a multi-condition electronic feedback reports on quality indicator performance in Swiss general practice without financial incentives. This randomized controlled trial involves general practitioners enrolled in the FIRE project, a database of electronic medical records from Swiss primary care. Participants are randomized to receive either a plain feedback report or a comprehensive quality indicator -specific feedback report bi-monthly for 12 months. The plain feedback report contains descriptive summaries of practice activities, while the quality indicator-specific feedback report includes performance data on 14 quality indicators across cardiovascular, endocrine, pulmonary, and renal domains. The quality indicators were selected in multi-step process involving review of the literature and clinical guidelines, domain expert consultations, and a panel discussion with general practitioners. The primary study objective is to compare the effectiveness of the quality indicator-specific feedback report and of the plain feedback report with respect to the performance of the selected quality indicators. The study addresses a critical gap by evaluating a multi-condition feedback report without financial incentives. Its findings can inform future health policies and strategies, in line with national and international initiatives that promote or even require the implementation of quality measurement activities in general practice. Trial registry: ISRCTN. Registration number: ISRCTN10637092, https://www.isrctn.com/ISRCTN10637092. Registered January 9, 2024.

Background Interventions to reduce low-value care vary considerably in effectiveness. International consensus considers vitamin D blood testing in a general population as a low-value care intervention, which lead to its inclusion in the Swiss Choosing Wisely TM recommendation in April 2021. In mid-2022, the Swiss Public Health authorities further restricted basic health insurance coverage for the test. Methods We conducted a retrospective analysis of health insurance claims data covering about 880’000 Swiss residents in the compulsory health insurance market. To assess the effects of a) the Choosing Wisely recommendation and b) the federal coverage restriction, we applied interrupted time series models at the physician level, controlling for seasonal effects, physician fixed effects, and patient characteristics. Results The Choosing Wisely recommendation reduced the average monthly number of tests prescribed per physician per 100 consultations by approximately 5.98% in the 12 months following the intervention. The national coverage restriction led to a significant 57.82% drop in vitamin D testing per physician per 100 consultations in the 6 months following the intervention. Conclusions Medical recommendations marginally reduced low-value services, and their impact on clinical practice was limited. In contrast, federal coverage restrictions drastically reduced unnecessary testing. Multicomponent strategies combining evidence-based guidance for healthcare professionals, patient involvement, and national regulation related to reimbursement could be a best practice model for guiding public health stakeholders and politicians in order to reduce low-value care.