Gender/Sex Disparities in the COVID-19 Cascade From Testing to Mortality: An Intersectional Analysis of Swiss Surveillance Data.

Objectives: This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age. Methods: We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]). Results: Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women's mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20-0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41-1.06). Conclusion: Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.

Cost-effectiveness analysis of procalcitonin and lung ultrasonography guided antibiotic prescriptions in primary care.

Antimicrobial resistance comes with high morbidity and mortality burden, and ultimately high impact on healthcare and social costs. Efficient strategies are needed to limit antibiotic overuse. This paper investigates the cost-effectiveness of testing patients with lower respiratory tract infection with procalcitonin, either at the point-of-care only or combined with lung ultrasonography. These diagnostic tools help detect the presence of bacterial pneumonia, guiding prescription decisions. The clinical responses of these strategies were studied in the primary care setting. Evidence is needed on their cost-effectiveness. We used data from a cluster-randomized bi-centric clinical trial conducted in Switzerland and estimated patient-level costs using data on resource use to which we applied Swiss tariffs. Combining the incremental costs of the two strategies and the reduction in the 28-days antibiotic prescription rate (APR) compared to usual care, we calculated Incremental Cost-Effectiveness Ratios (ICER). We also used the Cost-Effectiveness Acceptability Curve as an analytical decision-making tool. The robustness of the findings is ensured by Probabilistic Sensitivity Analysis and scenario analysis. In the base case scenario, the ICER compared to usual care is $2.3 per percentage point (pp) reduction in APR for the procalcitonin group, and $4.4 for procalcitonin-ultrasound combined. Furthermore, we found that for a willingness to pay per patient of more than $2 per pp reduction in the APR, procalcitonin is the strategy with the highest probability to be cost-effective. Our findings suggest that testing patients with respiratory symptoms with procalcitonin to guide antibiotic prescription in the primary care setting represents good value for money.

Exploration of the Acceptance of the Use of Procalcitonin Point-of-Care Testing and Lung Ultrasonography by General Practitioners to Decide on Antibiotic Prescriptions for Lower Respiratory Infections: A Qualitative Study.

OBJECTIVES: We aimed to explore the acceptance and opinions of general practitioners (GPs) on the use of procalcitonin point-of-care and lung ultrasonography for managing patients with lower respiratory tract infections in primary care. We suppose that there are several factors that can influence the physician's antibiotic prescribing decision, and the implementation of a new tool will only be possible when it can be inserted into the physician's daily practice, helping him/her in the decision-making process. DESIGN: Semistructured interviews; data analysis using the grounded theory method. SETTING: Lausanne, Switzerland. PARTICIPANTS: 12 GPs who participated in the randomised clinical trial UltraPro, which evaluated the impact of the use of procalcitonin only or an algorithm combining procalcitonin and lung ultrasonography on antibiotic prescription. RESULTS: GPs had mostly positive attitudes towards the use of point-of-care procalcitonin in lower respiratory tract infections and uncertainties regarding the usefulness of ultrasonography. Physicians' prescribing decisions result from interactions between three kinds of TrustS (core category): 'self-confidence', 'trust in the results' and 'trust in the doctor-patient relationship'. Procalcitonin reinforced the three levels of trust, while ultrasonography only strengthened the physician-patient relationship. To facilitate implementation of procalcitonin, physicians pointed out the need of coverage by insurance and of clear guidelines describing the targeted patient population. CONCLUSIONS: Our data show that there is a preference for the implementation of procalcitonin rather than lung ultrasonography for the management of patients with lower respiratory tract infections in primary care. Coverage by insurance plans and updated guidelines are prerequisite to the successful implementation of procalcitonin testing in primary care. TRIAL REGISTRATION NUMBER: NCT03191071.

Pulse Oximetry as an Aid to Rule Out Pneumonia among Patients with a Lower Respiratory Tract Infection in Primary Care.

Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR-) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR- of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR- (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs.

Overruling of Procalcitonin-Guided Antibiotics for Lower Respiratory Tract Infections in Primary Care: Ancillary Study of a Randomized Controlled Trial.

BACKGROUND: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28. AIM: To explore the factors associated with the overruling of initial procalcitonin guidance. DESIGN AND SETTING: Secondary analysis of a cluster randomized trial in which patients with an LRTI were included. METHOD: Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering. RESULTS: Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03-3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32-9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34-23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18-4.37); and the GP's number of years of experience (aOR per year 1.05, 1.01-1.09). CONCLUSIONS: Overruling of procalcitonin guidance was associated with GPs' socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship.

Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19.

This study aimed to estimate the diagnostic performance of patient symptoms and to describe the clinical course of RT-PCR-positive compared with RT-PCR-negative patients in primary care. Symptomatic COVID-19 suspects were assessed clinically at the initial consultation in primary care between March and May 2020, followed by phone consultations over a span of at least 28 days. Sensitivity and specificity were estimated for each symptom using the initial RT-PCR result as a reference standard. The proportions of symptomatic patients according to the RT-PCR test results were compared over time, and time to recovery was estimated. Out of 883 patients, 13.9% had a positive RT-PCR test, and 17.4% were not tested. Most sensitive symptoms were cough, myalgia, and a history of fever, while most specific symptoms were fever for ≥4 days, hypo/anosmia, and hypo/ageusia. At the final follow up (median time 55 days, range 28-105 days), 44.7% of patients still reported symptoms in the RT-PCR-positive group, compared with 18.3% in the negative group (p < 0.001), mostly with hypo/anosmia (16.3%), dyspnea (12.2%), and fatigue (10.6%). The discriminative value of individual symptoms for diagnosing COVID-19 was limited. Almost half of the SARS-CoV-2-positive patients still reported symptoms at least 28 days after the initial consultation.

Impact of the COVID-19 pandemic on adherence to infection prevention and control measures between 2019 and 2021 in Swiss sentinel private practices: repeated cross-sectional surveys.

AIMS OF THE STUDY: The COVID-19 pandemic has shown the importance of infection prevention and control (IPC) measures in health care settings, including primary care. We aimed to describe how it influenced adherence to infection prevention and control measures in private practices in the Swiss sentinel network (Sentinella). METHOD: An online cross-sectional survey was sent to the 181 Sentinella practices in 2021 that included questions on the practice's spatial organisation, staff habits and vaccination coverage, ventilation, mask wearing, hand hygiene, as well as triage and separation of patients with suspected infection. Results were compared with those of a 2019 survey conducted in the same setting. RESULTS: We received 127 valid questionnaires (70.2% response rate). At the time of the study, SARS-CoV-2 vaccination was underway among physicians (51.3%). Between 2019 and 2021, an absence of specific recommendations on mask wearing for staff (55.7%) changed into a recommendation for continuous wearing (93.7%); hand hygiene improved, especially upon arrival at the practice (63.9% vs 85.8%; p <0.001) and before examining patients (74.6% vs 88.2%; p <0.010); impossibility of distancing symptomatic patients dropped (27.9% vs 3.9%, p <0.001); and ventilation and cleaning improved (p <0.001). CONCLUSIONS: The COVID-19 pandemic led to important changes in adherence to the recommended IPC measures.

[Biomarker-guided antibiotics prescription for lower respiratory tract infections in primary care : CRP or PCT ?] / Prescription des antibiotiques guidée par les biomarqueurs en médecine de famille : CRP ou PCT ?

Lower respiratory tract infections are a frequent cause of excessive antibiotic prescription. The use of CRP and PCT has been evaluated by recent trials as a mean to assist antibiotic prescription. These studies suggest a safe reduction of antibiotic usage when prescription is guided by biomarkers. There is at the moment no evidence benefiting one of the biomarkers over the other, but a recent Swiss trial could suggest an added benefit for PCT. For now, PCT is less available, more expensive and not reimbursed. Democratization of its use, and/or clear thresholds for the use of CRP are additional ways that could participate to reduce excessive antibiotic prescription in primary care.

Les infections respiratoires basses sont une cause fréquente de prescription inappropriée d'antibiotiques en médecine de famille. L'utilisation de la CRP et de la procalcitonine (PCT) a été évaluée par plusieurs études comme moyen de guider la prescription d'antibiotiques. Ces études suggèrent une diminution sûre de la prescription lorsque l'utilisation est guidée par des biomarqueurs. Il n'y a pour l'instant pas d'évidence en faveur d'une supériorité d'un biomarqueur mais une étude suisse pourrait suggérer un effet additionnel de la PCT. Pour l'instant, elle est moins facilement accessible, plus chère et non remboursée. La démocratisation de son utilisation et/ou la définition de seuils clairs pour l'utilisation de la CRP pourraient aider à diminuer la prescription excessive d'antibiotiques en ambulatoire.

Post­COVID­19 Syndrome in Outpatients: a Cohort Study.

BACKGROUND: After mild COVID-19, some outpatients experience persistent symptoms. However, data are scarce and prospective studies are urgently needed. OBJECTIVES: To characterize the post-COVID-19 syndrome after mild COVID-19 and identify predictors. PARTICIPANTS: Outpatients with symptoms suggestive of COVID-19 with (1) PCR-confirmed COVID-19 (COVID-positive) or (2) SARS-CoV-2 negative PCR (COVID-negative). DESIGN: Monocentric cohort study with prospective phone interview between more than 3 months to 10 months after initial visit to the emergency department and outpatient clinics. MAIN MEASURES: Data of the initial visits were extracted from the electronic medical file. Predefined persistent symptoms were assessed through a structured phone interview. Associations between long-term symptoms and PCR results, as well as predictors of persistent symptoms among COVID-positive, were evaluated by multivariate logistic regression adjusted for age, gender, smoking, comorbidities, and timing of the survey. KEY RESULTS: The study population consisted of 418 COVID-positive and 89 COVID-negative patients, mostly young adults (median age of 41 versus 36 years in COVID-positive and COVID-negative, respectively; p = 0.020) and healthcare workers (67% versus 82%; p = 0.006). Median time between the initial visit and the phone survey was 150 days in COVID-positive and 242 days in COVID-negative patients. Persistent symptoms were reported by 223 (53%) COVID-positive and 33 (37%) COVID-negative patients (p = 0.006) and proportions were stable among the periods of the phone interviews. Overall, 21% COVID-positive and 15% COVID-negative patients (p = 0.182) attended care for this purpose. Four surveyed symptoms were independently associated with COVID-19: fatigue (adjusted odds ratio 2.14, 95% CI 1.04-4.41), smell/taste disorder (26.5, 3.46-202), dyspnea (2.81, 1.10-7.16), and memory impairment (5.71, 1.53-21.3). Among COVID-positive, female gender (1.67, 1.09-2.56) and overweight/obesity (1.67, 1.10-2.56) were predictors of persistent symptoms. CONCLUSIONS: More than half of COVID-positive outpatients report persistent symptoms up to 10 months after a mild disease. Only 4 of 14 symptoms were associated with COVID-19 status. The symptoms and predictors of the post-COVID-19 syndrome need further characterization as this condition places a significant burden on society.

What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland.

BACKGROUND: The medical field causes significant environmental impact. Reduction of the primary care practice carbon footprint could contribute to decreasing global carbon emissions. This study aims to quantify the average carbon footprint of a primary care consultation, describe differences between primary care practices (best, worst and average performing) in western Switzerland and identify opportunities for mitigation. METHODS: We conducted a retrospective carbon footprint analysis of ten private practices over the year 2018. We used life-cycle analysis to estimate carbon emissions of each sector, from manufacture to disposal, expressing results as CO2 equivalents per average consultation and practice. We then modelled an average and theoretical best- case and worst-case practices. Collected data included invoices, medical and furniture inventories, heating and power supply, staff and patient transport, laboratory analyses (in/out-house) waste quantities and management costs. RESULTS: An average medical consultation generated 4.8 kg of CO2eq and overall, an average practice produced 30 tons of CO2eq per year, with 45.7% for staff and patient transport and 29.8% for heating. Medical consumables produced 5.5% of CO2eq emissions, while in-house laboratory and X-rays contributed less than 1% each. Emergency analyses requiring courier transport caused 5.8% of all emissions. Support activities generated 82.6% of the total CO2eq. Simulation of best- and worst-case scenarios resulted in a ten-fold variation in CO2eq emissions. CONCLUSION: Optimizing structural and organisational aspects of practice work could have a major impact on the carbon footprint of primary care practices without large-scale changes in medical activities.

Factors Influencing the Implementation of Antimicrobial Stewardship in Primary Care: A Narrative Review.

Antimicrobial resistance (AMR) is directly driven by inappropriate use of antibiotics. Although the majority of antibiotics (an estimated 80%) are consumed in primary care settings, antimicrobial stewardship (AMS) activities in primary care remain underdeveloped and factors influencing their implementation are poorly understood. This can result in promising stewardship activities having little-to-no real-world impact. With this narrative review, we aim to identify and summarize peer-reviewed literature reporting on (1) the nature and impact of AMS interventions in primary care and (2) the individual and contextual factors influencing their implementation. Reported activities included AMS at different contextual levels (individual, collective and policy). AMS activities being often combined, it is difficult to evaluate them as stand-alone interventions. While some important individual and contextual factors were reported (difficulty to reach physicians leading to a low uptake of interventions, tight workflow of physicians requiring implementation of flexible and brief interventions and AMS as a unique opportunity to strengthen physician-patients relationship), this review identified a paucity of information in the literature about the factors that support or hinder implementation of AMS in primary care settings. In conclusion, identifying multilevel barriers and facilitators for AMS uptake is an essential step to explore before implementing primary care AMS interventions.

Trends in COVID-Related Activity in Sentinel Family Medicine Practices: An Observational Study.

Objectives: During the COVID pandemic, data collected in family medicine were scarce. The COVID-FM project aimed to monitor trends of COVID-related activity in family medicine practices of the canton of Vaud, Switzerland, during the year 2021. Methods: Practitioners were invited to join an ad hoc sentinel surveillance system. Online data collection was based on daily activity reports and monthly questionnaires. Participants categorized daily counts of consultations and phone calls into predefined categories. Data were reported and discussed on a weekly basis with public health authorities. Results: On the target of 50 physicians, 37 general physicians from 32 practices finally constituted the COVID-FM sentinel network, contributing to 901 practice-weeks of surveillance in family medicine and 604 in paediatrics. In paediatrics, COVID-related activity corresponded mostly to COVID-19 diagnostic consultations (2911/25990 face-to-face consultations = 11.2%) while in family medicine, other COVID-related topics-such as questions on vaccination-predominated (4143/42221 = 9.8%). Conclusion: COVID-related consultations constituted an important part of primary care practices' activity in 2021. Monitoring COVID-related activity in primary care provided health authorities with valuable information to guide public health action.

Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial.

OBJECTIVE: To assess whether point-of care procalcitonin and lung ultrasonography can safely reduce unnecessary antibiotic treatment in patients with lower respiratory tract infections in primary care. DESIGN: Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020. SETTING: 60 Swiss general practices. PARTICIPANTS: One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included. INTERVENTIONS: Randomisation in a 1:1:1 of general practitioners to either antibiotics guided by sequential procalcitonin and lung ultrasonography point-of-care tests (UltraPro; n=152), procalcitonin guided antibiotics (n=195), or usual care (n=122). MAIN OUTCOMES: Primary outcome was proportion of patients in each group prescribed an antibiotic by day 28. Secondary outcomes included duration of restricted activities due to lower respiratory tract infection within 14 days. RESULTS: 60 general practitioners included 469 patients (median age 53 years (interquartile range 38-66); 278 (59%) were female). Probability of antibiotic prescription at day 28 was lower in the procalcitonin group than in the usual care group (0.40 v 0.70, cluster corrected difference -0.26 (95% confidence interval -0.41 to -0.10)). No significant difference was seen between UltraPro and procalcitonin groups (0.41 v 0.40, -0.03 (-0.17 to 0.12)). The median number of days with restricted activities by day 14 was 4 days in the procalcitonin group and 3 days in the usual care group (difference 1 day (95% confidence interval -0.23 to 2.32); hazard ratio 0.75 (95% confidence interval 0.58 to 0.97)), which did not prove non-inferiority. CONCLUSIONS: Compared with usual care, point-of-care procalcitonin led to a 26% absolute reduction in the probability of 28 day antibiotic prescription without affecting patients' safety. Point-of-care lung ultrasonography did not further reduce antibiotic prescription, although a potential added value cannot be excluded, owing to the wide confidence intervals. TRIAL REGISTRATION: ClinicalTrials.gov NCT03191071.

Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial.

BACKGROUND: Although assessment of geriatric syndromes is increasingly encouraged in older adults, little evidence exists to support its systematic use by general practitioners (GPs). The aim of this study was to determine whether a systematic geriatric evaluation performed by GPs can prevent functional decline. METHODS: We conducted a controlled, open-label, pragmatic cluster-randomized trial in 42 general practices in Switzerland. Participating GPs were expected to enrol an average of 10 community-dwelling adults (aged ≥ 75 yr) who understood French, and had visited their GP at least twice in the previous year. The intervention consisted of yearly assessment by the GP of 8 geriatric syndromes with an associated tailored management plan according to assessment results, compared with routine care. Our primary outcomes were the proportion of patients who lost at least 1 instrumental activity of daily living (ADL) and the proportion who lost at least 1 basic ADL, over 2 years. Our secondary outcomes were quality-of-life scores, measured using the older adult module of the World Health Organization Quality of Life Instrument, and health care use. RESULTS: Forty-two GPs recruited 429 participants (63% women) with a mean age of 82.5 years (standard deviation 4.8 yr) at time of recruitment. Of these, we randomly assigned 217 participants to the intervention and 212 to the control arm. The proportion of patients who lost at least 1 instrumental ADL in the intervention and control arms during the course of the study was 43.6% and 47.6%, respectively (risk difference -4.0%, 95% confidence interval [CI] -14.9% to 6.7%, p = 0.5). The proportion of patients who lost at least 1 basic ADL was 12.4% in the intervention arm and 16.9% in the control arm (risk difference -5.1%, 95% CI -14.3% to 4.1%, p = 0.3). INTERPRETATION: A yearly geriatric evaluation with an associated management plan, conducted systematically in GP practices, does not significantly lessen functional decline among community-dwelling, older adult patients, compared with routine care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02618291.

[Innovating to understand the unknown : COVID-19 pandemic research in family medicine]. / Innover pour comprendre l'inconnu : recherche sur la pandémie de Covid-19 en médecine de famille.

The COVID-19 pandemic has brought challenges that sparked a multitude of research questions at the Institutes of Family Medicine in Geneva and Lausanne. This article presents a synthesis of these questions, and the research projects that have resulted from them.

Les défis posés par la pandémie de Covid-19 ont éveillé une multitude de questions de recherche au sein des instituts de médecine de famille de Genève et Lausanne. Cet article présente une synthèse de ces questions et des projets de recherche qui en découlent.

[Eco-design recommendations for family practices]. / Recommandations pour l'écoconception des cabinets de médecine de famille.

The disastrous consequences of global warming call for action at every level. Primary care practices have the potential to reduce their carbon footprint by a factor of ten without changing their medical habits. The main options for carbon emissions mitigation are in the areas of heating and transport. Thirteen recommendations for action have been developed with the help of established GPs.

Les conséquences désastreuses du réchauffement climatique appellent des actions de tous les milieux et à tous les niveaux. Les cabinets de médecine de famille ont un potentiel de réduction de leur empreinte carbone d'un facteur dix et ceci sans changer leurs pratiques médicales. Les principales options de réduction des émissions carbone concernent les domaines du chauffage et du transport. Treize recommandations d'actions ont été élaborées avec le concours de médecins généralistes installé·es.

Swiss family physicians and home visits: a 10-year retrospective analysis and typology based on billing data.

INTRODUCTION: In the context of an aging population, homecare visits by family physicians may contribute to maintaining older patients at home; however, home visits by family physicians have decreased in number in the last decade with the emergence of homecare-oriented healthcare services. We aimed to describe the diversity of activities and evolution over time of home visits by Swiss family physicians. METHODS: This was a retrospective observational descriptive study. We used billing data collected by the cantonal trust centre for home visits made by family physicians of the canton of Vaud, Switzerland from 2006 to 2015. We separated billed items into specific categories, including the Tarmed catalogue (Swiss pricing system for medical services), laboratory catalogue, medications, medical material and vaccines. We compared billing patterns between emergency and routine visits. We used discrete mixture models to identify cluster classes of visits, and compare their characteristics. RESULTS: From 2006 to 2015, Vaud family physicians made 451,634 home visits for which they billed a median of 5 items per visit (range 2–95). Most home visits (65%, 293,713) were routine visits consisting of consultation time without additional investigation. We identified four cluster classes of visits comprising routine visits, routine visits with laboratory tests, emergency visits during the day and emergency visits during the night. Routine visits were the main cluster class while emergency home visits were rare. CONCLUSIONS: Family physician home visits are mainly routine visits without additional investigation. Thus, we wonder if a part of this activity could be delegated to other healthcare professionals.