Associations between primary care practice type and patient-reported access.

BACKGROUND: We recently defined a global typology of primary care (PC) in Switzerland using a mixed inductive/deductive approach to construct latent, composite variables that summarize variance between practices. Now we explore associations between the primary variable that describes the comprehensiveness of services and patient-perceived access to PC in Switzerland. METHODS: Cross-sectional surveys were administered to physicians from the Swiss PC Active Monitoring (SPAM) network and their patients. The primary outcomes were patient responses to: "Was it easy to get the appointment?", "The opening hours are too restricted" and "In the past 12 months, did you postpone or abstain from a visit to this doctor or another GP when you needed one?" Multivariate, multilevel analyses with stepwise regression were used to assess associations between practice type (practices with a broader range of services have higher scores) and perceived access, controlling for patient characteristics. RESULTS: One hundred and ninety nine of 200 PC physicians in the network completed the questionnaire. Of 2628 patients approached after a physician visit, 1791 accepted (participation = 76%), with 9 patients at each practice. No association was observed between comprehensiveness of services and difficulty getting an appointment. When controlling for patient factors, there was a weak association between higher scores for comprehensiveness of services and patients reporting that the opening hours are too restricted (p = 0.05), though this was no longer significant after controlling for language area. Greater comprehensiveness of services was associated with fewer patients needing to postpone visits (OR 0.93, 95%CI 0.88-0.99, p = 0.03). CONCLUSIONS: Though fewer patients report needing to postpone visits at practices with more comprehensive offering of services, there is limited evidence of associations between patient-reported access and a global typology of Swiss primary care.

[Ten years of literature review in general internal medicine--a first assessment]. / Dix ans de revue de la littérature en médecine interne générale--un premier bilan.

A group of family physicians in an outpatient clinic in Switzerland prospectively followed scientific literature for ten years. What to remember among the numerous articles retrieved and which paper really changed our practice? If many readings are quickly forgotten, some of them marked our minds and changed our habits. This article is a summary of our efforts to keep the essential tools in clinical practice.

[Acute schistosomiasis: lessons learned from a cohort of 42 exposed travelers]. / Schistosomiase aiguë au retour de voyage. Enseignements tirés d'une cohorte de 42 voyageurs exposés.

Acute schistosomiasis is a regularly encountered disease in travelers. Because of the temporal delay, its unspecific presentation and the spontaneous resolution, acute schistosomiasis can easily remain unrecognized by physicians who are not familiar with tropical pathologies. In December 2011, a female traveler was admitted to the hospital with undetermined fever after having returned from Madagascar where she bathed in fresh water. Acute schistosomiasis was diagnosed and infection was suspected among other travelers of her group. Seroconversion was confirmed among 78% of participants. This article intends to clarify the preventive and diagnostic strategies based on the lessons learned from this cluster of 42 travelers exposed to schistosomiasis.

[Vulnerable older patients in primary care how to identify them? Which ressources to mobilize? ]. / Patients âgées vulnérables au cabinet: comment les identifier et quelles ressources mobiliser?

Trust is essential to foster and preserve a long-term relationship between primary care physicians and their patients suffering from chronic diseases. However, this relation remains insufficient to successfully manage more complex situations, such as those of older patients with multiple diseases and disability. For the primary care physician, a significant limitation is the time required to plan and coordinate interventions supplied by different health and social care providers. This article describes a structured approach to support primary care physicians in this difficult task and help them to identify vulnerable older patients requiring to mobilize and coordinate health and social care resources. Current and future resources available to family physicians to complete this challenging task are further described.

[Efficacy is good, impact is great]. / L'efficacité c'est bien, l'impact c'est top!

This article summarizes the different stages of research for the development of medical interventions and their specific characteristics in terms of design, population, resources, importance of results and scientific interest. The emphasis is focused on the two final stages of development, the effectiveness and the impact. An example from our own experience is given to illustrate the reduction of the effect of an intervention against malaria in young children at different stages of the development of the intervention, and the parallel decrease of the recognition by the scientific community of the importance of these results.

Infection prevention and control measures in practices of the Swiss sentinel network during seasonal influenza epidemics.

BACKGROUND: There are limited data on the transmission of influenza in the context of primary care practices, despite the fact that a significant proportion of the population consult their primary care physician for an influenza-like illness every year. AIM: To describe the use of influenza prevention and control methods in private practices of the Swiss sentinel network. METHODS: This online cross-sectional survey collected data about infection prevention and control measures in the 166 private practices of the Swiss sentinel surveillance network during the 2018-2019 influenza season. Questions pertained to the practice setting, infection prevention and control recommendations, influenza vaccination status of the physicians and their staff, adhesion to hand hygiene, and mask wearing. FINDINGS: Among the 122 practices that answered (response rate 73.5%), 90.2% of the responding physicians had been vaccinated themselves, and 46.7% (56/120) estimated that their staff vaccination coverage was >60%, although it was offered to employees in all practices. Most practices (N=68, 55.7%) had no specific recommendations for their staff concerning mask wearing. Most physicians reported washing or disinfecting their hands before examining a patient (N=91, 74.6%), after examination (N=110, 90.2%) and before a medical procedure (N=112, 91.8%). However, this rate was lower for arrival at the practice (N=78, 63.9%) and leaving the practice (N=83, 68.0%). CONCLUSION: Most physicians in the Swiss sentinel surveillance network have been vaccinated themselves. However, the vaccination rates among their staff are low, despite vaccine availability. Hand hygiene measures were also suboptimal. These results warrant further efforts to implement infection prevention and control measures in the ambulatory setting.

[Lymphoepithelial cysts of the parotid gland: a pathology linked to HIV infection]. / Les kystes lymphoépithéliaux de la glande parotide: une pathologie liée à l'infection VIH.

We review the various lesions encountered in the parotid gland associated with HIV infection and propose guidelines for the management of a chronic parotid swelling in this setting. Lymphoepithelial cysts is the main diagnosis of parotid masses presented by HIV positive patients. This benign condition is diagnosed on cytology and the treatment is usually conservative. Patients with a diagnosis of lymphoepithelial cysts should be tested for HIV.

[Pre- and post-exposure rabies prophylaxis: who to vaccinate and how?]. / Prophytaxie pre- et postexpositionnelle de la rage: qui vacciner et comment?

Switzerland is rabies free since 1996 (except bats). However sporadic cases in animals (imported dogs and local bats essentially) may occur from time to time. The disease is always fatal, which implies special attention when someone gets bitten or scratched by a wild or unknown animal, not only in a country with a high endemicity, but also in Switzerland. In this article, we will explore in detail the modalites of application of pre- and post-exposure prophylaxis following the publication of new recommandations from the Public Health authorites of Switzerland.