Ausserkantonale Hospitalisationen im Thurgau: Eine Studie der Dienstkreise Frauenfeld und Arbon-Romanshorn

Ausserkantonale Hospitalisationen (AKH) erzeugen, zumal seit die Kantone auch dafür Subventionsbeitrage entrichten müssen, erhebliche Kosten. Ziel unserer Umfrage bei 51 Thurgauer Hausärzten* war, die Beweggründe zu eruieren, ie Patienten veranlassen, sich ausserkantonal hospitalisieren zu lassen. Aus diesem Grund veranlassten wir im Frühling 2007 eine Ärzte- und von Februar bis September 2007 zudem eine Patientenbefragung

Medizinisches Callcenter im Nachtdienst, Teil 2: Die Wirkung auf die Befindlichkeit

Die Nächte stellen wohl die grösste Belastung der Ärzte2 im Notfalldienst dar, vor allem, nachdem wegen Überalterung Notfallkreise zusammengelegt werden mussten und damit der Druck auf den einzelnen Dienstarzt zugenommen hat. Die Dienstkreise Frauenfeld und Arbon–Romanshorn mit 30450 bzw. 37217 Einwohnern untersuchten, ob eine nächtliche Vortriagierung (22 bis 8 Uhr) der Anrufe durch ein medizinisches Callcenter die Dienstärzte entlasten könnte. Die Phase ohne Callcenter dauerte vom 1. 2. bis am 31. 5., jene mit vom 1. 6. bis 30. 9. 2007. 37 von 39 Ärzten nahmen an der Studie teil. Der Rücklauf der Fragebogen betrug 85 bis 92%. Die Ärzte äusserten eine verbesserte Schlaf- und Lebensqualität im Zusammenhang mit dem Notfalldienst und befürworteten den Callcentereinsatz tendenziell. Eine Beteiligung an den Kosten für das Callcenter lehnten sie jedoch allesamt ab. Die Anrufenden gaben sowohl den Dienstärzten als auch den Gesundheitsberatern des Callcenters gute Noten, beanstandeten aber den Tarif unserer 0900-Service-Nummern (CHF 1.93/min). Unsere Studie zeigt, dass eine Vortriagierung nächtlicher Anrufe im Notfalldienst von Patienten und Dienstärzten akzeptiert werden könnte

Medication incidents in primary care medicine: protocol of a study by the Swiss Federal Sentinel Reporting System.

BACKGROUND/RATIONALE: Patient safety is a major concern in healthcare systems worldwide. Although most safety research has been conducted in the inpatient setting, evidence indicates that medical errors and adverse events are a threat to patients in the primary care setting as well. Since information about the frequency and outcomes of safety incidents in primary care is required, the goals of this study are to describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. Label="METHODS AND ANALYSIS" ="METHODS"/> <AbstractText STUDY DESIGN AND SETTING: We will conduct a prospective surveillance study to identify cases of medication incidents among primary care patients in Switzerland over the course of the year 2015. PARTICIPANTS: Patients undergoing drug treatment by 167 general practitioners or paediatricians reporting to the Swiss Federal Sentinel Reporting System. INCLUSION CRITERIA: Any erroneous event, as defined by the physician, related to the medication process and interfering with normal treatment course. EXCLUSION CRITERIA: Lack of treatment effect, adverse drug reactions or drug-drug or drug-disease interactions without detectable treatment error. PRIMARY OUTCOME: Medication incidents. RISK FACTORS: Age, gender, polymedication, morbidity, care dependency, hospitalisation. STATISTICAL ANALYSIS: Descriptive statistics to assess type, frequency, seasonal and regional distribution of medication incidents and logistic regression to assess their association with potential risk factors. Estimated sample size: 500 medication incidents. LIMITATIONS: We will take into account under-reporting and selective reporting among others as potential sources of bias or imprecision when interpreting the results. ETHICS AND DISSEMINATION: No formal request was necessary because of fully anonymised data. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT0229537

Chronic conditions and multimorbidity in a primary care population: a study in the Swiss Sentinel Surveillance Network (Sentinella).

To provide estimates of the prevalence of chronic conditions in Swiss primary care. In total, 175 general practitioners (GP) or pediatricians (PED) reporting to the Swiss Sentinel Surveillance Network collected morbidity data. In 26,853 patient contacts, mean (± SD) age was 55.8 ± 21.6 or 6.1 ± 5.7 years (in GPs vs. PEDs, respectively) and 47% were males. In GP patients, median Thurgau Morbidity Index was 2 (IQR 1-3). The median numbers of chronic conditions and permanently used prescribed drugs were 2 (0-5) and 2 (1-4), respectively; in PEDs medians were 0. Out of all patients, 16.7 and 7.0% of the PED patients were hospitalized during the previous year; patients cared by family/proxies or community nurses were hospitalized significantly more often than patients living in homes (50.1 vs. 35.4%, OR 1.41, p < 0.001). Out of patients over 80 years of age, 51.5% were care dependent and 45.5% of the patients over 90 years were living in homes for the elderly. In a representative sample of Swiss primary care patients, a substantial part shows multimorbidity with a high prevalence of chronic diseases, multiple drug treatment, and care dependency. These data may serve to be compared with other patient groups or other primary care systems. Trial registration www.clinicaltrials.gov NCT0229537, national study registry www.kofam.ch SNCTP000001207