Interprofessional Collaboration in Fall Prevention: Insights from a Qualitative Study

(1) Background and objective: to explore the experiences of Swiss health care providers involved in a community fall prevention pilot project on barriers and facilitations in interprofessional cooperation between 2016 and 2017 in three regions of Switzerland. (2) Methods: semi-structured interviews with health care providers assessed their perspective on the evaluation of jointly developed tools for reporting fall risk, continuous training of the health care providers, sensitizing media campaigns, and others. (3) Results: One of the project's strengths is the interprofessional continuous trainings. These trainings allowed the health care providers to extend their network of health care providers, which contributed to an improvement of fall prevention. Challenges of the project were that the standardization of the interprofessional collaboration required additional efforts. These efforts are time consuming and, for some categories of health care providers, not remunerated by the Swiss health care system. (4) Conclusions: On a micro and meso level, the results of the present study indicate that the involved health care providers strongly support interprofessional collaboration in fall prevention. However, time and financial constraints challenge the implementation. On a macro level, potential ways to strengthen interprofessional collaboration are a core element in fall prevention.

[Evaluation of a prostate cancer E‑health tutorial : Development and testing of the website prostata-information.ch]

BACKGROUND

Due to the multitude of therapy options, the treatment decision after diagnosis of localized prostate cancer is challenging. Compared to printed booklets, web-based information technology offers more possibilities to tailor information to patients' individual needs.

OBJECTIVES

To support the decision-making process as well as the communication with patients, we developed an online tutorial in a systematic process in the German-speaking part of Switzerland and then tested it in a pilot study. The study investigated users' satisfaction, the coverage of information needs, the preparation for decision making, and the subjective quality of the decision.

MATERIALS AND METHODS

Based on already existing information material, the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. Of these patients, 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS).

RESULTS AND CONCLUSION

Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (mean PDMS 75, standard deviation [SD] 23), they had low decisional conflict (mean DCS 9.6, SD 11), and almost no decisional regret (mean DRS 6.4, SD 9.6). Based on these findings, further use of the tutorial can be recommended.

Temporal change to self-rated health in the Swiss population from 1997 to 2012: the roles of age, gender, and education

OBJECTIVES

Our study aimed to describe the temporal changes in self-rated health status (SRH) from 1997 to 2012 in adults aged 25 to 84 residing in Switzerland, with a view to identifying groups at risk for declining health.

STUDY DESIGN

Secondary analysis of population-based cross-sectional health surveys.

METHODS

Data were collected from the cross-sectional, population-based, five-year Swiss Health Survey, from 1997, 2002, 2007 and 2012. A total of 63,861 individuals' data were included. Multilevel mixed-effect logistic regression analysis was employed to estimate the probability of very good and good health within the framework of a hierarchical cross-classified age-period-cohort model (HAPC), adjusting for education level, gender, civil status, smoking status and body mass index.

RESULTS

Individuals with higher education were substantially more likely than those with primary education to report good SRH (OR = 2.12; 95% CI = 1.93-2.33 for secondary education and OR = 3.79; 95% CI = 3.39-4.23 for tertiary education). The education effect depended on birth cohort and age: higher proportions of good SRH were reported by secondary (8%-17%) and tertiary (10%-22%) compared with primary educated individuals from the 1940 birth cohort onward; the proportion of secondary/tertiary (compared to primary) educated people reporting good SRH increased with age (by 10/11% at 45-50 years and 25/36% at 80-84 years). Gender health equality was achieved by the 1955 (primary educated) and 1960 (secondary educated) birth cohorts, while these women overtook men in reporting good SRH from the 1975 birth cohort onward. Tertiary educated younger women were significantly less likely to report good SRH than men but parity was achieved at around pension age. Similarly, gender inequality in those with primary and secondary education reduced in the younger ages to not be significant at around age 55, with women overtaking men from age 65.

CONCLUSIONS

Younger birth cohorts with lower education levels appear most vulnerable in terms of their SRH. The education effect cumulatively increases when attaining incrementally higher education levels. While women report lower health than men, gender inequality in SRH has declined and even reversed over time and is substantially linked to differences in educational status. Swiss public health strategies should particularly target the younger adults with only primary school education of both genders; for women, to combat health burdens in their early life, and men, to mitigate issues in their later life.

Older persons’ and their families’ experience with live-in foreign home care workers. A grounded theory study

Background: Live-in arrangements with migrant care workers have considerably increased over the last years since they allow older frail persons to age-in-place despite functional limitations. However, little is known about the ramifications live-in care arrangements for families. Aim: The aim of the study was to investigate families’ experience with live-in migrant care workers and indicators of quality from their perspective. Method: Constructivist grounded theory study with 22 families who were recruited via care agencies in the German-speaking part of Switzerland and participated in 29 individual or dyadic interviews. Results: Live-in care by migrant care workers has potentially positive ramifications for older persons and their families, but only so if families, first, reach a consensus about the need for the employment of migrant care workers; second, experience them as competent; and third, mutually forge relationships and negotiate daily life. A successful care arrangement occurs when there is a relational fit among those involved, which leaves families feeling cared for, safe and relieved. They experience a renewed stability in their family system, enriching relationships, and assuredness about the quality present in the care situation. Conclusions: A successful care arrangement is the result of relationships that have been actively created and a negotiated shared existence in a family-like network. It has a positive effect on the well-being of those receiving care and their family members. The family-like network needs competent support.

Individual Characteristics Associated with Blood Donation: A Cross-National Comparison of the German and Swiss Population between 1994 and 2010

OBJECTIVE

The aim of this study is to compare individual characteristics associated with blood donation in the German and Swiss population between 1994 and 2010.

METHODS

Population-based survey data from the Eurobarometer 1994 and 2009, the Swiss Health Survey 1997, and the Swiss Blood Donation Survey 2010 were used to compare age-adjusted percentages of German and Swiss adults ever having donated blood (n = 8,746). A multivariate logistic regression was applied to the pooled data to estimate odds ratios (OR).

RESULTS

Donor rates between 1994 and 2010 increased by 8.6% in Germany (p = 0.0045) and remained stable in Switzerland. The likelihood to report donating increased with age. Gender differences (OR = 2.85; p = 0.0000) and differences between education levels were more pronounced in Switzerland as compared to Germany (OR = 2.56; p = 0.0000 and OR = 2.73; p = 0.0010). Furthermore education differences were more marked in men in both countries (OR = 1.99; p = 0.0000 and OR = 1.68; p = 0.0140).

CONCLUSION

The blood establishments should intensify their efforts to motivate women and lower educated people to give blood. Our data suggest that population-based surveys could be a helpful tool to describe donor rates in different countries and to guide future recruitment strategies.

Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland

BACKGROUND

Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status.

METHODS

Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed cross-sectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU.

RESULTS

We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest.

CONCLUSION

Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care.

[Information needs of patients with prostate cancer. Pronounced differences between individuals after diagnosis of localised prostate carcinoma]

BACKGROUND

In the context of shared decision-making it is important to know more about information needs of prostate cancer patients. Therefore, this study investigates content and extent of these information needs.

MATERIAL AND METHODS

We surveyed 330 patients of 4 urological Clinics in Switzerland with a well-established written questionnaire between 3 and 24 months after their diagnosis of an early-stage prostate cancer. A total of 179 patients responded and 128 (39%) questionnaires were entered into final statistical analysis.

RESULTS

Patients expressed broad information needs and pronounced differences between individuals were observed. Each of the 92 questions presented was rated as "essential" by at least 18% of the patients. On average 50 questions were rated as 'essential'. One patient rated only four questions as 'essential' whereas another participant reported all 92 questions as being 'essential' to him.

CONCLUSIONS

Concerning patient education it is important to identify the individual information needs of each prostate cancer patient separately.

Need for weight management in Switzerland: findings from National Blood Pressure Week 2009

Background

The Swiss Health Survey (SHS) provides the only source of data for monitoring overweight and obesity in the general population in Switzerland. However, this survey reports body mass index (BMI) based on self-reported height and weight, and is therefore subject to measurement errors. Moreover, it is not possible to differentiate between overall and abdominal overweight. In this study, we aimed to gain a better understanding of the need for weight management in the general population of Switzerland by exploring and comparing prevalence rates of BMI and waist circumference (WC) based on physical measurements by trained observers, based on data from the 2009 National Blood Pressure Week (NBPW).

Methods

Sample selection was based on a one-stage cluster design. A total of 385 pharmacies representing 3,600 subjects were randomly selected from pharmacies participating in NBPW. BMI measures based on physical weight and height (NBPW) were compared with self-reported BMI measures from the SHS. BMI and WC measurements from NBPW were then used to produce population estimates of overweight and obesity.

Results

BMI-based overall prevalence of overweight and obesity was 43.6%, which was 4.7% higher than the value based on the respective SHS data. Overweight and obesity were more common in men (54.3%) than in women (33.5%). However, the overall prevalence of increased WC in the general population was estimated to be 64.4%, with more women (68.4%) than men (60.1%) exhibiting a WC above the threshold. The prevalence of subjects requiring weight management in the Swiss population remained high, even after adjusting WC for false positive and negative cases.

Conclusions

Firstly, it may be more appropriate for health promotion programs to address the wider group identified by WC, which includes subjects who need to reduce their weight, or gain no further weight. Secondly, the gender differences are reversed depending on the use of WC or BMI to identify subjects suitable for health promotion programs; more women than men are identified by WC, and more men than women using BMI. These differences should be accounted for in gender-specific health promotion programs.

Occupation, social support and quality of life in persons with schizophrenic or affective disorders

BACKGROUND

Most people suffering from severe mental illness (SMI) lack paid employment. This study investigates the relationship between work status and objective as well as subjective quality of life (QoL) in people with SMI.

METHODS

The sample consists of 261 subjects (102 women, 159 men) aged 35 (men) and 38 (women) years on average, of whom 158 suffer from a schizophrenic disorder (ICD-10: F2) and 103 were diagnosed as having an affective disorder (ICD-10: F3). Subjective QoL was assessed with the WHOQOL-BREF scale.

RESULTS

Subjects with an occupation in general have a larger social network at their disposal and receive more social support. With regard to income, few (12%) of the subjects with a job on the open labour market live below the poverty level, but many (28-38%) of those engaged in sheltered or other work-like activities do. Occupation ameliorates satisfaction with life domains referring to social integration (social relationships, environment), whereas the individual's well-being (psychological, physical) is hardly affected. Social support is an important mediator of the relationship between occupation and subjective QoL. Income is weakly and negatively related to subjective QoL.

CONCLUSIONS

Supportive relationships to colleagues at the workplace mainly explain the better subjective QoL of SMI people with an occupation. When designing specific employment possibilities for people with SMI, we should take notice of the social support dimension at the workplace. Mentally ill people have a substantial poverty risk, even when they are working. In particular, payment for sheltered work should be ameliorated.

Perceived stigmatization of mentally ill people and its consequences for the quality of life in a Swiss population

The awareness of social conceptions of mental illness is essential in understanding the social realities of people with mental illness. Labeling due to psychiatric hospitalization can have a powerful influence on people's life chances. Little is known about subjective perceptions of stigmatization and discrimination and the influence of these beliefs on the quality of life of mentally ill people. We used a psychiatric inpatient sample and a community sample to analyze and compare perception of stigmatization and discrimination. Both patients and community members believed that most people rejected former mental patients. Thus, attitudes toward mental illness have their source in the socialization of the individual and his or her cultural context rather than in the currently pathological state of those affected. In a multiple regression analysis, we showed that even if controlled for demographic and clinical factors, perceived devaluation and discrimination had a significant negative effect on the quality of life of the mentally ill people. For planning and implementing psychiatric treatment programs, it is important to be aware of social conceptions of mental disorder.

[A risk profile of the aggressive psychiatric inpatient: can it be identified?]

Violent behavior of psychiatric inpatients has grown in interest. Within the scope of a prospective study,patient assaults in six psychiatric hospitals of the Swiss Canton of Zurich were assessed during a period of 6 months, from November 1999 until May 2000. Three hundred eighty-eight of 5,251 inpatients (7.4%) were reported to act aggressively. The following risk factors for aggressive behavior were identified: male gender, younger age, unemployment, severity of mental illness, and rehospitalization. Psychiatric diagnosis was not related to aggressiveness. In spite of the detection of risk factors, a characteristic profile of aggressive psychiatric inpatients cannot be stated. Research should pay more attention to situation-specific cues for the aggressive behavior of such individuals.

[Employment situation of psychiatric in-patients with schizophrenic or affective disorders]

OBJECTIVE

This study is on employment on the competitive as well as the sheltered work market of psychiatric in-patients suffering from schizophrenia or affective disorders. Furthermore it investigates the importance of characteristics of disorder and of educational and vocational background as predictors of occupation.

METHODS

A sample of 251 in-patients participated in a structured interview during their hospitalization.

RESULTS

43 % of in-patients suffering from schizophrenia and 46 % suffering from affective disorders were employed on the competitive work market during the year before index-hospitalization. Many were without any occupation too because sheltered employment was rarely used and mostly by schizophrenics (17 % vs 4 % of persons with affective disorders). Predictors of employment are past vocational experiences, education, length of past hospitalization, psychiatric diagnosis and sex.

CONCLUSIONS

Results raise the question of deficits in providing with sheltered employment opportunities for the mentally ill and in particular for people suffering from affective disorders. Alternatives to these deficits are discussed.

Comparison of four groups of substance-abusing in-patients with different psychiatric comorbidity

OBJECTIVE

Comparisons of different groups of dual patients are rare, yet potential differences could have therapeutic implications. In this study, four groups of psychiatric in-patients with substance use disorder were compared to each other: patients with no psychiatric comorbidity, patients with comorbid schizophrenia and patients with affective and personality disorder.

METHOD

Apart from sociodemographic, therapy-related variables and a detailed survey of their substance use, all subjects were assessed with BPRS and SCL-90-R.

RESULTS

No differences were found in the patients' demography, psychosocial adjustment and substance consumption career. Significant differences were found in regard to some therapy variables reflecting adherence to treatment and global outcome and to the level of psychopathology.

CONCLUSION

Both substance use and comorbid psychiatric disorder have a variable impact on distinct areas of patients' general condition and functioning. The group with comorbid affective disorder appeared to be the most difficult to treat and the therapeutic approach to this disorder deserves reconsideration.

Effectiveness of inpatient drug detoxification: links between process and outcome variables

The Psychiatric University Hospital of Zürich offers a 2-week residential detoxification treatment program for patients abusing illegal drugs. 96 out of 160 patients were interviewed at three intervals: upon admission, on the 10th day of treatment, and about 1 month after leaving the clinic. Approximately 17% of the patients were completely abstinent 1 month after treatment. About 50% of the patients could give up the consumption of particular drugs. For around one third of the dependents, the drug consumption remained the same or had increased. The analysis of the predictors of drug consumption after treatment stresses the importance of the social integration of the dependents before detoxification as well as of characteristics of the treatment process (relapse, dropping out of treatment, and referral to a follow-up program).

[Who is rehospitalized in a psychiatric hospital? Psychiatric hospitalization rates and social indicators in the Zurich canton (Switzerland)]

There are two approaches in the research on the relation between social conditions and mental disorder: The ecological approach is concerned with characteristics of the social composition of a certain geographical area and their relation to the frequency of disorders, whereas for the individualistic view variables of the psychosocial background of the individual are of interest. This study is on the risk for psychiatric admission (first and re-admission). While considering variables of the social context of the community as well as of the background of the individual, it tries to take into account both the ecological and the individualistic view of the relationship between social conditions and (treated) mental disorder. The sample of the study includes data of 4021 psychiatric inpatients treated in 1997 in one of the seven psychiatric hospitals of the Swiss canton of Zurich as well as data of social context of the 171 communities of the canton of Zurich. The psychiatric first and re-admission rates of the community can be predicted by the following variables of its social context: 1. pro portion of foreigners, 2. urban character of the living area, 3. population density. Two other variables are of relevance only for the prediction of first admissions: 4. proportion of one-person households and 5. local tax rate. However, further results of the study show that correlations between variables of the social context and psychiatric admission rate of the community cannot be interpreted as risks for the individual.