Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology.

AIMS OF THE STUDY: Little is known about the quality of diabetes management of patients with type 2 diabetes mellitus (T2DM) in Swiss primary care. Based on the recommendations of the National Council Quality Assurance Programme, an interprofessional working group of the Swiss Society of Endocrinology and Diabetology (SSED) established population-based national criteria for good disease management of T2DM in primary health care (the diabetes score). The objective of this study was to assess whether the implementation of these criteria improve diabetes management in primary care. METHODS: The diabetes score comprises eight criteria including three biometric measurements, two lifestyle-specific items and screening of three diabetes-associated complications. Practices can evaluate adherence to the criteria based on a point system, with the recommended aim to achieve ≥70/100 points. Group practices and single practices were included in this study and started implementing the SSED criteria in January 2018. The resulting score was compared with data retrospectively obtained for 2017. The primary endpoint was the overall change in Diabetes Score between 2017 and 2018 at each practice, further stratified by practice type. The absolute effect on individual diabetes score criteria was assessed by pooling all patient-level data. RESULTS: Nine practices (six single and three group) participated in the study. In 2017 and 2018, the primary care practices treated 727 and 704 patients with T2DM, respectively, of whom 676 were treated both years. Around half of the patients were cared for in group practices and half in single practices. Between 2017 and 2018 the median (interquartile range) diabetes score improved from 40 (35, 65) to 55 (45, 70; p = 0.078). One practice (single) obtained a score ≥70 in 2017, three practices (all single) achieved this target in 2018. Pooling patient-level data, we observed a significant absolute improvement in the following criteria: number of regular diabetes check ups, body mass index, glycated haemoglobin, blood pressure, low density lipoprotein cholesterol and screenings for diabetes-associated complications (all p <0.05). However, the extent of the improvements were often insufficient to reach the prefixed targets of the diabetes score criteria on the practice level. CONCLUSION: Overall, the implementation of the SSED criteria in the current setting led to a modest, nonsignificant improvement of the diabetes score. Only three (all single practices) out of the nine practices reached the recommended 70-point target, indicating that further strategies are needed to improve diabetes care in primary care practice. Trial registration: ClinicalTrials.gov (ID NCT04216875).

Experiences, Personal Attitudes, and Professional Stances of Swiss Health Care Professionals Toward Voluntary Stopping of Eating and Drinking to Hasten Death: A Cross-Sectional Study.

CONTEXT: Voluntary stopping of eating and drinking (VSED) is the self-determined decision of an individual with the decision-making capacity to cause premature death. During the course of VSED, the person is dependent on the support of relatives and health professionals. To date, little is known of the attitudes of Swiss health professionals on this topic. OBJECTIVES: The objective of this study was to assess the experiences, personal attitudes, and professional stances of Swiss health care professionals toward VSED. METHODS: We conducted a nationwide cross-sectional survey by questioning family physicians and the heads of outpatient care and long-term care (e.g., nursing directors, institute directors, or head nurses) about VSED (n = 1681; response rate 40.1%). Descriptive data analysis and hypothesis testing (occupational group, age, sex, professional years, VSED experience, and regions) were subsequently conducted. RESULTS: Individuals who are willing to die are granted the right to professional accompaniment during VSED (agreement 97.8%), and their death is usually classified as a natural form of dying (63.5%) and only rarely (5.4%) as suicide. Family physicians have significantly more moral concerns during accompaniment compared with the heads of outpatient and long-term care (P < 0.001). CONCLUSION: Swiss health care professionals support the autonomy and self-determination of patients, which is also reflected in their positive attitude toward VSED, even if they have moral reservations when accompanying patients.

Family physicians' perspective on voluntary stopping of eating and drinking: a cross-sectional study.

OBJECTIVE: We aimed to determine how often patients who choose voluntary stopping of eating and drinking (VSED) are accompanied by Swiss family physicians, how physicians classify this process, and physicians' attitudes and professional stance toward VSED. METHODS: We conducted a cross-sectional study between August 2017 and July 2018 among 751 practicing family physicians in Switzerland (response rate 74%; 70.7% men; average age 58 (±9) years). We used a standardized evidence-based questionnaire for the survey. RESULTS: VSED is well-known among family physicians (81.9%), and more than one-third (42.8%) had accompanied at least one patient during VSED. In 2017, 1.1% of all deaths that occurred in Swiss nursing homes or in a private home were owing to VSED. This phenomenon was classified as a natural dying process (59.3%), passive euthanasia (32.0%), or suicide (5.3%). CONCLUSIONS: Although about one in three Swiss family physicians have accompanied a person during VSED, family physicians lack sufficient in-depth knowledge to address patients and their relatives in an appropriate manner during the process. Further training and development of practice recommendations are needed to achieve more standardized accompaniment of VSED.International Registered Report Identifier: DERR1-10.2196/10358.

Optional part-time and longer GP training modules in GP practices associated with more trainees becoming GPs - a cohort study in Switzerland.

BACKGROUND: Switzerland, like many other countries, has a shortage of General Practitioners (GPs). Optional GP training modules in GP practices were offered during the at least 5-year GP training program to increase student and trainee interest in becoming a GP. The training modules had not yet been evaluated. We determined how many Swiss GP trainees became practicing GPs after they completed optional training modules, and if longer modules were associated with higher rates of GP specialization. METHODS: In this population-based cohort study, we included GP trainees who chose an optional GP training module in GP practice, provided by the Foundation to Promote Training in General Practice (WHM) between 2006 and 2015. GP trainees were invited to complete an online survey to assess the primary outcome (becoming a practicing GP by 2016). Data on non-responders was collected via an internet search. We calculated univariate time-to-event curves to become a practicing GP, stratified by trainee's gender, length, part-time training, and number of years after graduation until training modules were completed. We used a multivariate model to adjust for characteristics of participants, training, and satisfaction with training modules. RESULTS: We assessed primary outcome for 351 (92.1%) of 381 former GP trainees who participated in a WHM program between 2006 and 2015. Of these 218 (57%) were practicing GPs by 2016. When focusing on the trainees who had completed training between 2006 and 2010, the rate of practicing GPs was even 73%. Longer (p = 0.018) and part-time training modules (p = 0.003) were associated with higher rates of being a practicing GP. Most (81%) practicing GPs thought their optional GP training module was (very) important in their choice of specialty. CONCLUSION: GP trainees who spent more time training in a GP practice, or who trained part-time were more likely to become practicing GPs. Most (80%) rated their training module as (very) important in their choice of career, highlighting that these modules effectively encourage the interests of those already inclined towards the GP specialty. Longer GP training modules and more opportunities for part-time training may attract and retain more interested trainees, and possibly increase the number of practicing GPs.