General practitioners’ consultation counts and associated factors in Swiss primary care – A retrospective observational study

Rachamin, Yael; Meier, Rahel; Grischott, Thomas; Rosemann, Thomas; Markun, Stefan

doi:10.1371/journal.pone.0227280

Cited by 6 publications

(6 citation statements)

References 24 publications

(24 reference statements)

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“…In fact, the trend was similar in both DRG-groups for each age class, but the levels of costs and consultations depended on age. This is in line with other studies: [ 27 ] showed that an increase in the number of the elderly and infants, in the British population, led to a higher consultation rate of these 'extreme' age groups and [ 28 ] showed that, in Switzerland, an increase in consultation rates was associated with increasing age. In fact, the demand for primary care consultations is likely due to the accumulation of chronic conditions in the aging population [ 29 – 31 ].…”

Section: Discussionsupporting

confidence: 92%

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

et al. 2020

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Introduction In Switzerland, a nationwide Swiss Diagnosis related Groups (Swiss DRG) system for hospital reimbursement was introduced in 2012. However, the impact of DRG systems on primary care is still unclear with respect to number of consultations and costs. The aim of this study was to investigate the effect of the implementation of DRG on costs and volumes in the primary care sector, on a nationwide basis in Switzerland. Methods The study retrospectively analysed yearly data, from 2008 to 2014, of almost 60 Swiss health insurers that covered almost all Swiss general practitioners, with a total number of patients which represented approximately 76% of the Swiss population. GP consultations, total numbers and rates, and the relative costs reimbursed (TARMED tariff values) in the Swiss federal states, cantons, which already introduced a DRG-like system before 2012 (AP-DRG), were compared to the GP consultations and costs reimbursed in the other cantons (DRG-naive). Regression discontinuity design analysis and mixed regression models, at cantonal level, were performed to evaluate the effect of the nationwide implementation of the Swiss DRG on health care demand and costs in the primary care setting. Change in outcome level and yearly trend pattern difference between groups (AP-DRG vs. DRG-naive) were examined. Results Overall, the total number of GP consultations and the relative TARMED values increased from 2008 to 2014. In the DRG naive, 15 cantons: in 2008, the number of GP consultations were 13,114,126, with a TARMED value of 1,194,957,157 CHF, and in 2014, the GP consultation were 13,752,511, with a TARMED value of 1,513,861,260 CHF. In the AP-DRG group, 11 cantons, the total number of GP consultations increased from 8,787,646, in 2008, to 9,347,168 in 2014 and the TARMED value increased from 896,673,657 CHF in 2008, to 1,100,203,508 CHF in 2014. The yearly trend pattern of GP consultations and TARMED values, in the AP-DRG group, were not significantly different from the respective trends in the DRG- naive and, overall, no significant change was detected in consultations and costs trends before and after 2012. Discussion/Conclusion This study found no evidence of any effect of the introduction of the SwissDRG on the yearly trend of primary care consultations and costs. Nevertheless, potential negative impacts on vulnerable patients, as chronically ill patients, could not be excluded and further investigation is required.

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Section: Discussionsupporting

confidence: 92%

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

et al. 2020

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“…We performed all analyses using the statistical software package R (version 3.6.1) and considered p < 0.05 statistically significant for all tests [ 64 ]. For all analyses with specific GPs’ characteristics (e.g., age, gender, years in practice, consultations, type of practice), we used a validated dataset from 2018 [ 65 ] since differentiation between single and group GP practices is not yet possible in our database.…”

Section: Methodsmentioning

confidence: 99%

Time Trends and Factors Associated with Antibiotic Prescribing in Swiss Primary Care (2008 to 2020)

et al. 2020

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Antibiotic resistance (ABR) is a major threat to public health, and the majority of antibiotics are prescribed in the outpatient setting, especially in primary care. Monitoring antibiotic consumption is one key measure in containing ABR, but Swiss national surveillance data are limited. We conducted a retrospective cross-sectional study to characterise the patterns of antibiotic prescriptions, assess the time trends, and identify the factors associated with antibiotic prescribing in Swiss primary care. Using electronic medical records data, we analysed 206,599 antibiotic prescriptions from 112,378 patients. Based on 27,829 patient records, respiratory (52.1%), urinary (27.9%), and skin (4.8%) infections were the commonest clinical indications for antibiotic prescribing. The most frequently prescribed antibiotics were broad-spectrum penicillins (BSP) (36.5%), fluoroquinolones (16.4%), and macrolides/lincosamides (13.8%). Based on the WHO AWaRe classification, antibiotics were 57.9% Core-Access and 41.7% Watch, 69% of which were fluoroquinolones and macrolides. Between 2008 and 2020, fluoroquinolones and macrolides/lincosamides prescriptions significantly declined by 53% and 51%; BSP prescriptions significantly increased by 54%. Increasing patients’ age, volume, and employment level were significantly associated with antibiotic prescribing. Our results may inform future antibiotic stewardship interventions to improve antibiotic prescribing.

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“…The characteristics of the patients participating to the present study presented slightly lower level education, but similar age and health status compared to the general practitioners' patients of other Swiss studies. [43][44][45] T-tests analysing physician gender differences in empathy measures showed that most empathy measures (4/6) did not significantly differ between female and male physicians (Table 3). Nevertheless, female physicians selfrated their empathic concern significantly above male physicians, and male physicians were significantly more vocally synchronised with their patient compared to female physicians.…”

Section: Resultsmentioning

confidence: 97%

“…The patients participating in the present study had a slightly lower level of education on average, but similar age and health status compared with the general practice patients of other Swiss studies. 40 – 42 …”

Section: Resultsmentioning

confidence: 99%

Impact of physician empathy on patient outcomes: a gender analysis

Surchat

Carrard²,

Gaume

et al. 2021

Br J Gen Pract

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Background: Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and no study concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. Aim: To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation’s quality and trust in physician, and to determine whether this relationship is moderated by physician’s gender. Design and setting: Analysis of 61 primary care physicians’ empathy in relation to 244 patient experience questionnaires in French-speaking part of Switzerland. Method: Sixty-one physicians were videotaped with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded arousal. After the consultation, patients indicated their satisfaction, trust, and quality of the consultation. Results: Female physicians self-rated their empathic concern above their male counterparts, whereas male physicians were more synchronised to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was a man. Conclusion: Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes and could be used as a cost-effective proxy of relational quality.

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General practitioners’ consultation counts and associated factors in Swiss primary care – A retrospective observational study

Cited by 6 publications

References 24 publications

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

Time Trends and Factors Associated with Antibiotic Prescribing in Swiss Primary Care (2008 to 2020)

Impact of physician empathy on patient outcomes: a gender analysis

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