Determinants associated with deprivation in multimorbid patients in primary care-A cross-sectional study in Switzerland

Deprivation usually encompasses material, social, and health components. It has been shown to be associated with greater risks of developing chronic health conditions and of worse outcome in multimorbidity. The DipCare questionnaire, an instrument developed and validated in Switzerland for use in primary care, identifies patients subject to potentially higher levels of deprivation. To identifying determinants of the material, social, and health profiles associated with deprivation in a sample of multimorbid, primary care patients, and thus set priorities in screening for deprivation in this population. Secondary analysis from a nationwide cross-sectional study in Switzerland. A random sample of 886 adult patients suffering from at least three chronic health conditions. The outcomes of interest were the patients' levels of deprivation as measured using the DipCare questionnaire. Classification And Regression Tree analysis identified the independent variables that separated the examined population into groups with increasing deprivation scores. Finally, a sensitivity analysis (multivariate regression) confirmed the robustness of our results. Being aged under 64 years old was associated with higher overall, material, and health deprivation; being aged over 77 years old was associated with higher social deprivation. Other variables associated with deprivation were the level of education, marital status, and the presence of depression or chronic pain. Specific profiles, such as being younger, were associated with higher levels of overall, material, and health deprivation in multimorbid patients. In contrast, patients over 77 years old reported higher levels of social deprivation. Furthermore, chronic pain and depression added to the score for health deprivation. It is important that GPs consider the possibility of deprivation in these multimorbid patients and are able to identify it, both in order to encourage treatment adherence and limit any forgoing of care for financial reasons

Multimorbidity: can general practitioners identify the health conditions most important to their patients? Results from a national cross-sectional study in Switzerland

Faced with patients suffering from more than one chronic condition, or multimorbidity, general practitioners (GPs) must establish diagnostic and treatment priorities. Patients also set their own priorities to handle the everyday burdens associated with their multimorbidity and these may be different from the priorities established by their GP. A shared patient-GP agenda, driven by knowledge of each other's priorities, would seem central to managing patients with multimorbidity. We evaluated GPs' ability to identify the health condition most important to their patients. Data on 888 patients were collected as part of a cross-sectional Swiss study on multimorbidity in family medicine. For the main analyses on patients-GP agreement, data from 572 of these patients could be included. GPs were asked to identify the two conditions which their patient considered most important, and we tested whether either of them agreed with the condition mentioned as most important by the patient. In the main analysis, we studied the agreement rate between GPs and patients by grouping items medically-related into 46 groups of conditions. Socio-demographic and clinical variables were fitted into univariate and multivariate models. In 54.9% of cases, GPs were able to identify the health condition most important to the patient. In the multivariate model, the only variable significantly associated with patient-GP agreement was the number of chronic conditions: the higher the number of conditions, the less likely the agreement. GPs were able to correctly identify the health condition most important to their patients in half of the cases. It therefore seems important that GPs learn how to better adapt treatment targets and priorities by taking patients' perspectives into account

Baseline characteristics of study population.

<p>¹The PHQ9 is a measure of depression and its severity (range 0 to 27) as a self-administered questionnaire, values between 0 and 4 are interpreted as minimal depressive symptoms not requiring specific treatment</p><p>²The total n for this variable is the number of eyes, i.e. 92 in the intervention group and 98 in the control group</p><p>³The VFQ-25 composite score ranges from 0 to 100 and is a measure of visual function specific quality of life, 0 represents the lowest quality of life, 100 the highest quality of life.</p><p>⁴The PACIC summary score ranges from 1 to 5 and is a measure of the chronic illness care concordance to the chronic care model from the patient’s perspective, 1 represents the lowest concordance, 5 represents the highest concordance.</p><p>*Welch Two Sample t-test, p = <0.05</p><p>Baseline characteristics of study population.</p

ETDRS visual acuity.

<p>Fig 2 shows outcome data for the ETDRS visual acuity through the study period. Point estimates are mean numbers of correctly identified letters, error bars represent 95% confidence intervals. The red line is for the intervention group, the black line is for the control group.</p

NEI VFQ-25 quality of life.

<p>Fig 4 shows the visual function specific quality of life measured by the NEIVFQ-25 composite score. Point estimates are mean values, error bars represent 95% confidence intervals. The red line is for the intervention group, the black line is for the control group.</p

Clinic visits at the ophthalmologists.

<p>Fig 5 are boxplots comparing the intervention versus the control groups with regard to the number of visits at the ophthalmologist because of W-AMD. The hinges are the first and third quartile, the horizontal line is the median, the whiskers extend from the hinges to the value within 1.5 times the IQR.</p

Optical coherence tomography retinal thickness.

<p>Fig 3 shows the optical coherence tomography (OCT) macular retinal thickness in micrometers. Point estimates are mean values, error bars represent 95% confidence intervals. The red line is for the intervention group, the black line is for the control group.</p

Within group mean changes and 95% confidence intervals in secondary outcomes.

<p>¹The VFQ-25 composite score ranges from 0 to 100 and is a measure of visual function specific quality of life, 0 represents the lowest quality of life, 100 the highest quality of life.</p><p>²The PACIC summary score ranges from 1 to 5 and is a measure of the chronic illness care concordance to the chronic care model from the patient’s perspective, 1 represents the lowest concordance, 5 represents the highest concordance.</p><p>Within group mean changes and 95% confidence intervals in secondary outcomes.</p

Flow Chart of the study.

<p>Fig 1 shows the flow chart of the study. The number of patients as well as the number of eyes with W-AMD is shown through the process.</p

Data_Sheet_3_Perceived dilemma between protective measures and social isolation in nursing homes during the COVID-19 pandemic: a mixed methods study among Swiss nursing home directors.pdf

BackgroundCoronavirus pandemic (COVID-19) particularly affected older adults, with the highest risks for nursing home residents. Stringent governmental protective measures for nursing homes unintendedly led to social isolation of residents. Nursing home directors (NDs) found themselves in a dilemma between implementing protective measures and preventing the social isolation of nursing home residents.ObjectivesThe objectives of this study were to describe protective measures implemented, to investigate NDs’ perception of social isolation and its burden for nursing home residents due to these measures, and to explore experiences of NDs in the context of the dilemma.MethodsCross-sectional embedded mixed-method study carried out by an online survey between April 27 and June 09, 2022, among NDs in the German-speaking part of Switzerland. The survey consisted of 84 closed-ended and nine open-ended questions. Quantitative findings were analyzed with descriptive statistics and qualitative data were evaluated using content analysis.ResultsThe survey was completed by 398 NDs (62.8% female, mean age 55 [48–58] years) out of 1′044 NDs invited.NDs were highly aware of the dilemma. The measures perceived as the most troublesome were restrictions to leave rooms, wards or the home, restrictions for visitors, and reduced group activities. NDs and their teams developed a variety of strategies to cope with the dilemma, but were burdened themselves by the dilemma.ConclusionAs NDs were burdened themselves by the responsibility of how to deal best with the dilemma between protective measures and social isolation, supportive strategies for NDs are needed.</p