Soins intégrés et BPCO bénéfiques pour les patients !

La BPCO est responsabled'une diminution de la qualité de vie et de la tolérance à l'exercice, et cause des exacerbations pouvant nécessiter des hospitalisations. Idéalement, sa prise en charge devrait comprendre des éléments pharmacologiques (par exemple bronchodilatateurs, corticostéroïdes inhalés) et non pharmacologiques (éducation, autogestion, plan d'action, réentraînement). L'objectif de cette revue systématique est d'évaluer l'efficacité des programmes de soins intégrés de la BPCO en termes de qualité de vie, de tolérance à l'exercice, de risque et de durée d'hospitalisation. Elle actualise les revues systématiques non Cochrane publiées auparavant

Integrated care organizations in Switzerland

INTRODUCTION: The Swiss health care system is characterized by its decentralized structure and high degree of local autonomy. Ambulatory care is provided by physicians working mainly independently in individual private practices. However, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs) acting on the principles of gatekeeping. TOWARDS INTEGRATED CARE IN SWITZERLAND: The share of insured choosing an alternative (managed care) type of basic health insurance and therefore restrict their choice of doctors in return for lower premiums increased continuously since 1990. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84%) have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e., to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. CONCLUSION AND IMPLICATIONS: Swiss physician networks and HMOs were all established solely by initiatives of physicians and health insurance companies on the sole basis of a healthcare legislation (Swiss Health Insurance Law, KVG) which allows for such initiatives and developments. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed

Understanding recent trends in Swiss ambulatory care utilization when out-of-pocket payment is minimal

Summary.: Objective:: To examine trends in ambulatory care utilization when individuals face almost no financial barriers to health care. Methods:: Observational study of insurance data. Adults with minimal deductible were included. Ambulatory care visits and costs were measured from 1997 to 2002. Results:: Mean ambulatory care costs/insuree increased from 1 292.- to 1 790.- CHF, corresponding to higher increases in drug costs (+61.7%) than services costs (+24.3%). The proportion of visits to generalists decreased while those to hospital outpatient services increased. Conclusions:: In a demographically stable population of insurees, increases in ambulatory care costs were due neither to growth in physicians' ?visits nor to increasing physicians' fees per act, but to what was included in or prescribed during the visit

Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey

Objective: To describe chronic disease management programs active in Switzerland in 2007, using an exploratory survey. <br><br> Methods: We searched the internet (Swiss official websites and Swiss web-pages, using Google), a medical electronic database (Medline), reference lists of pertinent articles, and contacted key informants. Programs met our operational definition of chronic disease management if their interventions targeted a chronic disease, included a multidisciplinary team (≥2 healthcare professionals), lasted at least six months, and had already been implemented and were active in December 2007. We developed an extraction grid and collected data pertaining to eight domains (patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, clinical outcomes). <br><br> Results: We identified seven programs fulfilling our operational definition of chronic disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, psychosis and breast cancer. Interventions were multifaceted; all included education and half considered planned follow-ups. The recipients of the interventions were patients, and healthcare professionals involved were physicians, nurses, social workers, psychologists and case managers of various backgrounds. <br><br> Conclusions: In Switzerland, a country with universal healthcare insurance coverage and little incentive to develop new healthcare strategies, chronic disease management programs are scarce. For future developments, appropriate evaluations of existing programs, involvement of all healthcare stakeholders, strong leadership and political will are, at least, desirable

Healthcare utilization of overweight and obese Europeans aged 50-79years

To examine the association between overweight/obesity and healthcare utilization in middle-aged and aged Europeans. This is a baseline cross-sectional analysis of self-reported data from ten countries participating in the Survey of Health, Ageing and Retirement in Europe (SHARE), which reached an overall response rate of 62%. Included in the study were 16,695 non-institutionalized individuals aged 50-79years with body mass indexes (BMI) ≥18.5kg/m2. We used height and weight to compute BMI and categorized it into normal weight (BMI 18.5-24.9kg/m2), overweight (BMI 25.0-29.9kg/m2) and obesity (BMI ≥ 30kg/m2). Dichotomous measures of healthcare utilization during the previous 12months included any use of ambulatory care, high use of a general practitioner, visits to specialists, high use of medication, hospitalization, high number of times hospitalized and nights spent in the hospital, surgery, home healthcare and domestic help. Logistic regressions adjusted for age, socio-economic status, smoking, physical activity, alcohol consumption, country of residence, and chronic conditions. All analyses were stratified by gender. Among men and women, being overweight or obese was associated with a significantly increased risk of using ambulatory care and visiting general practitioners, as well as taking ≥2 medication categories. Those relationships were only partially explained by chronic conditions. Obese women were at increased risk and overweight men at decreased risk of hospitalization. For men, exploring other hospitalization dimensions did not reveal significant associations, however. Men and women, whether overweight or obese, did not report higher use of specialists, surgery, home healthcare or domestic help. For all outcomes, similar trends were found at the country level. Population-attributable fractions were highest for medication use, both for men (23%) and women (19%). Despite the rising prevalence of obesity and aging of the population, findings from SHARE show that overweight and obesity place a moderate burden on European healthcare systems, mostly by increasing ambulatory care and medication us

Factors associated with healthcare professionals' intent to stay in hospital: a comparison across five occupational categories

Objectives To identify factors associated with intent to stay in hospital among five different categories of healthcare professionals using an adapted version of the conceptual model of intent to stay (CMIS). Design A cross-sectional survey targeting Lausanne University Hospital employees performed in the fall of 2011. Multigroup structural equation modeling was used to test the adapted CMIS model among professional groups. Measures Satisfaction, self-fulfillment, workload, working conditions, burnout, overall job satisfaction, institutional identification and intent to stay. Participants Surveys of 3364 respondents: 494 physicians, 1228 nurses, 509 laboratory technicians, 935 administrative staff and 198 psycho-social workers. Results For all professional categories, self-fulfillment increased intent to stay (all β > 0.14, P 0.22, P < 0.05). Some factors were associated with specific professional categories: workload was associated with nurses' intent to stay (β = −0.15), and physicians' institutional identification mitigated the effect of burnout on intent to stay (β = −0.15 and β = 0.19). Conclusion Respondents' intent to stay in a position depended both on global and profession-specific factors. The identification of these factors may help in mapping interventions and retention plans at both a hospital level and professional groups' leve

Use of Preventive Services of Overweight and Obese Europeans Aged 50-79Years

Background: Although frequent contacts with health care systems may represent more opportunities to receive preventive services, excess body weight has been linked to decreased access to preventive services and quality of care. Objective: The objective of the study is to examine whether obese and overweight, compared to normal weight persons, have different experiences of preventive care. Design: The study design is cross-sectional. Baseline data (2004) of a population-based survey conducted in 10 European countries. Participants: The participants were noninstitutionalized adults, 13,859, (50-79years) with body mass index (BMI) ≥18.5kg/m2, who answered the baseline and supplementary questionnaires (overall response rate of 51.3%) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Measurements: BMI was divided into normal weight (BMI, 18.5-24.9kg/m2), overweight (BMI, 25.0-29.9kg/m2), and obesity (BMI >30kg/m2). Reported dependent variables were: influenza immunization, colorectal and breast cancer screening, discussion and recommendation about physical activity, and weight measurement. We performed multivariate logistic regressions, adjusting for age, sex, education, income, smoking, alcohol consumption, physical activity, and country. Results: Overweight and obesity were associated with higher odds of receiving influenza immunization but not with receipt of breast or colorectal cancer screening. Overweight and obese individuals mentioned more frequently that their general practitioner discussed physical activity or checked their weight, which was not explained by chronic diseases or the number of ambulatory care visits. Conclusions: These first data from SHARE did not suggest that overweight or obesity were associated with decreased use of preventive service