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Jendly M, Santschi V, Von Wyl V, Chiolero A. [Digital environment and population health]. Rev Med Suisse 2024; 20:808-812. [PMID: 38630042 DOI: 10.53738/revmed.2024.20.870.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Health and risk of disease are determined by exposure to the physical, socio-economic, and political environment and to this has been added exposure to the digital environment. Our increasingly digital lives have major implications for people's health and its monitoring, as well as for prevention and care. Digital health, which encompasses the use of health applications, connected devices and artificial intelligence medical tools, is transforming medical and healthcare practices. Used properly, it could facilitate patient-centered, inter-professional and data-driven care. However, its implementation raises major concerns and ethical issues, particularly in relation to privacy, equity, and the therapeutic relationship.
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Affiliation(s)
- Mathieu Jendly
- Population Health Laboratory (#PopHealthLab), Université de Fribourg, 1700 Fribourg
| | - Valérie Santschi
- Institut et Haute école de la santé La Source, HES-SO Haute école spécialisée de Suisse occidentale, 1004 Lausanne
| | - Viktor Von Wyl
- Institute für Epidemiologie, Biostatistik und Prävention, Université de Zurich, 8001 Zurich
- Institut für Implementation Science in Health Care, Université de Zurich, 8001 Zurich
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), Université de Fribourg, 1700 Fribourg
- Observatoire valaisan de la santé, 1950 Sion
- School of Population and Global Health, McGill University, Montreal, QC H3A 0G4, Canada
- Berner Institut für Hausarztmedizin, Université de Berne, 3012 Berne
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2
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Arnould R, Kramer C, Santschi V. [Avoiding medication administration errors: feedback from Pepper robot assistance for double-checking]. Soins 2024; 69:10-15. [PMID: 38453391 DOI: 10.1016/j.soin.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Safety during drug administration remains a major concern in nursing, particularly when it comes to calculating doses. The Institut et Haute école de la santé La Source in Lausanne, in partnership with the Avatarion company, has set up a co-development project using the humanoid robot Pepper as an assistant for double-checking dose calculations. Feedback from test users has been positive, although there is room for improvement.
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Affiliation(s)
- Rémi Arnould
- Institut et Haute école de la santé La Source, HES-SO, Haute école spécialisée de Suisse occidentale, avenue Alexandre-Vinet 30, 1004 Lausanne, Suisse
| | - Céline Kramer
- Institut et Haute école de la santé La Source, HES-SO, Haute école spécialisée de Suisse occidentale, avenue Alexandre-Vinet 30, 1004 Lausanne, Suisse.
| | - Valérie Santschi
- Institut et Haute école de la santé La Source, HES-SO, Haute école spécialisée de Suisse occidentale, avenue Alexandre-Vinet 30, 1004 Lausanne, Suisse
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Guinat M, Staffoni L, Santschi V, Didier A, Gachoud D, Greppin-Bécherraz C. Evaluating the impact of a blended interprofessional education course on students' attitudes towards interprofessional education: a pre-post study. BMC Med Educ 2024; 24:204. [PMID: 38413938 PMCID: PMC10900638 DOI: 10.1186/s12909-024-05170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Since 2011, five educational and healthcare institutions have implemented a short interprofessional education (IPE) course to bring together undergraduates from five disciplines. To meet the logistical challenges of IPE implementation, more specifically, the large number of classrooms needed to gather students together and the need for human resources to guide learning activities, a face-to-face IPE course was redesigned into a blended (online and face-to-face collaborative learning activities) IPE course. In March 2023, 183 medical, 378 nursing, 46 radiologic technology, 69 physiotherapy, and 74 occupational therapy students participated in a one-day IPE blended course to learn interprofessional team functioning and dynamics, role clarification and responsibilities of other professions, and interprofessional communication skills. This study aimed to assess students' changes in attitudes towards IPE after being involved in a large-scale interprofessional blended learning course. METHODS A before-after study was conducted using a French translation of the validated questionnaire "University of West of England Interprofessional Questionnaire" (UWE-IP questionnaire). Students' attitudes towards interprofessional (IP) relationships and IP learning were measured before and after the course. In March 2023, two hundred fifty-six students from five professions answered two subscales of the UWE-IP questionnaire before and after the course (response rate 34%). RESULTS Students' attitudes towards IP relationships improved significantly after the course. The score on this subscale (min 8; max 24) changed from 11.18 (SD 2,67) before the course to 10,38 (SD 2,55) after the course, indicating a significant improvement in attitudes towards IP relationships (p < 0,001). More specifically, students had more positive attitudes on the item "I have a good understanding of the roles of different health and social care professionals." and the item "I feel that I am respected by people from other health and social care disciplines." after the course. A positive change in students' attitudes towards IP learning was observed, but the results were not significative. CONCLUSION A face-to-face IPE course redesigned as a blended course helped overcome existing challenges to implementing an IPE course. The results suggest a blended IPE course improves students' attitudes towards interprofessionality.
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Affiliation(s)
- M Guinat
- Department of Intensive Care Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
- Medical Education Unit of the School of Medicine FBM, University of Lausanne, Lausanne, Switzerland.
| | - L Staffoni
- Haute Ecole de Santé Vaud (HESAV), School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - V Santschi
- La Source, School of Nursing Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - A Didier
- Haute Ecole de Santé Vaud (HESAV), School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - D Gachoud
- Medical Education Unit of the School of Medicine FBM, University of Lausanne, Lausanne, Switzerland
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - C Greppin-Bécherraz
- Haute Ecole de Santé Vaud (HESAV), School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Jendly M, Santschi V, Tancredi S, Konzelmann I, Raboud L, Chiolero A. eHealth profile of patients with diabetes. Front Public Health 2023; 11:1240879. [PMID: 37655284 PMCID: PMC10466783 DOI: 10.3389/fpubh.2023.1240879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background Digital health technology can be useful to improve the health of patients with diabetes and to support patient-centered care and self-management. In this cross-sectional study, we described the eHealth profile of patients with diabetes, based on their use of digital health technology, and its association with sociodemographic characteristics. Methods We used data from the "Qualité Diabète Valais" cohort study, conducted in one region of Switzerland (Canton Valais) since 2019. Participants with type 1 or type 2 diabetes completed questionnaires on sociodemographic characteristics and on the use of digital health technology. We defined eHealth profiles based on three features, i.e., ownership or use of (1) internet-connected devices (smartphone, tablet, or computer), (2) mHealth applications, and (3) connected health tools (activity sensor, smart weight scale, or connected blood glucose meter). We assessed the association between sociodemographic characteristics and participants' eHealth profiles using stratified analyses and logistic regression models. Results Some 398 participants (38% women) with a mean age of 65 years (min: 25, max: 92) were included. The vast majority (94%) were Swiss citizens or bi-national and 68% were economically inactive; 14% had a primary level education, 51% a secondary level, and 32% a tertiary level. Some 75% of participants had type 2 diabetes. Some 90% of the participants owned internet-connected devices, 43% used mHealth applications, and 44% owned a connected health tool. Older age and a lower educational level were associated with lower odds of all features of the eHealth profile. To a lesser extent, having type 2 diabetes or not being a Swiss citizen were also associated with a lower use of digital health technology. There was no association with sex. Conclusion While most participants owned internet-connected devices, only about half of them used mHealth applications or owned connected health tools. Older participants and those with a lower educational level were less likely to use digital health technology. eHealth implementation strategies need to consider these sociodemographic patterns among patients with diabetes.
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Affiliation(s)
- Mathieu Jendly
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | | | - Leila Raboud
- Observatoire Valaisan de la Santé (OVS), Sion, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Observatoire Valaisan de la Santé (OVS), Sion, Switzerland
- School of Population and Global Health, McGill University, Montreal, QC, Canada
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Chiolero A, Santschi V. An interprofessional strategy can strengthen secondary prevention. BMJ 2023; 380:505. [PMID: 36878572 DOI: 10.1136/bmj.p505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, 1700 Fribourg, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Gastens V, Tancredi S, Kiszio B, Del Giovane C, Tsuyuki R, Paradis G, Chiolero A, Santschi V. Pharmacist care in hypertension management: systematic review of randomized controlled trials. Eur J Public Health 2022. [PMCID: PMC9594180 DOI: 10.1093/eurpub/ckac131.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. Our objective is to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on BP amongst hypertensive outpatients compared with usual care. One major focus is to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting. Methods In collaboration with a medical librarian, a systematic literature search was conducted for any article published up to 22.10.2021 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. The outcomes are the change in BP, BP at follow-up, or BP control. Results will be synthesized descriptively and, if appropriate, will be pooled across studies to perform meta-analysis. We published the study protocol in BMJ Open. Results A total of 1768 study records were identified by electronic database searching and loaded to the systematic review management software Covidence. After removal of duplicates, 1744 were independently screened based on title and abstract by two authors (VG, ST), and 242 full texts were evaluated. A total of 72 studies with 32641 patients are currently included for data extraction. These studies were published between 1973 and 2021 and conducted in different regions (North America: n = 34, Europe: n = 13, other: n = 25). The data extraction and analysis are ongoing. Results will be presented at the congress. Conclusions This systematic review provides updated evidence on the effect of pharmacist intervention on BP management. Heterogeneity in the effect of interventions will be carefully evaluated which will help the implementation of effective interventions in various healthcare settings. Key messages • Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. • This systematic review provides updated evidence on the effect of pharmacist intervention on blood pressure management.
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Affiliation(s)
- V Gastens
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Population Health Laboratory, University of Fribourg , Fribourg, Switzerland
| | - S Tancredi
- Population Health Laboratory, University of Fribourg , Fribourg, Switzerland
| | - B Kiszio
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts , Lausanne, Switzerland
| | - C Del Giovane
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Population Health Laboratory, University of Fribourg , Fribourg, Switzerland
| | - R Tsuyuki
- EPICORE Centre, University of Alberta , Edmonton, Canada
| | - G Paradis
- School of Population and Global Health, McGill University , Montreal, Canada
| | - A Chiolero
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Population Health Laboratory, University of Fribourg , Fribourg, Switzerland
- School of Population and Global Health, McGill University , Montreal, Canada
| | - V Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts , Lausanne, Switzerland
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Schütz N, Knobel SEJ, Botros A, Single M, Pais B, Santschi V, Gatica-Perez D, Buluschek P, Urwyler P, Gerber SM, Müri RM, Mosimann UP, Saner H, Nef T. A systems approach towards remote health-monitoring in older adults: Introducing a zero-interaction digital exhaust. NPJ Digit Med 2022; 5:116. [PMID: 35974156 PMCID: PMC9381599 DOI: 10.1038/s41746-022-00657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
Using connected sensing devices to remotely monitor health is a promising way to help transition healthcare from a rather reactive to a more precision medicine oriented proactive approach, which could be particularly relevant in the face of rapid population ageing and the challenges it poses to healthcare systems. Sensor derived digital measures of health, such as digital biomarkers or digital clinical outcome assessments, may be used to monitor health status or the risk of adverse events like falls. Current research around such digital measures has largely focused on exploring the use of few individual measures obtained through mobile devices. However, especially for long-term applications in older adults, this choice of technology may not be ideal and could further add to the digital divide. Moreover, large-scale systems biology approaches, like genomics, have already proven beneficial in precision medicine, making it plausible that the same could also hold for remote-health monitoring. In this context, we introduce and describe a zero-interaction digital exhaust: a set of 1268 digital measures that cover large parts of a person’s activity, behavior and physiology. Making this approach more inclusive of older adults, we base this set entirely on contactless, zero-interaction sensing technologies. Applying the resulting digital exhaust to real-world data, we then demonstrate the possibility to create multiple ageing relevant digital clinical outcome assessments. Paired with modern machine learning, we find these assessments to be surprisingly powerful and often on-par with mobile approaches. Lastly, we highlight the possibility to discover novel digital biomarkers based on this large-scale approach.
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Affiliation(s)
- Narayan Schütz
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Samuel E J Knobel
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Angela Botros
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Michael Single
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Bruno Pais
- LaSource School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Valérie Santschi
- LaSource School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Daniel Gatica-Perez
- Idiap Research Institute, Martigny, Switzerland.,School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Prabitha Urwyler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stephan M Gerber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René M Müri
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern, Switzerland
| | - Urs P Mosimann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern, Switzerland
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Chiolero A, Cullati S, Tancredi S, Méan M, Rodondi N, Raileanu LE, Santschi V. [From evidence to quality improvement to provide high value and patient centered care]. Rev Med Suisse 2022; 18:1402-1405. [PMID: 35822751 DOI: 10.53738/revmed.2022.18.790.1402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Evidence-based practice and quality improvement should be at the heart of healthcare and public health. However, their implementation remains insufficient which is reflected in Switzerland in the high frequency of low-value care, in the wide regional variation in care practices, and in the absence of quality monitoring for the majority of healthcare processes. It is necessary to strengthen the monitoring of quality, particularly that perceived by patients, to help strengthening high-value and patient centered care. Because data do not speak for themselves, it is critical to organize how to use indicators for decision.
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Affiliation(s)
- Arnaud Chiolero
- Laboratoire de santé des populations (#PopHealthLab), Université de Fribourg, 1700 Fribourg
- School of Population and Global Health, Université McGill, Montréal, Québec H3A 1G1
- Institut de médecine de famille de Berne (BIHAM), Université de Berne, 3012 Berne
| | - Stéphane Cullati
- Laboratoire de santé des populations (#PopHealthLab), Université de Fribourg, 1700 Fribourg
- Service qualité des soins, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Stefano Tancredi
- Laboratoire de santé des populations (#PopHealthLab), Université de Fribourg, 1700 Fribourg
| | - Marie Méan
- Service de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Nicolas Rodondi
- Institut de médecine de famille de Berne (BIHAM), Université de Berne, 3012 Berne
- Clinique universitaire de médecine interne, Hôpital de l'Île, Université de Berne, 3010 Berne
| | - Laura Elena Raileanu
- Haute École d'ingénierie et de gestion du canton de Vaud, HES-SO, 1401 Yverdon-les-Bains
| | - Valérie Santschi
- Institut et haute école de la santé La Source, HES-SO, 1004 Lausanne
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Gastens V, Kiszio B, Del Giovane C, Tsuyuki R, Paradis G, Chiolero A, Santschi V. Pharmacist interventions to improve hypertension management: protocol for a systematic review of randomised controlled trials. BMJ Open 2022; 12:e059399. [PMID: 35537793 PMCID: PMC9092164 DOI: 10.1136/bmjopen-2021-059399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hypertension management remains a major public health challenge in primary care. Innovative interventions to improve blood pressure (BP) control are needed. One approach is through community-based models of care with the involvement of pharmacists and other non-physician healthcare professionals. Our objective is to systematically review the evidence of the impact of pharmacist care alone or in collaboration with other healthcare professionals on BP among hypertensive outpatients compared with usual care. Because these interventions can be complex, with various components, the effect size may differ between the type of interventions. One major focus of our study will be to assess carefully the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting. METHODS AND ANALYSIS Systematic searches of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (Embase) and Central Register of Controlled Trials (CENTRAL) databases will be conducted. Randomised controlled trials assessing the effect of pharmacist interventions on BP among outpatients will be included. Examples for pharmacist interventions are patient education, feedback to physician and medication management. The outcome will be the change in BP or BP at follow-up or BP control. Results will be synthesised descriptively and, if appropriate, will be pooled across studies to perform meta-analyses. If feasible, we will also perform a network meta-analysis to compare interventions that have not been compared directly head-to-head by using indirect evidence. Heterogeneity in the effect will be evaluated through prespecified subgroup and stratified analyses, accounting notably for the type and intensity of interventions, patients' characteristics and healthcare setting. ETHICS AND DISSEMINATION Ethical approval is not required as the results will be drawn from currently available published literature. Outcomes of the review will be shared through peer-reviewed journal and used for implementation policy. PROSPERO REGISTRATION NUMBER CRD42021279751.
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Affiliation(s)
- Viktoria Gastens
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Blanche Kiszio
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Cinzia Del Giovane
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ross Tsuyuki
- Epicore Center, Department of Medicine, Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Gilles Paradis
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Cullati S, Quecke B, Graf Y, Epure AM, Santschi V, Chiolero A, Carmeli C. Caesarean section and offspring obesity in young adulthood. Obes Rev 2022; 23:e13423. [PMID: 35014158 DOI: 10.1111/obr.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Berenike Quecke
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Yannick Graf
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Adina-Mihaela Epure
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Cristian Carmeli
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Quecke B, Graf Y, Epure AM, Santschi V, Chiolero A, Carmeli C, Cullati S. Caesarean section and obesity in young adult offspring: Update of a systematic review with meta-analysis. Obes Rev 2022; 23:e13368. [PMID: 34585502 PMCID: PMC9286585 DOI: 10.1111/obr.13368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022]
Abstract
As compared with vaginal delivery (VD), caesarean section (CS) birth could be associated with increased risk of obesity in young adult offspring. We aimed to evaluate this association by updating data from a systematic review with meta-analysis of observational studies. From 3774 records identified in PubMed and Embase, we retained six studies and added five studies from the last systematic review, for a total of 11 studies. Crude estimates of the association were retrieved from nine cohort studies (n = 143,869), and maximally adjusted estimates were retrieved from eight cohort studies. Young adults born by CS had higher risk of obesity (body mass index [BMI] ≥ 30 kg/m2 ) than young adults born by VD, corresponding to a crude pooled risk ratio (RR) of 1.30 [95% confidence interval (CI) 1.13 to 1.50] and a maximally adjusted pooled RR of 1.22 [95% CI 1.02 to 1.46]. In a sensitivity analysis pooling, five studies that included maternal prepregnancy BMI, a major potential confounding factor, in the set of controlled covariates, the RR was 1.08 [95% CI 0.92 to 1.27]. We concluded that the association between CS and obesity in young adulthood was mostly explained by confounding from maternal prepregnancy BMI.
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Affiliation(s)
- Berenike Quecke
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Yannick Graf
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Adina-Mihaela Epure
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,School of Population and Global Health, McGill University, Montreal, Canada
| | - Cristian Carmeli
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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Abolhassani N, Castioni J, Santschi V, Waeber G, Marques-Vidal P. Trends and Determinants of Polypharmacy and Potential Drug-Drug Interactions at Discharge From Hospital Between 2009-2015. J Patient Saf 2021; 17:e1171-e1178. [PMID: 29557932 DOI: 10.1097/pts.0000000000000482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Polypharmacy (PP) and excessive polypharmacy (EPP) are increasingly common and associated with risk of drug-drug interactions (DDIs). We aimed to measure the trends and determinants of PP and DDIs among patients discharged from the Department of Internal Medicine of the Lausanne University Hospital. METHODS The retrospective study included 17,742 adult patients discharged between 2009 and 2015. Polypharmacy and EPP were defined as the concomitant prescription of five or more and ten or more drugs, respectively. Drug-drug interactions were defined as any combination of a drug metabolized by a cytochrome P450 or P-glycoprotein, and a drug considered as strong inductor or inhibitor of the corresponding enzyme was defined as a potential interaction. RESULTS Three most commonly classes of drugs prescribed were "alimentary tract and metabolism (including insulins)," "nervous system," and "blood and blood forming organs." Polypharmacy decreased from 45% in 2009 to 41% in 2015, whereas EPP increased from 40% to 46%. In 2015, 13% of patients received 15 or more drugs. Age, coming from other health care settings, higher Charlson Index, number of comorbidities, and quartiles of length of stay were significantly and independently associated with PP and EPP. The risk of having at least one DDI decreased from 67.0% (95% confidence interval = 64.8-69.0) in 2009 to 59.3% (57.6-62.0) in 2015 (P < 0.001). Multivariate analysis showed number of drugs (odds ratio and 95% confidence interval = 3.68 [3.3-4.1], 9.39 [8.3-10.6], and 20.5 [17.3-28.4] for [5-9], [10-14], and 15+ drugs, respectively), gastrointestinal disease (3.13 [2.73-3.58]), and cancer (1.37 [1.18-1.58]) to be positively associated, and lung (0.82 [0.74-0.90]) and endocrinological (0.62 [0.52-0.74]) diseases to be negatively associated with risk of DDI. CONCLUSIONS The pattern of drug prescription has changed and most prescribed groups increased during the study period. Excessive polypharmacy is increasing among hospital patients. The decrease in the overall risk of DDI could be due to an improved management of multidrug therapy.
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Affiliation(s)
- Nazanin Abolhassani
- From the Department of Medicine, Internal Medicine, Lausanne University Hospital
| | - Julien Castioni
- From the Department of Medicine, Internal Medicine, Lausanne University Hospital
| | - Valérie Santschi
- La Source, School of Nursing Sciences; University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Gérard Waeber
- From the Department of Medicine, Internal Medicine, Lausanne University Hospital
| | - Pedro Marques-Vidal
- From the Department of Medicine, Internal Medicine, Lausanne University Hospital
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13
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Chiolero A, Calbimonte JP, Manzo G, Alves B, Schumacher M, Gaillard S, Schaller P, Santschi V. [Leveraging data from electronic medical record to improve quality of outpatient care]. Rev Med Suisse 2021; 17:2056-2059. [PMID: 34817945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Healthcare providers need indicators to monitor the quality of ambulatory care by making the best use of routinely collected data ; the goal is to provide high-value, patient-centered, evidence-based, and data-informed health care. While it may seem simple to produce indicators via the electronic medical record (EMR), these data do not speak by themselves. Indeed, it is necessary to : a) make the data usable ; b) define relevant indicators ; and c) ensure the dissemination of these indicators to patients and healthcare providers. In this article, we explain how the EMR can be used to produce indicators of quality of ambulatory care, using the example of hypertension and diabetes.
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Affiliation(s)
- Arnaud Chiolero
- Laboratoire de santé des populations (#PopHealthLab), Université de Fribourg, 1700 Fribourg
- Observatoire valaisan de la santé (OVS), 1970 Sion
| | | | - Gaetano Manzo
- Unité e-Health, Institut informatique de gestion, HES-SO Valais, 3960 Sierre
| | | | - Michael Schumacher
- Unité e-Health, Institut informatique de gestion, HES-SO Valais, 3960 Sierre
| | | | | | - Valérie Santschi
- Institut et haute école de la santé La Source, HES-SO Haute école spécialisée de Suisse occidentale, 1004 Lausanne
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14
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Santschi V, Wuerzner G, Pais B, Chiolero A, Schaller P, Cloutier L, Paradis G, Burnier M. Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial. Front Cardiovasc Med 2021; 8:760662. [PMID: 34760950 PMCID: PMC8572997 DOI: 10.3389/fcvm.2021.760662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: We evaluated the effect on long term blood pressure (BP) of an interprofessional team-based care (TBC) intervention, involving nurses, pharmacists, and physicians, compared to usual care. Methods: We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC or usual care (UC). In the TBC group, nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle, support medication adherence, and provide health education for 6 months. After each visit, they wrote a report to the physician who could adjust antihypertensive therapy. The outcome was the intention-to-treat difference in mean daytime ambulatory blood pressure measurement (ABPM) and control (<135/85 mmHg) at 6 and 12 months. Results: Eighty-nine patients (60 men/29 women; mean (SD) age: 61(12) year) were randomized to TBC (n = 43) or UC (n = 46). At baseline, mean (SD) BP was 144(10)/90(8) mmHg and 147(12)/87(11) mmHg in the TBC and UC groups. At 6 months, the between-groups difference in daytime systolic ABPM was−3 mmHg [95% confidence interval (CI):−10 to +4; p = 0.45]; at 12 months, this difference was−7 mmHg [95% CI:−13 to−2; p = 0.01]. At 6 months, the between-groups difference in daytime diastolic ABPM was +2 mmHg [95% CI:−1 to +6; p = 0.20]; at 12 months, this difference was−2 mmHg [95% CI:−5 to +2; 0.42]. Upon adjustment for baseline covariates including baseline BP, the between-groups differences at 6 and 12 months were maintained. At 6 months, there was no difference in BP control. At 12 months, the TBC group tended to have a better control in systolic BP (p = 0.07) but not in diastolic BP (p = 0.33). Conclusion: While there was not significant effect on BP at 6 months of follow-up, the TBC intervention can help decrease long-term systolic BP among uncontrolled hypertensive patients.
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Affiliation(s)
- Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Bruno Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Gilles Paradis
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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15
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Anker D, Carmeli C, Zwahlen M, Rodondi N, Santschi V, Henchoz Y, Wolfson C, Chiolero A. How blood pressure predicts frailty transitions in older adults in a population-based cohort study: a multi-state transition model. Int J Epidemiol 2021; 51:1167-1177. [PMID: 34652417 PMCID: PMC9365628 DOI: 10.1093/ije/dyab210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
Background Low blood pressure (BP) is associated with frailty in older adults. Our aim was to explore how BP predicts transitions between frailty states. Methods We used data from the Lausanne cohort Lc65+, a population-based cohort of older adults randomly drawn from a population registry in Switzerland, in 2004, 2009 and 2014. BP was measured using a clinically validated oscillometric automated device and frailty was defined using Fried’s phenotype, every 3 years. We used an illness-death discrete multi-state Markov model to estimate hazard ratios of forward and backward transitions between frailty states (outcome) in relation to BP categories (predictor of interest) with adjustment for sex, age and antihypertensive medication (other predictors). Results Among 4200 participants aged 65–70 years (58% female) at baseline, 70% were non-frail, 27% pre-frail and 2.0% frail. Over an average follow-up of 5.8 years, 2422 transitions were observed, with 1575 (65%) forward and 847 (35%) backward. Compared with systolic BP (SBP) <130 mmHg, the hazard ratio (95% confidence interval) of the transition from non-frail to pre-frail was 0.86 (0.74 to 1.00) for SBP 130–150 mmHg, and 0.89 (0.74 to 1.06) for SBP ≥150 mmHg. Compared with SBP <130 mmHg, the hazard ratio of the transition from pre-frail to frail was 0.71 (0.50 to 1.01) for SBP 130–150 mmHg, and 0.90 (0.62 to 1.32) for SBP ≥150 mmHg. Diastolic BP was a weaker predictor of forward transitions. Conclusions BP categories had no strong relationship with either forward transitions or backward transitions in frailty states. If our findings are confirmed with greater precision and assuming a causal relationship, they would suggest that there is no well-defined optimal BP level to prevent frailty among older adults.
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Affiliation(s)
- Daniela Anker
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Cristian Carmeli
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology and Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
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16
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Schütz N, Saner H, Botros A, Pais B, Santschi V, Buluschek P, Gatica-Perez D, Urwyler P, Müri RM, Nef T. Contactless Sleep Monitoring for Early Detection of Health Deteriorations in Community-Dwelling Older Adults: Exploratory Study. JMIR Mhealth Uhealth 2021; 9:e24666. [PMID: 34114966 PMCID: PMC8235297 DOI: 10.2196/24666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/27/2021] [Accepted: 04/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Population aging is posing multiple social and economic challenges to society. One such challenge is the social and economic burden related to increased health care expenditure caused by early institutionalizations. The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes. Sleep is a key factor when it comes to overall health and many health issues manifest themselves with associated sleep deteriorations. Sleep quality and sleep disorders such as sleep apnea syndrome have been extensively studied using various wearable devices at home or in the setting of sleep laboratories. However, little research has been conducted evaluating the potential of contactless and continuous sleep monitoring in detecting early signs of health problems in community-dwelling older adults. Objective In this work we aim to evaluate which contactlessly measurable sleep parameter is best suited to monitor perceived and actual health status changes in older adults. Methods We analyzed real-world longitudinal (up to 1 year) data from 37 community-dwelling older adults including more than 6000 nights of measured sleep. Sleep parameters were recorded by a pressure sensor placed beneath the mattress, and corresponding health status information was acquired through weekly questionnaires and reports by health care personnel. A total of 20 sleep parameters were analyzed, including common sleep metrics such as sleep efficiency, sleep onset delay, and sleep stages but also vital signs in the form of heart and breathing rate as well as movements in bed. Association with self-reported health, evaluated by EuroQol visual analog scale (EQ-VAS) ratings, were quantitatively evaluated using individual linear mixed-effects models. Translation to objective, real-world health incidents was investigated through manual retrospective case-by-case analysis. Results Using EQ-VAS rating based self-reported perceived health, we identified body movements in bed—measured by the number toss-and-turn events—as the most predictive sleep parameter (t score=–0.435, P value [adj]=<.001). Case-by-case analysis further substantiated this finding, showing that increases in number of body movements could often be explained by reported health incidents. Real world incidents included heart failure, hypertension, abdominal tumor, seasonal flu, gastrointestinal problems, and urinary tract infection. Conclusions Our results suggest that nightly body movements in bed could potentially be a highly relevant as well as easy to interpret and derive digital biomarker to monitor a wide range of health deteriorations in older adults. As such, it could help in detecting health deteriorations early on and provide timelier, more personalized, and precise treatment options.
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Affiliation(s)
- Narayan Schütz
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hugo Saner
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Angela Botros
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Bruno Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | | | - Daniel Gatica-Perez
- Idiap Research Institute, Martigny, Switzerland.,École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - René M Müri
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
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17
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Chiolero A, Paradis G, Santschi V, Cullati S. [How to fight infodemic and health obscurantism]. Rev Med Suisse 2021; 17:538-540. [PMID: 33755364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Physicians, pharmacists and caregivers, as well as public health officials and citizens, must sort through the enormous amount of information circulating about the pandemic. This crisis is accompanied by a real « infodemic » via multiple media, digital and otherwise. Is circulating a mixture of reliable information but also of misinformation, fed by the obscurantism jeopardizing the implementation of interventions such as vaccination or mask-wearing. To address this infodemic, evidence-based and data-driven public health should be strengthened. Debuting rumors - « see something, say something » - and promoting credible information limit misinformation. Strengthening people's knowledge in population health science would also help.
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Affiliation(s)
- Arnaud Chiolero
- Laboratoire de santé des populations (#PopHealthLab), Université de Fribourg Hôpital cantonal, 1700 Fribourg
- Observatoire valaisan de la santé (OVS), 1950 Sion
- School of Population and Global Health, Université McGill, H3A 1A2 Montréal, QC, Canada
| | - Gilles Paradis
- School of Population and Global Health, Université McGill, H3A 1A2 Montréal, QC, Canada
| | - Valérie Santschi
- Institut et Haute École de la santé La Source, HES-SO Haute École spécialisée de Suisse occidentale, 1004 Lausanne
| | - Stéphane Cullati
- Laboratoire de santé des populations (#PopHealthLab), Université de Fribourg Hôpital cantonal, 1700 Fribourg
- Département de réadaptation et gériatrie, Université de Genève, 1211 Genève 4
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18
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Affiliation(s)
- Arnaud Chiolero
- Population Health Laboratory, University of Fribourg, 1700 Fribourg, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory, University of Fribourg, 1700 Fribourg, Switzerland
| | - Valérie Santschi
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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19
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Pais B, Buluschek P, DuPasquier G, Nef T, Schütz N, Saner H, Gatica-Perez D, Santschi V. Evaluation of 1-Year in-Home Monitoring Technology by Home-Dwelling Older Adults, Family Caregivers, and Nurses. Front Public Health 2020; 8:518957. [PMID: 33134236 PMCID: PMC7562920 DOI: 10.3389/fpubh.2020.518957] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Population aging is increasing the needs and costs of healthcare. Both frailty and the chronic diseases affecting older people reduce their ability to live independently. However, most older people prefer to age in their own homes. New development of in-home monitoring can play a role in staying independent, active, and healthy for older people. This 12-month observational study aimed to evaluate a new in-home monitoring system among home-dwelling older adults (OA), their family caregivers (FC), and nurses for the support of home care. Methods: The in-home monitoring system evaluated in this study continuously monitored OA's daily activities (e.g., mobility, sleep habits, fridge visits, door events) by ambient sensor system (DomoCare®) and health-related events by wearable sensors (Activity tracker, ECG). In the case of deviations in daily activities, alerts were transmitted to nurses via email. Using specific questionnaires, the opinions of 13 OA, 13 FC, and 20 nurses were collected at the end of 12-months follow-up focusing on user experience and the impact of in-home monitoring on home care services. Results: The majority of OA, FC, and nurses considered that in-home sensors can help with staying at home, improving home care and quality of life, preventing domestic accidents, and reducing family stress. The opinion tended to be more frequently favorable toward ambient sensors (76%; 95% CI: 61-87%) than toward wearable sensors (Activity tracker: 65%; 95% CI: 50-79%); ECG: 60%; 95% CI: 45-75%). On average, OA (74%; 95% CI: 46-95%) and FC (70%; 95% CI: 39-91%) tended to be more enthusiastic than nurses (60%; 95% CI: 36-81%). Some barriers reported by nurses were a fear of weakening of the relationship with OA and lack of time. Discussion/Conclusion: Overall, the opinions of OA, FC, and nurses were positively related to in-home sensors, with nurses being less enthusiastic about their use in clinical practice.
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Affiliation(s)
- Bruno Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | | | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Narayan Schütz
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Daniel Gatica-Perez
- Idiap Research Institute, Martigny, Switzerland.,School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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20
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Pais B, Wuerzner G, Chiolero A, Schaller P, Cloutier L, Paradis G, Burnier M, Santschi V. Team-based care intervention: views and perspectives from patients and healthcare professionals. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Blood pressure (BP) control is poor in European countries. Team-based care (TBC) intervention involving different healthcare professionals has the potential to improve BP control. Within a patient-centered approach, we evaluated patients' and healthcare professionals' opinion about a TBC intervention involving nurses, pharmacists, and physicians (MD).
Methods
As part of the TBC study, a pragmatic randomized controlled study to evaluate the impact of a TBC interprofessional intervention on BP control, we collected opinion of patients and team-based members (nurses, community pharmacists, and MD) at the end of study period using specific questionnaires. A mean TBC-satisfaction score was computed, assessing various aspects of the intervention, and ranged from 0 to 60, where a higher score represents a greater satisfaction.
Results
All patients (100%), pharmacists (100%), MD (92%) and nurses (80%) were satisfied with TBC intervention. Most patients considered that TBC can help improving BP control (92%), drug intake (71%), and lifestyle habits (84%). Furthermore, patients reported that TBC improved their relationship with nurses (66%), pharmacists (55%), and MD (50%). Patients also reported that their discussion with nurses (95%) and pharmacists (89%) helped improve medication intake. Healthcare professionals considered that TBC improve the quality of care (91%) and an added value for the management of chronic disease (79%). Mean TBC-satisfaction score was higher among MD [42 (SD: 9)] and pharmacists [45 (SD: 6)] compared with nurses [36 (SD: 9)].
Conclusions
Overall, patients and healthcare professionals were highly satisfied regarding TBC engaging different healthcare professionals in a primary care setting.
Key messages
TBC intervention seem to be well appreciated by patients and healthcare professionals. Favourable patients’ and healthcare professionals’ perspectives will help implementing TBC intervention.
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Affiliation(s)
- B Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - G Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - A Chiolero
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics, and Occupational, McGill University, Montreal, Canada
| | | | - L Cloutier
- Département des Sciences Infirmières, UQTR, Trois-Rivières, Canada
| | - G Paradis
- Department of Epidemiology, Biostatistics, and Occupational, McGill University, Montreal, Canada
| | - M Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - V Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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21
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Santschi V, Wuerzner G, Pais B, Chiolero A, Schaller P, Cloutier L, Paradis G, Burnier M. Team-based Care for Improving Hypertension Management Among Outpatients. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Innovative models of care are needed to reduce poor blood pressure (BP) control in European countries. The TBC-HTA study evaluated the effects of an interprofessional team-based care (TBC) intervention, involving nurses, community pharmacists, and physicians, on BP control compared to usual care.
Methods
We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Lausanne and Geneva, Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC (N = 46) or usual care (UC: N = 43). The TBC intervention was led over 6 months. Nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle and medication adherence, and provide health education. After each visit, they wrote a report with recommendations to the physician who could adjust antihypertensive therapy accordingly. The outcome was ambulatory BP measured at 6 and 12 months.
Results
A total of 60 men and 29 women [mean (SD) age: 61(12) year; mean (SD) number of antihypertensive drugs: 2 (1)] were included. At baseline, mean (SD) BP was 144(10)/90(8) and 147(12)/87(11) mmHg in the TBC and UC care groups. 76 patients were followed up to 12 months. At 6 months, the between-group difference in mean BP was -3/+2 mmHg [95% CI: -10 to + 5 / -2 to + 5]; BP control was 38% in the TBC group and 33% in the UC group, respectively. At 12 months, the between-group difference in mean BP was -8/-3 mmHg [95% CI: -14 to -1/-7 to + 1]; BP control was 34% in the TBC group and 20% in the UC group, respectively.
Conclusions
This TBC intervention helped long-term BP control among hypertensive outpatients in Switzerland. In line with recent European guidelines (ESC/ESH), this type of care should be more widely implemented.
Key messages
A TBC of hypertension helped control BP in a Swiss healthcare setting. Policymakers should evaluate how to implement such intervention.
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Affiliation(s)
- V Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - G Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - B Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - A Chiolero
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics, and Occupational, McGill University, Montreal, Canada
| | - P Schaller
- Cité générations, Cité générations, Onex, Switzerland
| | - L Cloutier
- Département des Sciences Infirmières, UQTR, Trois-Rivières, Canada
| | - G Paradis
- Department of Epidemiology, Biostatistics, and Occupational, McGill University, Montreal, Canada
| | - M Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
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Chiolero A, Rodondi N, Santschi V. High-value, data-informed, and team-based care for multimorbidity. Lancet Public Health 2020; 5:e84. [PMID: 32032562 DOI: 10.1016/s2468-2667(20)30007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Arnaud Chiolero
- Population Health Laboratory, University of Fribourg, Fribourg 1700, Switzerland; Institute of Primary Health Care, University of Bern, Bern, Switzerland; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Nicolas Rodondi
- Institute of Primary Health Care, University of Bern, Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Pais B, Buluschek P, Nef T, Schütz N, Saner H, Gatica D, Santschi V. In-home monitoring evaluation by home-dwelling older adults, caregivers and healthcare providers. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In Europe, population ageing is increasing the healthcare needs and costs. Both frailty and chronic diseases affecting older people reduce their ability to live independently. However, most older people prefer to age in their own homes. New development of in-home monitoring can play a role in staying independent, active and healthy. Our objective was to evaluate a new in-home monitoring system among home-dwelling older adults (OA), their family caregivers (FC), and their healthcare providers (HCP) for the support of home care.
Methods
The system continuously monitored OA’s daily activities (e.g., mobility, sleep habits, fridge visits, door events) at home by ambient sensor system (DomoCare®) and health-related events by wearable sensors (Fitbit®, ECG). In case of deviations in daily activities (e.g., changes in mobility), alerts were transmitted to HCP via email. Using specific questionnaires, the opinion of 13 OA, 13 FC, and 20 HCP were collected at the end of 12-month of follow-up focusing on their user experience and the impact of in-home monitoring on home care services.
Results
These preliminary results underlined that the majority of OA, FC, and HCP consider that in-home sensors can help staying at home, improving home care, reducing family stress, and preventing domestic accidents. The opinion tended to be more favourable toward ambient sensors (80%) than toward Fitbit® (67%) and ECG (64%). On average, OA (80%) and FC (73%) tended to be more enthusiast than HCP (63%). Some barriers reported by HCP were a fear of weakening of the relationship with OA and an excessive surveillance.
Conclusions
Overall, the opinion of OA, FC and HCP were positive related to in-home sensors, with HCP being more mixed about their use in clinical practice.
Key messages
In-home monitoring technologies seem to be generally well accepted. In-home monitoring technologies could be help facilitating home care of older people.
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Affiliation(s)
- B Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - T Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - N Schütz
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - H Saner
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - D Gatica
- Idiap Research Institute, Martigny, Switzerland
| | - V Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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24
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Anker D, Santos-Eggimann B, Zwahlen M, Santschi V, Rodondi N, Wolfson C, Chiolero A. Blood pressure in relation to frailty in older adults: A population-based study. J Clin Hypertens (Greenwich) 2019; 21:1895-1904. [PMID: 31661601 DOI: 10.1111/jch.13722] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/23/2023]
Abstract
In frail older adults, low blood pressure (BP) might be associated with worse health outcomes and hypertension management in this population is highly debated. Using data from a population-based study of older adults, we assessed the association between frailty and BP. We used data collected between 2014 and 2016 from 3157 participants aged between 67 and 80 years in the Lausanne cohort Lc65+. BP was measured three times at one visit, and frailty status was assessed based on Fried's phenotype model. We analyzed the cross-sectional association between BP and frailty by computing mean systolic and diastolic BP stratified by sex, age, and frailty and by fitting regression models. The average age of the participants was 73.3 (standard deviation [SD]: 4.1) years, and 59.1% were women. 34.1% were pre-frail, and 3.3% were frail. Mean BP was 135.1/76.3 mm Hg (SD 18.5/11.0). Age- and sex-adjusted systolic BP was on average lower by 2.8 mm Hg (95% confidence interval [CI]: 1.4-4.2) and 6.7 mm Hg (95% CI: 3.2-10.3) among pre-frail and frail compared to non-frail participants. Similar differences in mean diastolic BP across frailty status were found. Upon adjustment for antihypertensive treatment, the associations between frailty status and BP did not change substantially. Frail individuals had a substantially lower BP compared with non-frail older adults. Because low BP could be detrimental among frail older patients, our findings raise questions about hypertension management in this population and stress the need for additional evidence.
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Affiliation(s)
- Daniela Anker
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Valérie Santschi
- La Source, School of nursing sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada.,Population Health Laboratory, Department of Community Health, University of Fribourg, Fribourg, Switzerland
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25
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Pais B, Buluschek P, Nef T, Schütz N, Saner H, Gatica D, Santschi V. [New healthcare technologies to support home care of older people]. Rev Med Suisse 2019; 15:1407-1411. [PMID: 31411832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ageing of the Swiss population is increasing the healthcare needs and costs. Both frailty and chronic diseases affecting older people reduce their ability to live independently. However, the vast majority of older people want to continue living at home, while having a quality of life and receiving the best healthcare services. In this context, new connected healthcare technologies can be a relevant solution to facilitate home care of older people. In this article, we present the issues related to these technologies and, more particularly, to what extent they could contribute to home care of older people and be a benefit for patients and family caregivers, but also for physicians and other healthcare professionals. Finally, the fears and risks associated with these technologies, and the importance of scientifically assessing their usefulness are discussed.
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Affiliation(s)
- Bruno Pais
- Institut et Haute Ecole de la Santé La Source, HES-SO Haute école spécialisée de Suisse occidentale, Avenue Vinet 30, 1004 Lausanne
| | | | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Université de Berne, 3012 Berne
| | - Narayan Schütz
- ARTORG Center for Biomedical Engineering Research, Université de Berne, 3012 Berne
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research, Université de Berne, 3012 Berne
- Hôpital de l'Ile, 3010 Berne
| | | | - Valérie Santschi
- Institut et Haute Ecole de la Santé La Source, HES-SO Haute école spécialisée de Suisse occidentale, Avenue Vinet 30, 1004 Lausanne
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Anker D, Tsuyuki RT, Paradis G, Chiolero A, Santschi V. Pharmacists to improve hypertension management: Guideline concordance from North America to Europe. Can Pharm J (Ott) 2019; 152:180-185. [PMID: 31156731 DOI: 10.1177/1715163519839675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniela Anker
- Institute of Primary Health Care (BIHAM) (Anker, Chiolero), University of Bern, Switzerland.,EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.,the Department of Epidemiology, Biostatistics and Occupational Health (Paradis, Chiolero), McGill University, Montreal, Canada.,La Source, School of Nursing Sciences (Santschi), HES-SO University of Applied Sciences and Arts of Western Switzerland, Switzerland
| | - Ross T Tsuyuki
- Institute of Primary Health Care (BIHAM) (Anker, Chiolero), University of Bern, Switzerland.,EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.,the Department of Epidemiology, Biostatistics and Occupational Health (Paradis, Chiolero), McGill University, Montreal, Canada.,La Source, School of Nursing Sciences (Santschi), HES-SO University of Applied Sciences and Arts of Western Switzerland, Switzerland
| | - Gilles Paradis
- Institute of Primary Health Care (BIHAM) (Anker, Chiolero), University of Bern, Switzerland.,EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.,the Department of Epidemiology, Biostatistics and Occupational Health (Paradis, Chiolero), McGill University, Montreal, Canada.,La Source, School of Nursing Sciences (Santschi), HES-SO University of Applied Sciences and Arts of Western Switzerland, Switzerland
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM) (Anker, Chiolero), University of Bern, Switzerland.,EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.,the Department of Epidemiology, Biostatistics and Occupational Health (Paradis, Chiolero), McGill University, Montreal, Canada.,La Source, School of Nursing Sciences (Santschi), HES-SO University of Applied Sciences and Arts of Western Switzerland, Switzerland
| | - Valérie Santschi
- Institute of Primary Health Care (BIHAM) (Anker, Chiolero), University of Bern, Switzerland.,EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.,the Department of Epidemiology, Biostatistics and Occupational Health (Paradis, Chiolero), McGill University, Montreal, Canada.,La Source, School of Nursing Sciences (Santschi), HES-SO University of Applied Sciences and Arts of Western Switzerland, Switzerland
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27
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Rios-Leyvraz M, Bloetzer C, Chatelan A, Bochud M, Burnier M, Santschi V, Paradis G, Tabin R, Bovet P, Chiolero A. Sodium intake and blood pressure in children with clinical conditions: A systematic review with meta-analysis. J Clin Hypertens (Greenwich) 2018; 21:118-126. [DOI: 10.1111/jch.13436] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/25/2018] [Accepted: 10/12/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Magali Rios-Leyvraz
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Clemens Bloetzer
- Institute of Social and Preventive Medicine (ISPM); University of Bern; Bern Switzerland
| | - Angeline Chatelan
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension; Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Valérie Santschi
- La Source School of Nursing Sciences; University of Applied Sciences and Arts Western Switzerland; Lausanne Switzerland
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Quebec Canada
| | - René Tabin
- Department of Pediatrics; Hospital of Valais; Sion Switzerland
- Faculty of Medicine; University of Geneva; Geneva Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Quebec Canada
- Institute of Primary Health Care (BIHAM); Bern University; Bern Switzerland
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28
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Anker D, Santos-Eggimann B, Santschi V, Del Giovane C, Wolfson C, Streit S, Rodondi N, Chiolero A. Screening and treatment of hypertension in older adults: less is more? Public Health Rev 2018; 39:26. [PMID: 30186660 PMCID: PMC6120092 DOI: 10.1186/s40985-018-0101-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/06/2018] [Indexed: 02/16/2023] Open
Abstract
Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.
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Affiliation(s)
- Daniela Anker
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Brigitte Santos-Eggimann
- 2Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Cinzia Del Giovane
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christina Wolfson
- 4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sven Streit
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,5Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arnaud Chiolero
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,2Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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29
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Anker D, Santschi V, Chiolero A. Self-reported hypertension as a public health surveillance tool: Don't throw out the baby with the bathwater. J Clin Hypertens (Greenwich) 2018; 20:1215-1216. [PMID: 29900671 PMCID: PMC8031004 DOI: 10.1111/jch.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniela Anker
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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30
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Chiolero A, Tremblay S, Delmas P, Scherrer F, Wuerzner G, Burnier M, Santschi V. Interprofessional education in hypertension: foundation for a team-based care culture. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - S Tremblay
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - P Delmas
- La Source, School of Nursing Sciences, Lausanne, Switzerland
| | - F Scherrer
- La Source, School of Nursing Sciences, Lausanne, Switzerland
| | - G Wuerzner
- Lausanne University Hospital, Lausanne, Switzerland
| | - M Burnier
- Lausanne University Hospital, Lausanne, Switzerland
| | - V Santschi
- La Source, School of Nursing Sciences, Lausanne, Switzerland
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31
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Santschi V, Wuerzner G, Chiolero A, Burnand B, Schaller P, Cloutier L, Paradis G, Burnie M. Team-Based Care for Improving Hypertension management: the TBC-HTA randomized controlled study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - G Wuerzner
- Lausanne University Hospital, Lausanne, Switzerland
| | - A Chiolero
- Lausanne University Hospital, Lausanne, Switzerland
| | - B Burnand
- Lausanne University Hospital, Lausanne, Switzerland
| | - P Schaller
- Département des Sciences Infirmières, UQTR, Trois-Rivières, Canada
| | | | - G Paradis
- La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland, Lausanne, Switzerland
| | - M Burnie
- Lausanne University Hospital, Lausanne, Switzerland
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32
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Verloo H, Chiolero A, Kiszio B, Kampel T, Santschi V. Nurse interventions to improve medication adherence among discharged older adults: a systematic review. Age Ageing 2017; 46:747-754. [PMID: 28510645 DOI: 10.1093/ageing/afx076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/24/2017] [Indexed: 01/09/2023] Open
Abstract
Background discharged older adult inpatients are often prescribed numerous medications. However, they only take about half of their medications and many stop treatments entirely. Nurse interventions could improve medication adherence among this population. Objective to conduct a systematic review of trials that assessed the effects of nursing interventions to improve medication adherence among discharged, home-dwelling and older adults. Method we conducted a systematic review according to the methods in the Cochrane Collaboration Handbook and reported results according to the PRISMA statement. We searched for controlled clinical trials (CCTs) and randomised CCTs (RCTs), published up to 8 November 2016 (using electronic databases, grey literature and hand searching), that evaluated the effects of nurse interventions conducted alone or in collaboration with other health professionals to improve medication adherence among discharged older adults. Medication adherence was defined as the extent to which a patient takes medication as prescribed. Results out of 1,546 records identified, 82 full-text papers were evaluated and 14 studies were included-11 RCTs and 2 CCTs. Overall, 2,028 patients were included (995 in intervention groups; 1,033 in usual-care groups). Interventions were nurse-led in seven studies and nurse-collaborative in seven more. In nine studies, adherence was higher in the intervention group than in the usual-care group, with the difference reaching statistical significance in eight studies. There was no substantial difference in increased medication adherence whether interventions were nurse-led or nurse-collaborative. Four of the 14 studies were of relatively high quality. Conclusion nurse-led and nurse-collaborative interventions moderately improved adherence among discharged older adults. There is a need for large, well-designed studies using highly reliable tools for measuring medication adherence.
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Affiliation(s)
- Henk Verloo
- School of Health sciences, HES-SO Valais - Wallis, University of Applied sciences Western Switzerland, Chémin de l'Agasse 6, Sion, Switzerland
- La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- IUMSP, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Blanche Kiszio
- La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Thomas Kampel
- La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
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33
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Santschi V, Wuerzner G, Chiolero A, Burnand B, Schaller P, Cloutier L, Paradis G, Burnier M. Team-based care for improving hypertension management among outpatients (TBC-HTA): study protocol for a pragmatic randomized controlled trial. BMC Cardiovasc Disord 2017; 17:39. [PMID: 28109266 PMCID: PMC5251291 DOI: 10.1186/s12872-017-0472-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 12/22/2022] Open
Abstract
Background Blood pressure (BP) is poorly controlled among a large proportion of hypertensive outpatients. Innovative models of care are therefore needed to improve BP control. The Team-Based Care for improving Hypertension management (TBC-HTA) study aims to evaluate the effect of a team-based care (TBC) interprofessional intervention, involving nurses, community pharmacists and physicians, on BP control of hypertensive outpatients compared to usual care in routine clinical practice. Methods/design The TBC-HTA study is a pragmatic randomized controlled study with a 6-month follow-up which tests a TBC interprofessionnal intervention conducted among uncontrolled treated hypertensive outpatients in two ambulatory clinics and among seven nearby community pharmacies in Lausanne and Geneva, Switzerland. A total of 110 patients are being recruited and randomized to TBC (TBC: N = 55) or usual care group (UC: N = 55). Patients allocated to the TBC group receive the TBC intervention conducted by an interprofessional team, involving an ambulatory clinic nurse, a community pharmacist and a physician. A nurse and a community pharmacist meet patients every 6 weeks to measure BP, to assess lifestyle, to estimate medication adherence, and to provide education to the patient about disease, treatment and lifestyle. After each visit, the nurse and pharmacist write a summary report with recommendations related to medication adherence, lifestyle, and changes in therapy. The physician then adjusts antihypertensive therapy accordingly. Patients in the UC group receive usual routine care without sessions with a nurse and a pharmacist. The primary outcome is the difference in daytime ambulatory BP between TBC and UC patients at 6-month of follow-up. Secondary outcomes include patients’ and healthcare professionals’ satisfaction with the TBC intervention and BP control at 12 months (6 months after the end of the intervention). Discussion This ongoing study aims to evaluate the effect of a newly developed team-based care intervention engaging different healthcare professionals on BP control in a primary care setting in Switzerland. The results will inform policymakers on implementable strategies for routine clinical practice. Trial registration ClinicalTrials.gov registration: NCT02511093. Retrospectively registered on 28 July 2015.
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Affiliation(s)
- Valérie Santschi
- La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland, Av. Vinet 30, 1004, Lausanne, Switzerland. .,Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Lyne Cloutier
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
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34
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Roulet C, Bovet P, Brauchli T, Simeoni U, Xi B, Santschi V, Paradis G, Chiolero A. Secular trends in blood pressure in children: A systematic review. J Clin Hypertens (Greenwich) 2016; 19:488-497. [DOI: 10.1111/jch.12955] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/17/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Céline Roulet
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Thomas Brauchli
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Umberto Simeoni
- Department of Pediatrics; Lausanne University Hospital; Lausanne Switzerland
| | - Bo Xi
- Department of Epidemiology; School of Public Health; Shandong University; Jinan China
| | - Valérie Santschi
- La Source, School of Nursing Sciences; University of Applied Sciences Western Switzerland; Lausanne Switzerland
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Canada
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Canada
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Michaud L, Ludwig G, Berney S, Rodrigues S, Niquille A, Santschi V, Favre AS, Lange AC, Michels AA, Vrijens B, Bugnon O, Pilon N, Pascual M, Venetz JP, Stiefel F, Schneider MP. Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence? Pharm Pract (Granada) 2016; 14:822. [PMID: 28042353 PMCID: PMC5184375 DOI: 10.18549/pharmpract.2016.04.822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022] Open
Abstract
Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. Objective: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Methods: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Results: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Conclusion: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
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Affiliation(s)
- Laurent Michaud
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Gundula Ludwig
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Sylvie Berney
- General Psychiatry Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | | | - Anne Niquille
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | - Valérie Santschi
- Professor, La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland . Lausanne ( Switzerland ).
| | - Anne-Sophie Favre
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | | | - Annemieke A Michels
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | - Bernard Vrijens
- University of Liège , Belgium and Chief Science Officer, Westrock Healthcare. Visé ( Belgium ).
| | - Olivier Bugnon
- School of pharmaceutical sciences, University of Geneva, University of Lausanne , Switzerland and Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne. Lausanne ( Switzerland ).
| | - Nathalie Pilon
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Manuel Pascual
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Jean-Pierre Venetz
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Friedrich Stiefel
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Marie-Paule Schneider
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne , Switzerland and Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne . Lausanne ( Switzerland ).
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Affiliation(s)
- Valérie Santschi
- La Source School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Lausanne
| | - Ross T Tsuyuki
- La Source School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Lausanne
| | - Gilles Paradis
- La Source School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Lausanne
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Affiliation(s)
- A Chiolero
- Chronic Diseases Division, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - M Burnier
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - V Santschi
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.,La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
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Abstract
Overdiagnosis is the diagnosis of an abnormality that is not associated with a substantial health hazard and that patients have no benefit to be aware of. It is neither a misdiagnosis (diagnostic error), nor a false positive result (positive test in the absence of a real abnormality). It mainly results from screening, use of increasingly sensitive diagnostic tests, incidental findings on routine examinations, and widening diagnostic criteria to define a condition requiring an intervention. The blurring boundaries between risk and disease, physicians' fear of missing a diagnosis and patients' need for reassurance are further causes of overdiagnosis. Overdiagnosis often implies procedures to confirm or exclude the presence of the condition and is by definition associated with useless treatments and interventions, generating harm and costs without any benefit. Overdiagnosis also diverts healthcare professionals from caring about other health issues. Preventing overdiagnosis requires increasing awareness of healthcare professionals and patients about its occurrence, the avoidance of unnecessary and untargeted diagnostic tests, and the avoidance of screening without demonstrated benefits. Furthermore, accounting systematically for the harms and benefits of screening and diagnostic tests and determining risk factor thresholds based on the expected absolute risk reduction would also help prevent overdiagnosis.
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Affiliation(s)
- Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland
| | - Fred Paccaud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, Switzerland
| | - Valérie Santschi
- La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital, Switzerland
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Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffé P, Burnier M, Burnand B, Paradis G. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc 2014; 3:e000718. [PMID: 24721801 PMCID: PMC4187511 DOI: 10.1161/jaha.113.000718] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/10/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. METHODS AND RESULTS Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. CONCLUSIONS Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.
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Affiliation(s)
- Valérie Santschi
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.S., A.C., P.T., B.B.)
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland (V.S., M.B.)
- La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland (V.S.)
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.S., A.C., P.T., B.B.)
| | - April L. Colosimo
- McGill Library, Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada (A.L.C.)
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada (R.W.P., G.P.)
| | - Patrick Taffé
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.S., A.C., P.T., B.B.)
| | - Michel Burnier
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland (V.S., M.B.)
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.S., A.C., P.T., B.B.)
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada (R.W.P., G.P.)
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Santschi V, Paradis G. Evidence of Pharmacist Care to Prevent Cardiovascular Disease. Public Health Rep 2013; 128:352-3. [DOI: 10.1177/003335491312800503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Valérie Santschi
- Lausanne University Hospital, Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | - Gilles Paradis
- McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Canada
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Santschi V, Burnier M, Peytremann-Bridevaux I. [Do drug taking aids improve compliance?]. Praxis (Bern 1994) 2013; 102:807-808. [PMID: 23773941 DOI: 10.1024/1661-8157/a001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Valérie Santschi
- Institut Universitaire de Médecine Sociale et Préventive, CHUV et Université de Lausanne
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Chiolero A, Santschi V, Paccaud F. Public health surveillance with electronic medical records: at risk of surveillance bias and overdiagnosis. Eur J Public Health 2013; 23:350-1. [PMID: 23599219 DOI: 10.1093/eurpub/ckt044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arnaud Chiolero
- Institute of Social and Preventive Medicine, University Hospital Center, Lausanne, Switzerland.
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Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care 2012; 35:2706-17. [PMID: 23173140 PMCID: PMC3507563 DOI: 10.2337/dc12-0369] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis of randomized controlled trials (RCTs) assesses the effect of pharmacist care on cardiovascular disease (CVD) risk factors among outpatients with diabetes. RESEARCH DESIGN AND METHODS MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched. Pharmacist interventions were classified, and a meta-analysis of mean changes of blood pressure (BP), total cholesterol (TC), LDL cholesterol, HDL cholesterol, and BMI was performed using random-effects models. RESULTS The meta-analysis included 15 RCTs (9,111 outpatients) in which interventions were conducted exclusively by pharmacists in 8 studies and in collaboration with physicians, nurses, dietitians, or physical therapists in 7 studies. Pharmacist interventions included medication management, educational interventions, feedback to physicians, measurement of CVD risk factors, or patient-reminder systems. Compared with usual care, pharmacist care was associated with significant reductions for systolic BP (12 studies with 1,894 patients; -6.2 mmHg [95% CI -7.8 to -4.6]); diastolic BP (9 studies with 1,496 patients; -4.5 mmHg [-6.2 to -2.8]); TC (8 studies with 1,280 patients; -15.2 mg/dL [-24.7 to -5.7]); LDL cholesterol (9 studies with 8,084 patients; -11.7 mg/dL [-15.8 to -7.6]); and BMI (5 studies with 751 patients; -0.9 kg/m(2) [-1.7 to -0.1]). Pharmacist care was not associated with a significant change in HDL cholesterol (6 studies with 826 patients; 0.2 mg/dL [-1.9 to 2.4]). CONCLUSIONS This meta-analysis supports pharmacist interventions-alone or in collaboration with other health care professionals-to improve major CVD risk factors among outpatients with diabetes.
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Affiliation(s)
- Valérie Santschi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Chiolero A, Santschi V, Burnand B, Platt RW, Paradis G. Meta-analyses: with confidence or prediction intervals? Eur J Epidemiol 2012; 27:823-5. [DOI: 10.1007/s10654-012-9738-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
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Santschi V, Wuerzner G, Chiolero A, Burnand B, Paradis G, Burnier M. [Team-based care involving pharmacists and nurses to improve the management of hypertension]. Rev Med Suisse 2012; 8:1694-1698. [PMID: 23029981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Only half of hypertensive patients has controlled blood pressure. Chronic kidney disease (CKD) is also associated with low blood pressure control, 25-30% of CKD patients achieving adequate blood pressure. The Community Preventive Services Task Force has recently recommended team-based care to improve blood pressure control. Team-based care of hypertension involves facilitating coordination of care among physician, pharmacist and nurse and requires sharing clinical data, laboratory results, and medications, e.g., electronically or by fax. Based on recent studies, development and evaluation of team-based care of hypertensive patients should be done in the Swiss healthcare system.
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Affiliation(s)
- V Santschi
- Institut universitarie de médecine sociale et préventive, CHUV et Université de Lausanne.
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Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. ACTA ACUST UNITED AC 2011; 171:1441-53. [PMID: 21911628 DOI: 10.1001/archinternmed.2011.399] [Citation(s) in RCA: 230] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pharmacists may improve the clinical management of major risk factors for cardiovascular disease (CVD) prevention. A systematic review was conducted to determine the impact of pharmacist care on the management of CVD risk factors among outpatients. METHODS The MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist care interventions among outpatients with CVD risk factors. Two reviewers independently abstracted data and classified pharmacists' interventions. Mean changes in blood pressure, total cholesterol, low-density lipoprotein cholesterol, and proportion of smokers were estimated using random effects models. RESULTS Thirty randomized controlled trials (11,765 patients) were identified. Pharmacist interventions exclusively conducted by a pharmacist or implemented in collaboration with physicians or nurses included patient educational interventions, patient-reminder systems, measurement of CVD risk factors, medication management and feedback to physician, or educational intervention to health care professionals. Pharmacist care was associated with significant reductions in systolic/diastolic blood pressure (19 studies [10,479 patients]; -8.1 mm Hg [95% confidence interval {CI}, -10.2 to -5.9]/-3.8 mm Hg [95% CI,-5.3 to -2.3]); total cholesterol (9 studies [1121 patients]; -17.4 mg/L [95% CI,-25.5 to -9.2]), low-density lipoprotein cholesterol (7 studies [924 patients]; -13.4 mg/L [95% CI,-23.0 to -3.8]), and a reduction in the risk of smoking (2 studies [196 patients]; relative risk, 0.77 [95% CI, 0.67 to 0.89]). While most studies tended to favor pharmacist care compared with usual care, a substantial heterogeneity was observed. CONCLUSION Pharmacist-directed care or in collaboration with physicians or nurses improve the management of major CVD risk factors in outpatients.
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Affiliation(s)
- Valérie Santschi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Santschi V, Burnier M, Peytremann-Bridevaux I. [Do elderly hypertensive patients benefit from drug therapy?]. Praxis (Bern 1994) 2011; 100:731-732. [PMID: 21656501 DOI: 10.1024/1661-8157/a000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- V Santschi
- Institut de Médecine Sociale et Préventive, CHUV et Université de Lausanne
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Santschi V, Hullin R, Peytremann-Bridevaux I. [Can telemetry improve treatment of patients with heart failure? ]. Praxis (Bern 1994) 2011; 100:481-482. [PMID: 21484712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- V Santschi
- Institut de médecine sociale et préventive, CHUV et Université de Lausanne
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Santschi V, Lord A, Berbiche D, Lamarre D, Corneille L, Prud'homme L, Normandeau M, Lalonde L. Impact of collaborative and multidisciplinary care on management of hypertension in chronic kidney disease outpatients. Journal of Pharmaceutical Health Services Research 2011. [DOI: 10.1111/j.1759-8893.2011.00038.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Santschi V, Rodondi N, Bugnon O, Burnier M. Impact of electronic monitoring of drug adherence on blood pressure control in primary care: a cluster 12-month randomised controlled study. Eur J Intern Med 2008; 19:427-34. [PMID: 18848176 DOI: 10.1016/j.ejim.2007.12.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 11/04/2007] [Accepted: 12/18/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Poor long-term adherence is an important cause of uncontrolled hypertension. We examined whether monitoring drug adherence with an electronic system improves long-term blood pressure (BP) control in hypertensive patients followed by general practitioners (GPs). METHODS A pragmatic cluster randomised controlled study was conducted over one year in community pharmacists/GPs' networks randomly assigned either to usual care (UC) where drugs were dispensed as usual, or to intervention (INT) group where drug adherence could be monitored with an electronic system (Medication Event Monitoring System). No therapy change was allowed during the first 2 months in both groups. Thereafter, GPs could modify therapy and use electronic monitors freely in the INT group. The primary outcome was a target office BP<140/90 mmHg. RESULTS Sixty-eight treated uncontrolled hypertensive patients (UC: 34; INT: 34) were enrolled. Over the 12-month period, the likelihood of reaching the target BP was higher in the INT group compared to the UC group (p<0.05). At 4 months, 38% in the INT group reached the target BP vs. 12% in the UC group (p<0.05), and 21% vs. 9% at 12 months (p: ns). Multivariate analyses, taking account of baseline characteristics, therapy modification during follow-up, and clustering effects by network, indicate that being allocated to the INT group was associated with a greater odds of reaching the target BP at 4 months (p<0.01) and at 12 months (p=0.051). CONCLUSION GPs monitoring drug adherence in collaboration with pharmacists achieved a better BP control in hypertensive patients, although the impact of monitoring decreased with time.
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