What are patients' expectations about the organization of their primary care physicians' practices?

BACKGROUND: To our knowledge no study has at the same time assessed patients' satisfaction and their expectations concerning the organizational and contextual aspects of health care provided by their primary care physician (PCP). Assessing these aspects is important to inform future primary healthcare service planning. Our objective was thus to document patients' satisfaction with and expectations from their PCP, in terms of availability and organization of their practices, and to assess whether these indicators varied across age groups and type of practice (solo, duo, group). METHODS: Cross-sectional study based on the answers to questionnaires completed by patients consulting their PCP in Geneva, Switzerland. A random sample of PCPs was asked to recruit consecutively between 50 and 100 patients coming to the practice for a scheduled medical consultation. The patients were asked to complete an anonymous questionnaire centered on their satisfaction levels and expectations towards their PCP. RESULTS: One thousand six hundred thirty-seven patients agreed to participate (participation rate: 97%, women: 63%, mean age: 54 years). Patient satisfaction was high for all the items, except for the availability of the doctor by phone and for the waiting time in the waiting room. The satisfaction rate increased with age and was higher for small practices. In relation to patients' expectations from their doctor, older patients and patients visiting larger practices tended to be more demanding. CONCLUSIONS: Patients are generally highly satisfied with their PCP. They have a wide range of expectations which should be taken into account when considering potential improvements.

Growing discontent of Swiss doctors, 1998-2007.

BACKGROUND: Work satisfaction of doctors is a useful indicator of the functioning of the health-care system. We documented the work satisfaction of doctors nine years apart, before and after the implementation of several health-care reforms (limitation of working hours for medical trainees, restrictions on new doctors' offices, new reimbursement fee schedule, greater administrative controls). METHODS: Two surveys of all doctors working in the Canton of Geneva, Switzerland (1998: 1146 respondents, 2007: 1546 respondents). The doctors filled in a 17-item questionnaire rating their satisfaction with different aspects of their professional life, each on a scale between 1 and 7. For each item, proportions of highly satisfied (scores 6-7) and highly dissatisfied (scores 1-2) doctors were compared over time. RESULTS: The proportion of doctors who were highly satisfied decreased significantly for 15 out of 17 items between 1998 and 2007. Meanwhile, 'time available for family, friends, or leisure' improved, and 'opportunity for continuing education' remained stable. Proportions of highly satisfied respondents decreased the most for 'enjoyment of work' (-17.2%), 'autonomy in treating your patients' (-15.8%), 'autonomy in referring patients to a specialist' (-14.0%), 'relations with patients' (-13.9%) and 'global satisfaction with current work situation' (-13.3%). The proportion of respondents who were highly dissatisfied (score 1-2) increased the most for 'administrative burden' (+8.9%) and 'social status and respect' (+5.0%). CONCLUSIONS: Doctors' satisfaction with most aspects of their professional lives has decreased sharply during the past decade. This trend may be linked, tentatively, with specific policy changes.

Predicted 30-year protection after vaccination with an aluminum-free virosomal hepatitis A vaccine.

Few studies have examined the duration of protection following vaccination against hepatitis A virus (HAV) with currently licensed HAV vaccines. This study explored the long-term immunogenicity in individuals vaccinated with the virosomal hepatitis A virus, Epaxal. Adult volunteers (N = 130) previously enrolled into four different studies between 1992 and 1994 and who had completed a 0/12-month immunization regimen (primary and booster dose) were asked to participate in this follow-up study. Yearly anti-HAV titers up to 6 years following booster vaccination, and then once 9-11 years after booster were measured using two assays, Enzygnost and AxSYM HAVAB 2.0. Based on the Enzygnost assay, the seroprotection rate 9-11 years after booster was 100%, with a geometric mean concentration (GMC) of anti-HAV antibodies of 526 mIU/ml. Females had markedly higher GMCs than males (741 mIU/ml vs. 332 mIU/ml). Using an anti-HAV cut-off titer of >or=10 mIU/ml, a linear mixed mathematical model predicted a median duration of protection of 52.1 years. A duration of protection >or= 35.7 years was predicted for 95% of subjects. A more stringent cut-off of >or=20 mIU/ml shortened the median predicted duration of protection to 45.0 years. In conclusion, a two-dose Epaxal vaccination regimen confers in healthy adults a real-time protection of at least 9-11 years; this protection is predicted to last at least 30 years in over 95% of individuals. Further studies are necessary to assess the real duration of seroprotection and whether an additional booster is necessary later.

What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients.

BACKGROUND: How doctors perceive managed care tools and incentives is not well known. We assessed doctors' opinions about the expected impact of eight managed care tools on quality of care, control of health care costs, professional autonomy and relations with patients. METHODS: Mail survey of doctors (N = 1546) in Geneva, Switzerland. Respondents were asked to rate the impact of 8 managed care tools on 4 aspects of care on a 5-level scale (1 very negative, 2 rather negative, 3 neutral, 4 rather positive, 5 very positive). For each tool, we obtained a mean score from the 4 separate impacts. RESULTS: Doctors had predominantly negative opinions of the impact of managed care tools: use of guidelines (mean score 3.18), gate-keeping (2.76), managed care networks (2.77), second opinion requirement (2.65), pay for performance (1.90), pay by salary (2.24), selective contracting (1.56), and pre-approval of expensive treatments (1.77). Estimated impacts on cost control were positive or neutral for most tools, but impacts on professional autonomy were predominantly negative. Primary care doctors held more positive opinions than doctors in other specialties, and psychiatrists were in general the most critical. Older doctors had more negative opinions, as well as those in private practice. CONCLUSIONS: Doctors perceived most managed care tools to have a positive impact on the control of health care costs but a negative impact on medical practice. Tools that are controlled by the profession were better accepted than those that are imposed by payers.

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians.

BACKGROUND: Work-related satisfaction is an important determinant of quality of care. However, its relationship with doctors' mental health is poorly understood. It could have an independent beneficial effect on mental health (direct association) or simply reduce the impact of work stress on mental health (moderating or 'buffering' role). METHODS: One thousand seven hundred and thirty-two Swiss primary care physicians (824 board-certified generalists, 436 general internists, 162 paediatricians, 147 internal medicine specialists and 163 physicians without specialty qualification) completed a mailed questionnaire. Previously, validated instruments were used to measure mental health (SF-12), emotional exhaustion [Maslach Burnout Inventory (MBI)] and work-related satisfaction. Linear regression models with mental health as dependant variable were used to study the relationships between these variables. Differences in mental health scores were standardized to represent a one standard deviation (SD) difference in the other scales [standardized beta coefficients (SBC)]. RESULTS: In multivariate analyses, higher levels of mental health were found in respondents with higher work-related satisfaction with current income and social prestige (SBC 1.04) and professional relations (SBC 0.57), and in respondents with lower emotional exhaustion (SBC -4.98) and higher personal accomplishment scores (SBC 1.72). Interaction terms between these dimensions of work-related satisfaction and emotional exhaustion were significant, supporting a 'buffering' role of these dimensions. CONCLUSION: Work-satisfaction with current income, social prestige and professional relations are important correlates of mental health among primary care physicians, as well as emotional exhaustion. Higher levels of these dimensions of work-related satisfaction seems to mitigate the relationship between emotional exhaustion and physicians' mental health.

Reliability of doctors' anthropometric measurements to detect obesity.

OBJECTIVE: To evaluate the reliability of anthropometric measurements (weight, height, Body Mass Index (BMI), waist and hip circumferences (WC; HC) and waist-to-hip ratio (WHR)) performed by doctors to assess obesity. METHOD: Repeated anthropometric measurements were performed by 12 primary care physicians on 24 adult volunteers in Geneva, Switzerland, 2006. Volunteers (54% women, mean age 41) had a mean BMI of 28.1 (respective mean values for WC, HC and WHR: 91.4, 108.3, 0.84). Inter-observer reliability coefficient (R) and percent disagreement in categorisation of volunteers (normal weight, overweight, obesity, abdominal obesity) were computed according to these measurements. RESULTS: The inter-observer reliability for weight, height, and derived BMI were excellent (R>0.99), but unsatisfactory for WC (R=0.92), HC (R=0.76) and WHR (R=0.51). Based on the BMI, only 1% of the volunteers were misclassified as overweight or obese, whereas the use of WC and WHR lead to misclassification in 6% and 23% respectively. Reliability for the measurements improved after a one-hour training in anthropometric measurements (R=0.97 for WC, 0.92 for HC and 0.89 for WHR), but the proportion who were misclassified remained high despite the training session for WC (5%) and WHR (9%). CONCLUSIONS: BMI remains the most reliable measure to detect obesity in medical practice, whereas WC, HC and WHR are less reliable. These results challenge current recommendations on obesity-related cardio-vascular risk management based on WC and WHR and underline the need for further research to improve the reliability of anthropometric measurements by doctors.

Doctor-patient gender concordance and patient satisfaction in interpreter-mediated consultations: an exploratory study.

BACKGROUND: Research suggests that doctor-patient communication patterns and patient satisfaction are influenced by gender. However, little is known about the effect of gender in consultations with foreign language-speaking patients and in interpreter-mediated consultations. METHODS: The objective of the study was to explore the effect of doctor-patient gender concordance on satisfaction of foreign language-speaking patients in consultations with and without a professional interpreter. Its design consists of a cross-sectional analysis of patients' reports. A total of 363 consultations with foreign language-speaking patients were included in the analysis. We measured the mean scores of six items on the quality of communication (answer scale 0-10): the doctor's response to the patient's needs, the doctors' explanations, the doctor's respectfulness toward the patient, the quality of communication in general, the overall consultation process, and information provided regarding follow-up. RESULTS: When interpreters were used, mean scores were similar for doctor-patient concordant and discordant pairs. However, in the absence of interpreters, doctor-patient gender discordance was associated with lower overall ratings of the quality of communication (-0.46, p= 0.01). CONCLUSIONS: Our results suggest that the presence of a professional interpreter may reduce gender-related communication barriers during medical encounters with foreign language-speaking patients.

[Medical tourism: a new kind of traveler?]. / Explosion du tourisme médical: des voyageurs d'un nouveau type?

In an era of globalisation, an increasing number of patients are seeking medical care abroad, for a fraction of the price in their home country The reasons are numerous. Some countries face an increasing demand, either because of inappropriate health insurance coverage (e.g. United States) or long waiting lists (e.g. United-Kingdom, Canada). In parallel, medical care facilities and infrastructures of many countries of Asia and latin America offer now high quality care, if not better, than their European or North American counterparts. In theses conditions, more and more patients decide now to travel abroad for cardiovascular and orthopedic surgery that they cannot readily have in their home country. In Switzerland, this phenomenon is still marginal but changes could occur in a near future.

Stress from uncertainty from graduation to retirement--a population-based study of Swiss physicians.

BACKGROUND: Uncertainty shapes many decisions made by physicians everyday. Uncertainty and physicians' inability to handle it may result in substandard care and unexplained variations in patterns of care. OBJECTIVE: To describe socio-demographic and professional characteristics of reactions to uncertainty among physicians from all specialties, including physicians in training. DESIGN: Cross-sectional postal survey. PARTICIPANT: All physicians practicing in Geneva, Switzerland (n = 1,994). MEASUREMENT: Reaction to medical care uncertainty was measured with the Anxiety Due to Uncertainty and Concern About Bad Outcomes scales. The questionnaire also included items about professional characteristics and work-related satisfaction scales. RESULTS: After the first mailing and two reminders, 1,184 physicians responded to the survey. In univariate analysis, women, junior physicians, surgical specialists, generalist physicians, and physicians with lower workloads had higher scores in both scales. In multivariate models, sex, medical specialty, and workload remained significantly associated with both scales, whereas clinical experience remained associated only with concern about bad outcomes. Higher levels of anxiety due to uncertainty were associated with lower scores of work-related satisfaction, while higher levels of concern about bad outcomes were associated with lower satisfaction scores for patient care, personal rewards, professional relations, and general satisfaction, but not for work-related burden or satisfaction with income-prestige. The negative effect of anxiety due to uncertainty on work-related satisfaction was more important for physicians in training. CONCLUSION: Physicians' reactions to uncertainty in medical care were associated with several dimensions of work-related satisfaction. Physicians in training experienced the greatest impact of anxiety due to uncertainty on their work-related satisfaction. Incorporating strategies to deal with uncertainty into residency training may be useful.

Protection against snake bites by sleeping under a bed net in southeastern Nepal.

Snake bites in persons while they are asleep indoors are associated with a high risk of fatal outcome in southeastern Nepal. The preventive impact of sleeping under a bed net was assessed in four villages in a case-control study. A case was defined as a person with a history of snake bite that occurred indoors while asleep. Cases were matched with controls by village, type of household, sex, and age category. Of the 11,176 households visited, 56 cases, including 13 (23%) with a fatal outcome and 56 controls were included in the analysis. Sleeping under a bed net was a strong protective factor (odds ratio = 0.02, 95% confidence interval = 0.007-0.07, P < 0.0001), whereas the place of sleeping in the household and the use of a cot were not associated with the risk of snake bite. These findings provide further support for use of bed nets in this region.

Personal use of medical care and drugs among Swiss primary care physicians.

OBJECTIVE: To measure medical care and pharmaceutical drug use among Swiss primary care physicians and its determinants. DESIGN: Cross-sectional mailed survey. SETTING: 1784 randomly selected Swiss primary care physicians, including general practitioners, internists and paediatricians. RESULTS: Twenty one percent (95% CI: 19 to 23) indicated having a regular doctor and 53% (95% CI: 50 to 55) reported at least one visit to a health professional in the preceding year. Sixty five percent (95% CI: 62 to 67) of the respondents had used pharmaceutical drugs during the preceding week, 34% (95% CI: 31 to 36) analgesics, 14% (95% CI: 12 to 15) tranquillizers, 6% (95% CI: 5 to 8) antidepressant and 13% (95% CI: 12 to 15) antihypertensive drugs. Among respondents reporting drug use in the past week, self-medication was reported in 90% (95% CI: 88 to 92) of the cases. In multivariate analyses, female sex, older age, higher work-related satisfaction and higher perceived stress were associated with more frequent visits to any health professionals; paediatricians reported more visits to primary care physicians, whereas women and physicians living alone reported more visits to mental health specialists. Reported use of analgesics was more frequent for younger physicians and general internists. Older physicians reported a higher use of tranquillizers, whereas physicians living alone reported higher use of antidepressants. Finally use of antihypertensive drugs was more frequent among men, older physicians, general internists and physicians with higher levels of work-related stress. CONCLUSIONS: Swiss primary care physicians rarely have their own general practitioner and self medication is common with frequent use of analgesics and tranquillizers. Psychological distress due to increasing constraints on primary care doctors probably contributes to these behaviours.

Adherence to recommended standards of diabetes care by Swiss primary care physicians.

OBJECTIVES: To assess adherence to recommended standards of diabetes care by Swiss primary care physicians. METHODS: Medical files of community-based primary care physician were reviewed to assess adherence to recommended standards of diabetes care. These standards of care were based on a uniform set of definitions addressing medical care processes involved in the detection and follow-up of pre-diabetic and diabetic patients. RESULTS: 186 physicians agreed to participate and 3,682 medical files were assessed. The prevalence of diabetes was 11% and 5% had impaired glucose tolerance (pre-diabetic). Screening of diabetes based on family or personal history was reported for 83% of the patients and on cardiovascular risk factors for 69%. Counselling for dietary changes was reported for 91% of diabetic patients and for 79% for physical activity, but only for 66% and respectively 60% of pre-diabetic patients. Among diabetic patients, regular HbA1c control was reported for 65%, yearly fundoscopy for 62%, yearly feet examination for 65%, yearly microalbuminuria control for 49%, regular blood pressure control for 96%, and yearly lipid profile for 89%. Regular screening of microangiopathic complications was reported for only 33% of diabetic patients. CONCLUSION: Adherence to recommended standards of diabetes care displayed important variations among this convenience sample of Swiss primary care patients. Screening and counselling of diabetic patients were frequent, whereas counselling for lifestyle changes of pre-diabetic patients and regular follow-up of microangiopathic complications among diabetic patients were suboptimal. These results could help to target areas of diabetes care that need to be addressed to improve adherence to recommended standards.

Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey.

BACKGROUND: Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier. When the dangers of smoking become better known, physicians began to give up smoking at a higher rate than the general population. For alcohol consumption, the situation is quite different: prevalence is still very high among physicians and the dangers are not so well perceived. To study the situation in Switzerland, data of a national survey were analysed to determine the prevalence of smoking and alcohol drinking among primary care physicians. METHODS: 2,756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT-C < 4 for women and < 5 for men) and at risk drinkers (higher scores). RESULTS: 1'784 physicians (65%) responded (men 84%, mean age 51 years). Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%), but were more likely to be drinkers (96% vs. 78%), and twice more likely to be at risk drinkers (30% vs. 15%). CONCLUSION: The prevalence of current smokers among Swiss primary care physicians was much lower than in the general population in Switzerland, reflecting that the hazards of smoking are well known to doctors. However, the opposite was found for alcohol use, underlining the importance of making efforts in this area to increase awareness among physicians of the dangers of alcohol consumption.

Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings.

BACKGROUND: How to use clinical score, the rapid streptococcal antigen test (RSAT), and culture results is uncertain for efficient management of acute pharyngitis in adults. METHODS: This prospective cohort study included 372 adult patients with pharyngitis treated at a Swiss university-based primary care clinic. In eligible patients with 2 to 4 clinical symptoms and signs (temperature >or=38 degrees C, tonsillar exudate, tender cervical adenopathy, and no cough or rhinitis), we performed an RSAT and obtained a throat culture. We measured sensitivity and specificity of RSAT with culture as a gold standard and compared appropriate antibiotic use with cost per patient appropriately treated for the following 5 strategies: symptomatic treatment, systematic RSAT, selective RSAT, empirical antibiotic treatment, and systematic culture. RESULTS: RSAT had high sensitivity (91%) and specificity (95%) for the diagnosis of streptococcal pharyngitis. Systematic throat culture resulted in the highest antibiotic use, in 38% of patients with streptococcal pharyngitis. Systematic RSAT led to nearly optimal treatment (94%) and antibiotic prescription (37%), with minimal antibiotic overuse (3%) and underuse (3%). Empirical antibiotic treatment in patients with 3 or 4 clinical symptoms or signs resulted in a lower rate of appropriate therapy (59%) but higher rates of antibiotic use (60%), overuse (32%), and underuse (9%). Systematic RSAT was more cost-effective than strategies based on empirical treatment or culture: 15.00 dollars, 26.00 dollars, and 32.00 dollars, respectively, per patient appropriately treated. CONCLUSIONS: The RSAT we used is a valid test for diagnosis of pharyngitis in adults. A clinical approach combining this RSAT and clinical findings efficiently reduces inappropriate antibiotic prescription in adult patients with acute pharyngitis. Empirical therapy in patients with 3 or 4 clinical symptoms or signs results in antibiotic overuse.

Importance of lifestyle counselling by primary care physicians for diabetic patients.

OBJECTIVE: To identify diabetic patients' characteristics and medical care factors associated with recommended glycaemic control (HbA(1c) < or =7%). METHODS: As part of a cross-sectional assessment of diabetes care involving 204 Swiss primary care physicians, we identified 366 diabetic patients with a recent HbA(1c) value. Cross-tabulations and X(2) tests were used to explore the association of patients' sociodemographic and disease characteristics and medical care characteristics with HbA(1c) < or =7%. Significant factors were included in a regression logistic model to identify multivariate predictors of HbA(1c) < or =7%. RESULTS: HbA(1c) values were in the recommended range for 57% of the patients. A less than five years' history of diabetes, absence of followup by a diabetes specialist, absence of microalbuminuria or retinopathy, adherence to dietary and physical activity counselling, no participation in a diabetic education programme, no glycaemic self-monitoring, oral or no antidiabetic therapy and influenza vaccine in the last 12 months were associated with HbA(1c) < or =7%. In the multivariate analysis, HbA(1c) < or =7% remained associated with a less than five years diabetes history (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.3), as well as patients' adherence to dietary (OR 1.9, 95% CI 1.2-3.0) and physical activity counselling (OR 1.8, 95% CI 1.1-2.9). CONCLUSION: In this sample of diabetic patients, adherence to dietary and physical activity counselling were associated with better glycaemic control. Further research should focus on the importance of appropriate lifestyle counselling by Swiss primary care physicians, ideally in prospective trials using objective and reproducible measures of patients' observance.

Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis.

Patients with second-stage human African trypanosomiasis treated with eflornithine (n = 251) in 2003 in Kiri, southern Sudan, had an adjusted relative risk of death of 0.2 and experienced significantly fewer cutaneous and neurological adverse effects than did patients who were treated with melarsoprol in 2001 and 2002 (n = 708).

Patient reports of undesirable events during hospitalization.

BACKGROUND: Thus far, incident reporting in health care has relied on health professionals. However, patients too may be able to signal the occurrence of undesirable events. OBJECTIVE: To estimate the frequency of undesirable events reported by recently discharged patients, and to identify correlates of undesirable events. DESIGN: Mailed patient survey. SETTING: Swiss public teaching hospital. PARTICIPANTS: Adult patients (N=1,518) discharged from hospital. MEASUREMENTS: Self-reports of 27 undesirable events during hospitalization, including 9 medical complications, 9 interpersonal problems, and 9 incidents related to the health care process. RESULTS: Most survey respondents (1,433, 94.4%) completed the section about undesirable events, and 725 (50.6%) reported at least 1 event. The most frequent events were phlebitis (11.0%), unavailable medical record (9.5%), failure to respect confidentiality (8.4%), and hospital-acquired infection (8.2%). The odds of an unfavorable rating increased with each additional interpersonal problem (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3 to 1.8), each additional process-related problem (OR 1.5, 95% CI 1.3 to 1.9), but not with each additional medical complication (OR 1.0, 95% CI 0.9 to 1.2). Longer duration of stay, poor health, and depressed mood were all related to a greater reported frequency of undesirable events. CONCLUSION: Patients are able to report undesirable events that occur during hospital care. Such events occur in about a half of the hospitalizations, and have a negative impact on satisfaction with care.

Swiss primary care physicians reporting of utility and use of recommended vaccinations for adults.

QUESTION: To determine how recommended vaccinations in adults are perceived and used by primary care physicians in Switzerland. METHODS: A cross-sectional mail survey of primary care physicians randomly selected from the register of the Swiss medical association was conducted, including specific items measuring perceived utility and reported use for fourteen recommended vaccinations for adults. The answers were standardized to have a minimum of 0 and a maximum of 100. Other items assessed socio-demographic and work characteristics, opinion regarding the use of vaccinations, sources of recommendations used for vaccinations, and patient and organisational barriers. Frequency tables and crosstabulations were used to describe differences in perceived utility and reported use across these characteristics. RESULTS: After three reminders, 1166 physicians participated in the survey (response rate 64%). Perceived utility was the highest for rubella immunisation in young women (93.6; 95% CI: 92.8 to 94.3) and hepatitis B immunisation in high-risk adults (91.9; 95% CI: 91.0 to 92.7); it was the lowest for immunisations against measles (56.7; 95% CI: 55.3 to 58.2) and pneumococcal diseases (55.2; 95% CI: 53.8 to 56.7). The highest levels of use were reported for diphtheria-tetanus booster after a wound (91.7; 95% CI: 90.7 to 92.7) and poliomyelitis immunisation of travelers (89.5; 95% CI: 88.4 to 90.6); the lowest for immunisations against measles (40.3; 95% CI: 38.5 to 42.1) and pneumococcal diseases (33.3; 95% CI: 31.8 to 34.8). Lower reported use was associated with reports of physicians not having the time to verify vaccination status and convince a patient to be immunised, and other logistic issues related to physician's practice, but not with reports of patient's refusal of immunisation. CONCLUSION: There are several avenues to strengthen promotion programs aiming at improving immunisation use by Swiss primary care physicians in adults, among which a high better recognition of time spent for health promotion activities should have priority.