CoDiab-VD : Résultats du suivi 2019

La cohorte des patient·e·s diabétiques vaudois·es (CoDiab-VD) a été constituée dans le cadre du développement et de l’évaluation du Programme cantonal Diabète. Elle avait pour objectifs principaux de décrire la population de personnes diabétiques dans le canton de Vaud et d’évaluer leur prise en charge. Le premier recrutement des participant·e·s à CoDiab-VD a eu lieu en 2011-12, puis le second recrutement en 2017, permettant de comparer les résultats des deux cohortes de patient·e·s et d’accroitre le collectif. Les participant·e·s ont été suivis annuellement entre 2013 et 2017, puis chaque deux ans dès 2017. Le suivi 2019 représente ainsi le sixième suivi des personnes recrutées en 2011-12 et le premier de celles recrutées en 2017 (Figure 1). Bien que le Programme cantonal Diabète ait cessé d’exister en tant que tel à fin 2018, la cohorte CoDiab-VD et son financement continuent jusqu’à l’automne 2021

Brief survey on current Swiss hospitals satisfaction practices & Literature review on international large-scale initiatives evaluating inpatient satisfaction

The ANQ (Swiss National Association for Quality Development in Hospitals and Clinics) has been conducting annual satisfaction surveys for inpatients in acute care settings since 2011. Within a few years, similar surveys were developed and implemented in other settings, for parents of hospitalized children in acute hospitals, adult inpatients in rehabilitation and in psychiatric clinics. The implementation of patient surveys is a mandatory component of the National Measurement Plan to promote and maintain the quality of care in Swiss hospitals. The ANQ surveys are very brief and actually carried out once every two years during one to three months. The findings are used for monitoring temporal changes, for benchmarking among providers and are published in a transparent way to inform the public. However, the usefulness of these results for quality improvement in hospitals is somewhat limited because the selected questions are of a general nature and not suitable to identify precisely potential areas for improvement, a near real-time analysis is not possible and the limited collection period reduces the sample size for small hospital sites. Therefore, hospitals and clinics who would like to monitor and improve patient care have to carry out their own surveys. The purpose of this brief survey among Swiss hospitals and clinics was to make an inventory of existing satisfaction/care experiences surveys, to find out which instruments are used, which methods are applied, and how the findings of the surveys are used to improve inpatient care

Integrated care models in Swiss primary care : an embedded multiple case study

Rationale, Aimsand Objectives: Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient-centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face. Method: We used an embedded multiple case study design to describe in-depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within-case analysis followed by a cross-case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted. Results: Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging. Conclusion: The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice

Une enquête sur le bien-être au travail et l'intention de rester dans la profession

La cohorte SCOHPICA s’intéresse aux trajectoires des professionnel·le·s de la santé et aux raisons qui les conduisent à rester ou quitter leur poste ou leur profession. Ce projet a été lancé en automne 2022 dans le but de fournir des données précises sur la situation des professionnel·le·s de la santé en Suisse, dont les pharmacien·ne·s et assistant·e·s en pharmacie. Le projet a pour but de soutenir les acteurs de la santé et les décideurs dans la gestion du personnel et l’élaboration de politiques publiques

Nationwide implementation of the self-management program “Living well with COPD”: Process and effectiveness evaluation using a mixed-methods approach

Objective To evaluate the nationwide implementation of the “Living well with COPD” program by the Swiss Lung Association in various cantons in Switzerland. Methods For the process evaluation, we used qualitative (interview, focus group) and quantitative (questionnaires, documentation analysis) methods to assess the implementation outcomes reach, dose, fidelity and acceptability. For the effectiveness, we performed a pre-post analysis of patient data collected at baseline and program end (after 14 months). Results Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times and included 122 COPD patients. Patients’ attendance rate was 81% and coaches’ fidelity to protocol 94%. Acceptance and satisfaction of all involved persons was high. Integration of the coaches’ additional workload, uncertainties regarding roles and responsibilities and sustainable reimbursement were major challenges. Patients significantly improved in COPD specific quality of life and increased exercise capacity with on average 3.2 more repetitions in the 1-minute sit-to-stand test. Conclusion The program was successfully implemented throughout Switzerland with high acceptability and positive association with patients’ quality of life. Practice implications Our findings support the broader multiplication throughout Switzerland and serves the international community since it is one of the first nationwide implementations beyond study settings

O1-8 Evaluation of the implementation of the ‘Living well with COPD' self-management program in Switzerland

Background Self-management can improve health status and reduce hospitals admissions in patients with chronic obstructive pulmonary disease (COPD). The aim of this mixed-methods study was to evaluate the implementation of the ‘Living well with COPD’ self-management program, a nation-wide effort by the Swiss Lung Associations and the Swiss society of pulmonary medicine. Methods For the implementation evaluation we used qualitative (interviews, focus groups) and quantitative (questionnaires, documentation analysis) methods to assess indicators of the outcomes reach, dose, fidelity, acceptability and appropriateness of the program. To evaluate the effectiveness, we assessed exercise capacity (1-minute sit-to-stand test), disease specific quality of life (Chronic Respiratory Questionnaire CRQ), symptoms, health care utilisation and health behaviour including physical activity at baseline and at the end of the program (after 12 months). Results Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times during 1 year and included in total 122 COPD patients (mean age 69 years, 48% female). The patients' attendance rate and the coaches' fidelity to the protocol were high (81% and 94%, respectively). Overall, acceptance and satisfaction of all involved persons (patients, coaches, responsible persons from the Lung Associations) was very high; they particularly acknowledged the meaningfulness of the program. Challenges were sustainable funding, integration of the coaches' additional workload and uncertainties regarding roles and responsibilities. After 14 month, the patients did not just avoid a decline in exercise capacity and health status but significantly improved in the 1-minute sit-to-stand test (23.9 vs. 27.1 repetitions) and in 3 of 4 CRQ subscales (with 0.2-0.5 units). Conclusions The ‘Living well with COPD' program was successfully implemented despite a tight schedule and showed a remarkably positive impact of the COPD patients' health status. The insights of this study will support the broader multiplication of the program throughout Switzerland and also serves the international community since it is one of the first nation-wide implementations beyond study settings

Совместная работа в виртуальных средах с помощью проблемно-ориентированного обучения

El objetivo es potenciar una competencia crucial como es el trabajo colaborativo y en equipo de los alumnos mediante la utilización de entornos virtuales en el aprendizaje en las enseñanzas universitarias basado en problemas Resulta innegable que el trabajo en equipo y colaborativo fomenta la motivación de los estudiantes y favorece el aprendizaje, debido al propio efecto social que genera la pertenencia a un grupo. Contribuyendo, asimismo, al desarrollo de la capacidad de debate y argumentación, el razonamiento crítico y creativo o la organización de procesos de trabajo complejos, entre otras muchas competencias esenciales. El proyecto pone el foco en el trabajo colaborativo en entornos digitales dentro del aprendizaje basado en problemas y persigue favorecer un modelo de aprendizaje más participativo, mediante el uso de los recursos que nos ofrecen las nuevas tecnologías de la comunicación, aumentando la interacción de los estudiantes, incluso en entornos digitales. El trabajo colaborativo supone la creación de grupos integrados por varios estudiantes con, a priori, el mismo nivel formativo, y con una asunción compartida del liderazgo y la responsabilidad en el proceso de aprendizaje. El trabajo colaborativo se basa, además, en la autonomía de trabajo de sus integrantes que presentan funcionalidades y competencias heterogéneas, y que tienen que desarrollar y fortalecer elementos como la confianza, la comunicación, la gestión de conflictos y solución de problemas y la adopción de decisiones.The aim is to enhance a crucial competence such as collaborative and teamwork of students through the use of virtual environments in problem-based learning in university education. It is undeniable that team and collaborative work fosters students' motivation and favours learning, due to the very social effect that belonging to a group generates. It also contributes to the development of debate and argumentation skills, critical and creative reasoning or the organisation of complex work processes, among many other essential competences. The project focuses on collaborative work in digital environments within problem-based learning and aims to promote a more participatory learning model, through the use of the resources offered by new communication technologies, increasing student interaction, even in digital environments. Collaborative work involves the creation of groups made up of several students with, a priori, the same level of training, and with a shared assumption of leadership and responsibility in the learning process. Collaborative work is also based on the working autonomy of its members, who have heterogeneous functionalities and competences, and who have to develop and strengthen elements such as trust, communication, conflict management and problem solving and decision-making.L'obiettivo è quello di migliorare una competenza cruciale come il lavoro collaborativo e di gruppo degli studenti attraverso l'uso di ambienti virtuali nell'apprendimento basato su problemi nell'istruzione universitaria. È innegabile che il lavoro di gruppo e collaborativo promuova la motivazione degli studenti e favorisca l'apprendimento, proprio per l'effetto sociale che l'appartenenza a un gruppo genera. Contribuisce inoltre allo sviluppo delle capacità di discussione e argomentazione, del ragionamento critico e creativo o dell'organizzazione di processi di lavoro complessi, oltre a molte altre competenze essenziali. Il progetto si concentra sul lavoro collaborativo in ambienti digitali nell'ambito dell'apprendimento basato su problemi e mira a promuovere un modello di apprendimento più partecipativo, attraverso l'uso delle risorse offerte dalle nuove tecnologie di comunicazione, aumentando l'interazione degli studenti, anche in ambienti digitali. Il lavoro collaborativo prevede la creazione di gruppi composti da più studenti con, a priori, lo stesso livello di formazione e con un'assunzione condivisa di leadership e responsabilità nel processo di apprendimento. Il lavoro collaborativo si basa anche sull'autonomia di lavoro dei suoi membri, che hanno funzionalità e competenze eterogenee e devono sviluppare e rafforzare elementi come la fiducia, la comunicazione, la gestione dei conflitti, la risoluzione dei problemi e il processo decisionale.L'objectif est d'améliorer une compétence cruciale telle que le travail collaboratif et d'équipe des étudiants par l'utilisation d'environnements virtuels dans l'apprentissage par problème dans l'enseignement universitaire. Il est indéniable que le travail en équipe et en collaboration stimule la motivation des élèves et favorise l'apprentissage, en raison de l'effet social même que génère l'appartenance à un groupe. Elle contribue également au développement des capacités de débat et d'argumentation, du raisonnement critique et créatif ou de l'organisation de processus de travail complexes, parmi de nombreuses autres compétences essentielles. Le projet se concentre sur le travail collaboratif dans les environnements numériques dans le cadre de l'apprentissage par problèmes et vise à promouvoir un modèle d'apprentissage plus participatif grâce à l'utilisation des ressources offertes par les nouvelles technologies de communication, en augmentant l'interaction des étudiants, même dans les environnements numériques. Le travail collaboratif implique la création de groupes composés de plusieurs étudiants ayant, a priori, le même niveau de formation, et assumant ensemble le leadership et la responsabilité du processus d'apprentissage. Le travail collaboratif repose également sur l'autonomie de travail de ses membres, qui ont des fonctionnalités et des compétences hétérogènes, et qui doivent développer et renforcer des éléments tels que la confiance, la communication, la gestion des conflits, la résolution de problèmes et la prise de décision.Ziel ist es, durch den Einsatz virtueller Umgebungen beim problembasierten Lernen in der Hochschulbildung eine entscheidende Kompetenz wie die Zusammenarbeit und die Teamarbeit von Studierenden zu fördern. Es ist unbestreitbar, dass Team- und Kooperationsarbeit die Motivation der Schüler fördert und das Lernen begünstigt, und zwar aufgrund des sozialen Effekts, den die Zugehörigkeit zu einer Gruppe bewirkt. Sie trägt auch zur Entwicklung von Diskussions- und Argumentationsfähigkeiten, kritischem und kreativem Denken oder der Organisation komplexer Arbeitsprozesse bei, neben vielen anderen wichtigen Kompetenzen. Das Projekt konzentriert sich auf die kollaborative Arbeit in digitalen Umgebungen im Rahmen des problembasierten Lernens und zielt darauf ab, ein partizipativeres Lernmodell zu fördern, indem die von den neuen Kommunikationstechnologien gebotenen Ressourcen genutzt werden und die Interaktion zwischen den Studierenden auch in digitalen Umgebungen verstärkt wird. Bei der Zusammenarbeit werden Gruppen gebildet, die sich aus mehreren Studenten zusammensetzen, die von vornherein das gleiche Ausbildungsniveau haben und die gemeinsam die Leitung und Verantwortung für den Lernprozess übernehmen. Die Zusammenarbeit beruht auch auf der Arbeitsautonomie ihrer Mitglieder, die über heterogene Funktionen und Kompetenzen verfügen und Elemente wie Vertrauen, Kommunikation, Konfliktmanagement, Problemlösung und Entscheidungsfindung entwickeln und stärken müssen.O objectivo é reforçar uma competência crucial como a colaboração e o trabalho de equipa dos estudantes através da utilização de ambientes virtuais na aprendizagem baseada em problemas no ensino universitário. É inegável que o trabalho em equipa e em colaboração promove a motivação dos estudantes e favorece a aprendizagem, devido ao próprio efeito social que a pertença a um grupo gera. Também contribui para o desenvolvimento de capacidades de debate e argumentação, de raciocínio crítico e criativo ou para a organização de processos de trabalho complexos, entre muitas outras competências essenciais. O projecto centra-se no trabalho colaborativo em ambientes digitais no âmbito da aprendizagem baseada em problemas e visa promover um modelo de aprendizagem mais participativo através da utilização dos recursos oferecidos pelas novas tecnologias de comunicação, aumentando a interacção dos estudantes, mesmo em ambientes digitais. O trabalho colaborativo envolve a criação de grupos compostos por vários estudantes com, a priori, o mesmo nível de formação, e com uma assunção partilhada de liderança e responsabilidade no processo de aprendizagem. O trabalho colaborativo baseia-se também na autonomia de trabalho dos seus membros, que têm funcionalidades e competências heterogéneas, e que têm de desenvolver e reforçar elementos tais como confiança, comunicação, gestão de conflitos e resolução de problemas e tomada de decisões.Цель - повысить такую важную компетенцию, как совместная и командная работа студентов посредством использования виртуальных сред в проблемно-ориентированном обучении в университетском образовании. Неоспоримо, что командная и совместная работа повышает мотивацию учащихся и способствует обучению, благодаря тому самому социальному эффекту, который порождает принадлежность к группе. Она также способствует развитию навыков ведения дискуссий и аргументации, критического и творческого мышления или организации сложных рабочих процессов, а также многих других важных компетенций. Проект сосредоточен на совместной работе в цифровой среде в рамках проблемно-ориентированного обучения и направлен на продвижение модели обучения с более широким участием, посредством использования ресурсов, предлагаемых новыми коммуникационными технологиями, увеличивая взаимодействие студентов даже в цифровой среде. Совместная работа предполагает создание групп, состоящих из нескольких студентов, имеющих априори одинаковый уровень подготовки, и совместно принимающих на себя руководство и ответственность в процессе обучения. Совместная работа также основана на рабочей автономии ее членов, которые обладают разнородными функциональными возможностями и компетенциями, и которые должны развивать и укреплять такие элементы, как доверие, коммуникация, управление конфликтами, решение проблем и принятие решений.Depto. de Derecho del Trabajo y Seguridad SocialFac. de DerechoFALSEUniversidad Complutense de Madridsubmitte