Finanzierung von medizinischen Verbrauchsgütern bei Spitex-Dienstleistern : wie geht es weiter?

Seit Januar 2018 müssen die Krankenversicherungen medizinische Verbrauchsgüter, die von Fachpersonen an Patienten/Patientinnen zu Hause angewendet werden, nicht mehr bezahlen. Dieser Artikel untersucht die Implikationen dieser veränderten Vergütungspraxis. Werden die Spitex-Organisationen diese Kosten selber tragen müssen? Werden die Kantone in die Rolle als Restfinanzierer treten, und welches Vergütungssystem werden sie allenfalls einführen? Welche Konsequenzen wird der Systemwechsel für die Versorgung im Bereich der Pflege zu Hause haben? Der Artikel gibt einen Überblick über die politische und rechtliche Entwicklung auf Bundesebene und zeigt, wie sich die Situation der verschiedenen Akteure im Bereich Pflege zu Hause dadurch verändert hat. Auch werden Hypothesen unter der Prämisse aufgestellt, dass die seit Januar 2018 geltende Regelung in Zukunft beibehalten würde, und parlamentarische Vorstösse somit erfolglos blieben. Dies führt zum Ergebnis, dass der kantonale Spielraum bei der Gestaltung eines Vergütungssystems zu heterogenen Lösungen führen könnte. Pauschale Beiträge der Kantone für Pflegematerial (pro Patient/Patientin und Tag) hätten stärkere Fehlanreize für die Leistungserbringer als differenzierte Vergütungssysteme (nach Patiententyp/Pflegematerial) und könnten die Versorgung beeinflussen. Die Qualität der angewendeten medizinischen Verbrauchsgüter könnte dadurch sinken und der Grundsatz «ambulant vor stationär» ausgehebelt werden. Aus Sicht der Leistungserbringer wäre damit zu rechnen, dass der finanzielle Druck ansteigt und dass Einsparungspotentiale konsequenter genutzt werden müssten, um das ökonomische Bestehen zu sichern

Lessons From the First Wave of COVID-19: Work-Related Consequences, Clinical Knowledge, Emotional Distress, and Safety-Conscious Behavior in Healthcare Workers in Switzerland

The coronavirus disease (COVID-19) imposes an unusual risk to the physical and mental health of healthcare workers and thereby to the functioning of healthcare systems during the crisis. This study investigates the clinical knowledge of healthcare workers about COVID-19, their ways of acquiring information, their emotional distress and risk perception, their adherence to preventive guidelines, their changed work situation due to the pandemic, and their perception of how the healthcare system has coped with the pandemic. It is based on a quantitative cross-sectional survey of 185 Swiss healthcare workers directly attending to patients during the pandemic, with 22% (n = 40) of them being assigned to COVID-19-infected patients. The participants answered between 16th June and 15th July 2020, shortly after the first wave of COVID-19 had been overcome and the national government had relaxed its preventive regulations to a great extent. The questionnaire incorporated parts of the “Standard questionnaire on risk perception of an infectious disease outbreak” (version 2015), which were adapted to the case of COVID-19. Clinical knowledge was lowest regarding the effectiveness of standard hygiene (p < 0.05). Knowledge of infectiousness, incubation time, and life-threatening disease progression was higher, however still significantly lower than regarding asymptomatic cases and transmission without physical contact (p < 0.001). 70% (95%-confidence interval: 64-77%) of the healthcare workers reported considerable emotional distress on at least one of the measured dimensions. They worried significantly more strongly about patients, elderly people, and family members, than about their own health (p < 0.001). Adherence to (not legally binding) preventive guidelines by the government displayed patterns such that not all guidelines were followed equally. Most of the participants were faced with a lack of protective materials, personnel, structures, processes, and contingency plans. An increase in stress level was the most prevalent among the diverse effects the pandemic had on their work situation. Better medical equipment (including drugs), better protection for their own mental and physical health, more (assigned) personnel, more comprehensive information about the symptoms of the disease, and a system of earlier warning were the primary lessons to be learned in view of upcoming waves of the pandemic

Lessons From the First Wave of COVID-19: Work-Related Consequences, Clinical Knowledge, Emotional Distress, and Safety-Conscious Behavior in Healthcare Workers in Switzerland

The coronavirus disease (COVID-19) imposes an unusual risk to the physical and mental health of healthcare workers and thereby to the functioning of healthcare systems during the crisis. This study investigates the clinical knowledge of healthcare workers about COVID-19, their ways of acquiring information, their emotional distress and risk perception, their adherence to preventive guidelines, their changed work situation due to the pandemic, and their perception of how the healthcare system has coped with the pandemic. It is based on a quantitative cross-sectional survey of 185 Swiss healthcare workers directly attending to patients during the pandemic, with 22% (n = 40) of them being assigned to COVID-19-infected patients. The participants answered between 16th June and 15th July 2020, shortly after the first wave of COVID-19 had been overcome and the national government had relaxed its preventive regulations to a great extent. The questionnaire incorporated parts of the “Standard questionnaire on risk perception of an infectious disease outbreak” (version 2015), which were adapted to the case of COVID-19. Clinical knowledge was lowest regarding the effectiveness of standard hygiene (p &lt; 0.05). Knowledge of infectiousness, incubation time, and life-threatening disease progression was higher, however still significantly lower than regarding asymptomatic cases and transmission without physical contact (p &lt; 0.001). 70% (95%-confidence interval: 64-77%) of the healthcare workers reported considerable emotional distress on at least one of the measured dimensions. They worried significantly more strongly about patients, elderly people, and family members, than about their own health (p &lt; 0.001). Adherence to (not legally binding) preventive guidelines by the government displayed patterns such that not all guidelines were followed equally. Most of the participants were faced with a lack of protective materials, personnel, structures, processes, and contingency plans. An increase in stress level was the most prevalent among the diverse effects the pandemic had on their work situation. Better medical equipment (including drugs), better protection for their own mental and physical health, more (assigned) personnel, more comprehensive information about the symptoms of the disease, and a system of earlier warning were the primary lessons to be learned in view of upcoming waves of the pandemic

Healthcare workers’ knowledge, risk perception, safety-relevant practices, and work situation during the COVID-19 pandemic: A quantitative survey from Switzerland

Objective: To determine the impact of the COVID-19 pandemic on healthcare workers and healthcare students in higher education and to assess their clinical knowledge, media use, risk perception, perception of governmental measures, and adherence to preventive guidelines to provide policymakers with field-based evidence.Methods: This cross-sectional quantitative survey was conducted by two-stage cluster sampling among Swiss healthcare workers, who performed patient care during the first pandemic wave, and who also pursued an education at a university of applied sciences at the same time (a Bachelor’s or Master’s degree in nursing or an executive degree in healthcare). 75 individuals participated between 5th May and 1st June 2020. Their data was analyzed by bivariate hypothesis testing and multiple logistic regression.Results: Considerable levels of task-related and emotional stress were prevalent, accompanied by a large proportion of respondents who did not have sufficient protective materials or necessary decisions in place to effectively protect themselves or others from infection with COVID-19. Knowledge was considerably limited, especially regarding the efficacy of standard hygiene as a preventive measure. The preparation of the government and the healthcare sector was perceived as insufficient.Conclusions: Comprehensive management of infodemic challenges and foresighted development of education, human resources, clinical processes, and protective materials are highly recommended

Healthcare workers’ knowledge, risk perception, safety-relevant practices, and work situation during the COVID-19 pandemic: A quantitative survey from Switzerland

Objective: To determine the impact of the COVID-19 pandemic on healthcare workers and healthcare students in higher education and to assess their clinical knowledge, media use, risk perception, perception of governmental measures, and adherence to preventive guidelines to provide policymakers with field-based evidence. Methods: This cross-sectional quantitative survey was conducted by two-stage cluster sampling among Swiss healthcare workers, who performed patient care during the first pandemic wave, and who also pursued an education at a university of applied sciences at the same time (a Bachelor’s or Master’s degree in nursing or an executive degree in healthcare). 75 individuals participated between 5th May and 1st June 2020. Their data was analyzed by bivariate hypothesis testing and multiple logistic regression. Results: Considerable levels of task-related and emotional stress were prevalent, accompanied by a large proportion of respondents who did not have sufficient protective materials or necessary decisions in place to effectively protect themselves or others from infection with COVID-19. Knowledge was considerably limited, especially regarding the efficacy of standard hygiene as a preventive measure. The preparation of the government and the healthcare sector was perceived as insufficient. Conclusions: Comprehensive management of infodemic challenges and foresighted development of education, human resources, clinical processes, and protective materials are highly recommended

Editorial: Statistical Relational Artificial Intelligence

n/

Impact evaluation of Swiss Medical Board reports on routine care in Switzerland : a case study of PSA screening and treatment for rupture of anterior cruciate ligament

Questions under Study: Evidence-based recommendations play an important role in medical decision-making, but barriers to adherence are common. In Switzerland, the Swiss Medical Board (SMB) publishes evidence reports that conclude with recommendations. We assessed the impact of two SMB reports on service provision (2009: Recommendation of conservative treatment as first option for rupture of the anterior cruciate ligament of the knee; 2011: Recommendation against PSA screening for prostate cancer). Methods: We performed an observational study and assessed quantitative data over time via interrupted times series analyses. The primary outcome was the quarterly number of performed prostate-specific antigen (PSA) tests and the annual rates of surgical ACL repair in patients with ACL rupture. Data were adjusted for time trends and relevant confounders. Results: We analysed PSA tests in 662,874 outpatients from 2005-2013 and treatment data in 101,737 patients with knee injury from 1990-2011. For the number of PSA tests, the secular trend before the intervention showed a continuous but diminishing increase over time. A statistically significant reduction in tests was estimated immediately after the intervention, but a later return to the trend before the intervention cannot be ruled out. The rate of surgical ACL repair had already declined after the late 1990s to about 55% in 2009. No relevant additional change emerged in this secular trend after the intervention. Conclusions: Despite some evidence of a possible change, we did not find a sustained and significant impact of SMB recommendations in our case study. Further monitoring is needed to confirm or refute these findings

Diurnal and semidiurnal cyclicity of Radon (222Rn) in groundwater, Giardino Spring, Central Apennines, Italy

Understanding natural variations of Rn (222Rn) concentrations is the fundamental prerequisite of using this radioactive gas as a tracer, or even precursor, of natural processes, including earthquakes. In this work, Rn concentrations in groundwater were continuously measured over a seven-month period, during 2017, in the Giardino Spring, Italy, together with groundwater levels in a nearby well installed into a fractured regional aquifer. Data were processed to reduce noise, and then analyzed to produce the Fourier spectra of Rn concentrations and groundwater levels. These spectra were compared with the spectrum of tidal forces. Results showed that diurnal and semidiurnal cycles of Rn concentrations, and filtered oscillations of groundwater levels, in the nearby well, are correlated with solar and luni-solar components of tidal forces, and suggested no correlation with the principal lunar components. Therefore, influencing factors linked to solar cycles, such as daily oscillations of temperature and atmospheric pressure, and related rock deformations, may have played a role in Rn concentrations and groundwater levels. An open question remains regarding the correlation, which is documented elsewhere, of Rn concentrations and groundwater levels with the lunar components of the solid Earth tides

Logic-Based Decision Support for Strategic Environmental Assessment

Strategic Environmental Assessment is a procedure aimed at introducing systematic assessment of the environmental effects of plans and programs. This procedure is based on the so-called coaxial matrices that define dependencies between plan activities (infrastructures, plants, resource extractions, buildings, etc.) and positive and negative environmental impacts, and dependencies between these impacts and environmental receptors. Up to now, this procedure is manually implemented by environmental experts for checking the environmental effects of a given plan or program, but it is never applied during the plan/program construction. A decision support system, based on a clear logic semantics, would be an invaluable tool not only in assessing a single, already defined plan, but also during the planning process in order to produce an optimized, environmentally assessed plan and to study possible alternative scenarios. We propose two logic-based approaches to the problem, one based on Constraint Logic Programming and one on Probabilistic Logic Programming that could be, in the future, conveniently merged to exploit the advantages of both. We test the proposed approaches on a real energy plan and we discuss their limitations and advantages.Comment: 17 pages, 1 figure, 26th Int'l. Conference on Logic Programming (ICLP'10