Gaps in continuity of care at the interface between primary care and specialized care: general practitioners’ experiences and expectations

Introduction: Discontinuity of care at the interface between inpatient and outpatient management can lead to increased morbidity and mortality. Appropriate communication and flow of information is indispensable to ensure continuity of care. Consequently, the aim of this study was to assess general practitioners’ (GPs) experiences of cooperation with a university hospital, as well as their needs and obvious barriers regarding an optimized information flow. Methods: A qualitative study was performed. In March 2011, 300 GPs from the Zurich Canton were invited to participate in two focus group meetings. Based on a review of the literature, an interview guide was created addressing two main issues. In the first part, experiences and barriers regarding cooperation with the university were explored. In the second part, needs and suggestions to improve cooperation were addressed. Results: Fifteen GPs participated in two focus groups. GPs complained that they have often not been adequately informed about ongoing treatments or appointments for their patients. GPs feel responsible for the continuity of care and wish to be more involved, especially in long-term treatment decisions or at the end of life. By not involving them, they stated, important information concerning patients’ medical history and social setting was not taken into account. Improvements are also required at discharge: GPs often do not receive important information about treatments in the hospital and further requirements within a reasonable time. Conclusion: Exchange of information between the hospital and the GP at admission and discharge is essential. However, at present, involvement during hospitalization of the patient is lacking. This includes the exchange of information after an unexpected clinical procedure and input from GPs when difficult clinical decisions are made, such as at the beginning or termination of long-term therapies

Attractiveness of medical disciplines amongst Swiss first-year medical students allocated to different medical education tracks: cross-sectional study

Background: As most countries, Switzerland is experiencing a shortage of physicians especially in general practice and new medical education tracks with respective focusses have been started in response. This study investigated Swiss medical students' career openness and attractiveness of different medical disciplines as well as the concordance of students' career intentions with assigned medical education tracks. Methods: Cross-sectional study surveying first year medical students assigned to four different Swiss medical education tracks with distinctive additional education focuses (ETH Zurich: medical technology and engineering, University of St. Gallen and University of Lucerne: primary healthcare and University of Zurich: no distinctive focus). Results: We surveyed 354 medical students (response rate across all included medical education tracks 71.1%), 64.8% female, mean age 20 years. Regarding career openness, we found that 52.8% of medical students had neither a strong commitment nor a strong reservation for any of the proposed career options and 17.0% had a strong commitment. Among medical disciplines, medical subspecialties were attractive to the largest part of students (inpatient subspecialties attractive for 71%, outpatient for 58%), attractiveness of general practice was moderate (30%), academic (22%) and industrial sector (17%) careers were least attractive. Proportions of medical students attracted to general practice were similar at medical education tracks with focus on primary healthcare compared to other medical education tracks (32.2% vs. 25.8%, p = 0.391). Conversely, proportions of medical students attracted to academic or industry careers were significantly higher at the ETH Zurich compared to other medical education tracks (37.2%, vs. 13.1%, p < 0.001 and 31.9%, vs. 8.8%, p < 0.001 respectively). Conclusion: While most first-year medical students were open to careers in many medical disciplines, attractiveness of disciplines varied strongly. Students attracted to academic or industrial careers accumulated at the medical education track with concordant teaching focus but students attracted to general practice did not accumulate at medical education tracks focused on primary healthcare. For medical education tracks with primary care teaching focus this is both a challenge and an opportunity to specifically counteract the shortage of general practitioners in Switzerland. Keywords: Career choice; Medical disciplines; Medical school; Medical students

Screening and prevention in Swiss primary care: a systematic review

BACKGROUND AND OBJECTIVES: Prevention is a challenging area of primary care. In Switzerland, little is known about attitudes to and performance of screening and prevention services in general practice. To implement prevention services in primary care it is important to know about not only potential facilitators but also barriers. Primary care encompasses the activities of general practitioners, including those with particular interest and/or specializations (eg, pediatrics, gynecology). The aim of this study was to review all studies with a focus on prevention services which have been conducted in Switzerland and to reveal barriers and facilitators for physicians to participate in any preventive measures. METHODS: The Cochrane Library, PubMed, EMBASE and BIOSIS were searched from January 1990 through December 2010. Studies focussing on preventive activities in primary care settings were selected and reviewed. The methodological quality of the identified studies was classified according to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement. RESULTS: We identified 49 studies including 45 descriptive studies and four randomised controlled trials (RCTs). Twelve studies addressed the prevention of epidemics, eleven out of them vaccinations. Further studies focused on lifestyle changes, physical activity counselling, smoking cessation, cardiovascular prevention and cancer screening. Perceived lack of knowledge/training and lack of time were the most commonly stated barriers. Motivation, feasibility and efficiency were the most frequently reported supporting factors for preventive activities. The methodological quality was weak, only one out of four RCTs met the applied quality criteria. CONCLUSION: Most studies focussing on screening and prevention activities in primary care addressed vaccination, lifestyle modification or cardiovascular disease prevention. Identified barriers and facilitators indicate a need for primary-care-adapted education and training which are easy to handle, time-saving and reflect the specific needs of general practitioners. If new prevention programs are to be implemented in general practices, RCTs of high methodological quality are needed to assess their impact

Perancangan Aplikasi Android Katalog Buku Dengan Fitur Barcode Scanner Menggunakan Google ML Kit

Teknologi Barcode Scanner&nbsp; merupakan teknologi lama dimana terdapat device khusus untuk melakukan scanning barcode&nbsp; atau QR Code.&nbsp; Namun apabila dikombinasikan dengan sebuah aplikasi ber-platform mobile khususnya Android, diperlukan sebuah teknologi khusus untuk mewadahinya yaitu teknologi Google ML Kit.&nbsp; Pada tulisan ini dijelaskan perancangan aplikasi katalog buku dengan fitur Barcode Scanner &nbsp;menggunakan Google ML Kit, dimana fitur Barcode Scanner&nbsp; tersebut digunakan untuk melakukan pencarian data katalog buku

Penerapan Algoritma Simple Moving Average Untuk Prediksi Data Time Series Dengan T-SQL Microsoft SQL Server

Microsoft SQL Server merupakan DBMS yang sangat populer, yang digunakan sebagai media penyimpanan data. Kemampuan Microsoft SQL Server sebenarnya tidak hanya pada kemampuan memanajemen penyimpanan data saja, namun juga dapat digunakan sebagai data analytic.&nbsp; Pada tulisan ini dijelaskan penerapan algoritma Simple Moving Average untuk prediksi data time series pada Microsoft SQL Server.&nbsp; Teknik pemrograman query yang dipakai adalah T-SQL (Transact SQL) yang merupakan teknik bawaan SQL Server dan didalamnya termasuk teknik – teknik pemrograman query seperti looping, selection dan lainnya.&nbsp; Algoritma Simple Moving Average berhasil diterapkan pada Microsoft SQL Server dan berhasil menghitung angka prediksi data aktual yang telah di-record-kan pada tabel database

Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study

To characterise in details a random sample of multimorbid patients in Switzerland and to evaluate the clustering of chronic conditions in that sample. 100 general practitioners (GPs) each enrolled 10 randomly selected multimorbid patients aged ≥18 years old and suffering from at least three chronic conditions. The prevalence of 75 separate chronic conditions from the International Classification of Primary Care-2 (ICPC-2) was evaluated in these patients. Clusters of chronic conditions were studied in parallel. The final database included 888 patients. Mean (SD) patient age was 73.0 (12.0) years old. They suffered from 5.5 (2.2) chronic conditions and were prescribed 7.7 (3.5) drugs; 25.7% suffered from depression. Psychological conditions were more prevalent among younger individuals (≤66 years old). Cluster analysis of chronic conditions with a prevalence ≥5% in the sample revealed four main groups of conditions: (1) cardiovascular risk factors and conditions, (2) general age-related and metabolic conditions, (3) tobacco and alcohol dependencies, and (4) pain, musculoskeletal and psychological conditions. Given the emerging epidemic of multimorbidity in industrialised countries, accurately depicting the multiple expressions of multimorbidity in family practices' patients is a high priority. Indeed, even in a setting where patients have direct access to medical specialists, GPs nevertheless retain a key role as coordinators and often as the sole medical reference for multimorbid patients

Eine Krankheit kommt selten allein – multimorbide Patienten beim Hausarzt

Was praktisch arbeitende Ärzte aus eigener Erfahrung wissen, wurde mit Hilfe der FIRE-Datenbank statistisch bewiesen: Ein grosser Anteil von Patienten in der Grundversorgung plagt sich nicht nur mit einem, sondern mit mehreren chronischen Leiden

Skill-mix: Ein Review fördert methodische Schwächen zutage

Die verstärkte Einbindung von Pflegefachpersonen in der Grundversorgung wird politisch auf allen Ebenen heiss diskutiert. Hausärzte Schweiz hat das Institut für Hausarztmedizin Zürich beauftragt, eine systematische Review durchzuführen, deren Ergebnisse ebenfalls Diskussionen anregen