Interprofessional Collaboration in Fall Prevention: Insights from a Qualitative Study.

(1) Background and objective: to explore the experiences of Swiss health care providers involved in a community fall prevention pilot project on barriers and facilitations in interprofessional cooperation between 2016 and 2017 in three regions of Switzerland. (2) Methods: semi-structured interviews with health care providers assessed their perspective on the evaluation of jointly developed tools for reporting fall risk, continuous training of the health care providers, sensitizing media campaigns, and others. (3) Results: One of the project's strengths is the interprofessional continuous trainings. These trainings allowed the health care providers to extend their network of health care providers, which contributed to an improvement of fall prevention. Challenges of the project were that the standardization of the interprofessional collaboration required additional efforts. These efforts are time consuming and, for some categories of health care providers, not remunerated by the Swiss health care system. (4) Conclusions: On a micro and meso level, the results of the present study indicate that the involved health care providers strongly support interprofessional collaboration in fall prevention. However, time and financial constraints challenge the implementation. On a macro level, potential ways to strengthen interprofessional collaboration are a core element in fall prevention.

Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland: A public health and healthcare providers' perspective.

BACKGROUND: Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers' perspective. METHODS: First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators' public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers' perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index. RESULTS: 18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers' perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically. CONCLUSIONS: The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.

Older persons' and their families' experience with live-in foreign home care workers. A grounded theory study / Erfahrungen von älteren Menschen und deren Familien mit einer Rund-um-die-Uhr Betreuung durch Care MigrantInnen. Eine Grounded Theory Studie

Background: Live-in arrangements with migrant care workers have considerably increased over the last years since they allow older frail persons to age-in-place despite functional limitations. However, little is known about the ramifications live-in care arrangements for families. Aim: The aim of the study was to investigate families' experience with live-in migrant care workers and indicators of quality from their perspective. Method: Constructivist grounded theory study with 22 families who were recruited via care agencies in the German-speaking part of Switzerland and participated in 29 individual or dyadic interviews. Results: Live-in care by migrant care workers has potentially positive ramifications for older persons and their families, but only so if families, first, reach a consensus about the need for the employment of migrant care workers; second, experience them as competent; and third, mutually forge relationships and negotiate daily life. A successful care arrangement occurs when there is a relational fit among those involved, which leaves families feeling cared for, safe and relieved. They experience a renewed stability in their family system, enriching relationships, and assuredness about the quality present in the care situation. Conclusions: A successful care arrangement is the result of relationships that have been actively created and a negotiated shared existence in a family-like network. It has a positive effect on the well-being of those receiving care and their family members. The family-like network needs competent support.

Information needs of early-stage prostate cancer patients: within- and between-group agreement of patients and health professionals.

PURPOSE: The aims of this study were to analyze agreement on information needs within a group of early-state prostate cancer patients and to compare information preferences of patients with the view of health-care professionals about patients' needs. METHODS: Sample consists of patients (n = 128) and six subgroups of health-care professionals (urologists, n = 32; nurses, n = 95; radiotherapy technologists (RTTs), n = 36; medical oncologists, n = 19; radiation oncologists, n = 12; general practitioners (GPs), n = 10). Information needs have been assessed with 92 questions concerning prostate cancer and its treatment. Respondents judged the importance of addressing each question. Within- and between-group agreements of patients and health-care professional groups were estimated with raw agreement indices as well as chance-corrected Kappa and Gwet's AC1 measures. Finally, group-specific core items rated with high importance as well as high agreement were defined. RESULTS: Patients rated on average (median) half, i.e., 51 out 92 items as essential (interquartile range (IQR) = 36-66), 26 items as desired (IQR = 14-38), and 10 items as avoidable (IQR = 2-22). Within-group agreement on the presented information topics is modest for any participating group (AC1(patients)= 0.319; AC1(professionals) = 0.295-0.398). Agreement between patients and professionals is low too (AC1 = 0.282-0.329). Defining group-specific core sets of information topics results in 51 items being part of at least one core set. Concordance of the item core sets of patients and professionals is moderate with κ = 0.38-0.66, sensitivity of professionals' core sets for patients' preferences varies between 56 and 74%. CONCLUSIONS: Results emphasize the need for dialogue between doctor/professional and patient in identifying the information needed by individual patients and support the importance of shared decision making.

Individual Characteristics Associated with Blood Donation: A Cross-National Comparison of the German and Swiss Population between 1994 and 2010.

OBJECTIVE: The aim of this study is to compare individual characteristics associated with blood donation in the German and Swiss population between 1994 and 2010. METHODS: Population-based survey data from the Eurobarometer 1994 and 2009, the Swiss Health Survey 1997, and the Swiss Blood Donation Survey 2010 were used to compare age-adjusted percentages of German and Swiss adults ever having donated blood (n = 8,746). A multivariate logistic regression was applied to the pooled data to estimate odds ratios (OR). RESULTS: Donor rates between 1994 and 2010 increased by 8.6% in Germany (p = 0.0045) and remained stable in Switzerland. The likelihood to report donating increased with age. Gender differences (OR = 2.85; p = 0.0000) and differences between education levels were more pronounced in Switzerland as compared to Germany (OR = 2.56; p = 0.0000 and OR = 2.73; p = 0.0010). Furthermore education differences were more marked in men in both countries (OR = 1.99; p = 0.0000 and OR = 1.68; p = 0.0140). CONCLUSION: The blood establishments should intensify their efforts to motivate women and lower educated people to give blood. Our data suggest that population-based surveys could be a helpful tool to describe donor rates in different countries and to guide future recruitment strategies.

Fruit and vegetable consumption among migrants in Switzerland.

OBJECTIVE: To assess the relative risk of low daily fruit and vegetable consumption for six large migrant groups in Switzerland. DESIGN: Cross-sectional health survey carried out 2007 (Swiss Health Survey) and 2010 (Swiss Migrant Health Survey) in Switzerland. Multinomial logistic regression models were used to estimate relative risk rates (RRR) of migrants relative to Swiss nationals. SETTING: Data obtained from representative samples of Swiss and foreign nationals living in Switzerland. SUBJECTS: A random sample (n =14637) of the Portuguese, German, Italian, Turkish, Serbian, Kosovan and Swiss permanent resident adult population (17-64 years old) was interviewed. RESULTS: The proportion of participants who adhered to the recommended fruit and vegetable consumption was below one-third in all study populations. Compared with Swiss nationals, the relative risk of low daily fruit and vegetable intake relative to recommended intake was higher in Turkish nationals (RRR = 2.92, 95 % CI 1.91, 4.48; P = 0.0000) and Kosovan nationals (RRR = 4.76, 95 % CI 3.01, 7.55; P = 0.0000). The respective relative risks of Portuguese, Serbian, German and Italian nationals were not significantly different from the Swiss reference group. CONCLUSIONS: Initiatives for the promotion of fruit and vegetable consumption should continue to address the population at large. At the same time, programmes that are tailored to the specific needs of migrants from Turkey and Kosovo should be considered.

Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland.

BACKGROUND: Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status. METHODS: Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed cross-sectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU. RESULTS: We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest. CONCLUSION: Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care.

Need for weight management in Switzerland: findings from National Blood Pressure Week 2009.

BACKGROUND: The Swiss Health Survey (SHS) provides the only source of data for monitoring overweight and obesity in the general population in Switzerland. However, this survey reports body mass index (BMI) based on self-reported height and weight, and is therefore subject to measurement errors. Moreover, it is not possible to differentiate between overall and abdominal overweight. In this study, we aimed to gain a better understanding of the need for weight management in the general population of Switzerland by exploring and comparing prevalence rates of BMI and waist circumference (WC) based on physical measurements by trained observers, based on data from the 2009 National Blood Pressure Week (NBPW). METHODS: Sample selection was based on a one-stage cluster design. A total of 385 pharmacies representing 3,600 subjects were randomly selected from pharmacies participating in NBPW. BMI measures based on physical weight and height (NBPW) were compared with self-reported BMI measures from the SHS. BMI and WC measurements from NBPW were then used to produce population estimates of overweight and obesity. RESULTS: BMI-based overall prevalence of overweight and obesity was 43.6%, which was 4.7% higher than the value based on the respective SHS data. Overweight and obesity were more common in men (54.3%) than in women (33.5%). However, the overall prevalence of increased WC in the general population was estimated to be 64.4%, with more women (68.4%) than men (60.1%) exhibiting a WC above the threshold. The prevalence of subjects requiring weight management in the Swiss population remained high, even after adjusting WC for false positive and negative cases. CONCLUSIONS: Firstly, it may be more appropriate for health promotion programs to address the wider group identified by WC, which includes subjects who need to reduce their weight, or gain no further weight. Secondly, the gender differences are reversed depending on the use of WC or BMI to identify subjects suitable for health promotion programs; more women than men are identified by WC, and more men than women using BMI. These differences should be accounted for in gender-specific health promotion programs.

Perceived stigmatization of mentally ill people and its consequences for the quality of life in a Swiss population.

The awareness of social conceptions of mental illness is essential in understanding the social realities of people with mental illness. Labeling due to psychiatric hospitalization can have a powerful influence on people's life chances. Little is known about subjective perceptions of stigmatization and discrimination and the influence of these beliefs on the quality of life of mentally ill people. We used a psychiatric inpatient sample and a community sample to analyze and compare perception of stigmatization and discrimination. Both patients and community members believed that most people rejected former mental patients. Thus, attitudes toward mental illness have their source in the socialization of the individual and his or her cultural context rather than in the currently pathological state of those affected. In a multiple regression analysis, we showed that even if controlled for demographic and clinical factors, perceived devaluation and discrimination had a significant negative effect on the quality of life of the mentally ill people. For planning and implementing psychiatric treatment programs, it is important to be aware of social conceptions of mental disorder.

[Employment situation of psychiatric in-patients with schizophrenic or affective disorders]. / Beschäftigungslage von Schizophrenie- und Affektkranken.

OBJECTIVE: This study is on employment on the competitive as well as the sheltered work market of psychiatric in-patients suffering from schizophrenia or affective disorders. Furthermore it investigates the importance of characteristics of disorder and of educational and vocational background as predictors of occupation. METHODS: A sample of 251 in-patients participated in a structured interview during their hospitalization. RESULTS: 43 % of in-patients suffering from schizophrenia and 46 % suffering from affective disorders were employed on the competitive work market during the year before index-hospitalization. Many were without any occupation too because sheltered employment was rarely used and mostly by schizophrenics (17 % vs 4 % of persons with affective disorders). Predictors of employment are past vocational experiences, education, length of past hospitalization, psychiatric diagnosis and sex. CONCLUSIONS: Results raise the question of deficits in providing with sheltered employment opportunities for the mentally ill and in particular for people suffering from affective disorders. Alternatives to these deficits are discussed.