A5005722801- Health and Medical Studies
- Health Systems, Economic Evaluations, Quality of Life
- Chronic Disease Management Strategies
- Pharmaceutical Practices and Patient Outcomes
- Medication Adherence and Compliance
- Primary Care and Health Outcomes
- Blood Pressure and Hypertension Studies
- Healthcare Systems and Practices
- COVID-19 and healthcare impacts
- Healthcare cost, quality, practices
- Global Health Workforce Issues
- Patient-Provider Communication in Healthcare
- Diversity and Career in Medicine
- Dementia and Cognitive Impairment Research
- Clinical practice guidelines implementation
- Social and Demographic Issues in Germany
- Medical Practices and Rehabilitation
- Health, Medicine and Society
- Diabetes Management and Education
- Innovations in Medical Education
- Pharmaceutical studies and practices
- Palliative Care and End-of-Life Issues
- Global Cancer Incidence and Screening
- Interprofessional Education and Collaboration
- Medical and Health Sciences Research
University of Bern
2016-2025
Solothurner Spitäler
2020-2024
Primary Health Care
2017-2024
Centre universitaire de médecine générale et santé publique, Lausanne
2024
Kantonsspital Baden
2024
University of Lausanne
2024
The University of Sydney
2023
Lindenhofspital
2015-2023
Dr. A. Ramachandran's Diabetes Hospitals
2019-2022
Primary HealthCare
2022
In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not frailty despite high prevalence in oldest-old. This may lead variation how General Practitioners (GPs) treat hypertension. Our aim was investigate treatment GPs oldest-olds across countries identify role that...
the appropriateness of lowering systolic blood pressure remains controversial in oldest-old. We tested whether is associated with all-cause mortality and change cognitive function for patients prescribed antihypertensive treatment those without treatment. we studied participants population-based Leiden 85-plus cohort study. Baseline use were predictors; measured using Mini-Mental State Examination outcomes. Grip strength was as a proxy physical frailty. used Cox proportional hazards...
To study the effects of a primary care medication review intervention centred around an electronic clinical decision support system (eCDSS) on appropriateness and number prescribing omissions in older adults with multimorbidity polypharmacy compared discussion about line usual care.Cluster randomised trial.Swiss care, between December 2018 February 2021.Eligible patients were ≥65 years age three or more chronic conditions five long term medications.The to optimise pharmacotherapy eCDSS was...
Importance Better understanding of patients’ attitudes toward deprescribing specific medications will inform future interventions. Objective To investigate older adults’ by investigating which they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, Participants This survey study was conducted from May 2022 December 2023 primary care settings 14 countries. Patients aged 65 years or taking 5 more were consecutively...
Multimorbidity and polypharmacy are very common in older adults primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging deprescribe given time constraints few recommendations from guidelines. Further, patient related barriers enablers deprescribing have be accounted for. The aim of this study was as reported by with multimorbidity.We conducted a...
Abstract Background General practitioners (GPs) play a key role in managing the COVID-19 outbreak. However, they may encounter difficulties adapting their practices to pandemic. We provide here an analysis of guidelines for reorganisation GP surgeries during beginning pandemic from 15 countries. Methods A network GPs collaborated together three-step process: (i) identification recommendations surgery reorganisation, according WHO, CDC and health professional resources care facilities; (ii)...
Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) appropriateness of and (3) implementation prescribing recommendations generated by electronic decision support system tested ‘Optimising PharmacoTherapy In Multimorbid Elderly Primary CAre’ (OPTICA) trial. Design A longitudinal sub-study OPTICA trial, a cluster randomised controlled Setting Swiss primary care settings. Participants were...
To characterise in details a random sample of multimorbid patients Switzerland and to evaluate the clustering chronic conditions that sample.100 general practitioners (GPs) each enrolled 10 randomly selected aged ≥18 years old suffering from at least three conditions. The prevalence 75 separate International Classification Primary Care-2 (ICPC-2) was evaluated these patients. Clusters were studied parallel.The final database included 888 Mean (SD) patient age 73.0 (12.0) old. They suffered...
Introduction Multimorbidity and polypharmacy are important risk factors for drug-related hospital admissions (DRAs). DRAs often linked to prescribing problems (overprescribing underprescribing), as well non-adherence with drug regimens different reasons. In this trial, we aim assess whether a structured medication review compared standard care can reduce in multimorbid older patients polypharmacy. Methods analysis OPtimising thERapy prevent Avoidable Multimorbid people is European...
Introduction Multimorbidity and polypharmacy are current challenges when caring for the older population. Both have led to an increase of potentially inappropriate medication (PIM), illustrating need assess patients' attitudes towards deprescribing. We aimed prevalence PIM use whether this was associated with patient factors willingness deprescribe. Method analysed data from LESS Study, a cross-sectional study on self-reported barriers enablers deprescribe (rPATD questionnaire). The survey...
Polypharmacy is an increasing problem, leading to increased morbidity and mortality, especially in older, multimorbid patients. Consequently, there a need for reduction of polypharmacy. The aim this study was explore attitudes, beliefs, concerns towards deprescribing among patients with polypharmacy who chose not pursue at least one their GP's offers deprescribe. Exploratory using telephone interviews cluster-randomized Northern Switzerland. interview included qualitative part consisting...
Continuity of care is important for the health aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision non-urgent care, at-risk patients depending upon regular consultations general practitioners (GPs) faced confusion about possibility seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting quantitative component followed by qualitative...
Objectives Proton pump inhibitors (PPIs) are widely prescribed medications and commonly used for the treatment of gastric acid-related disorders. Nevertheless, PPIs often overused leading to potential adverse effects unnecessary healthcare costs. Deprescribing strategies have emerged safely reduce or substitute inappropriate optimise patient care in an evidence-based manner. This protocol describes a study evaluate effectiveness PPI deprescribing intervention comparison usual Swiss primary...
Objectives To assess and compare the self-perceived Health Related Quality of Life (HRQoL) multimorbid patients general population using health utilities (HU) visual analogue scale (VAS) methods. Methods We analyzed data (n = 888) from a national, cross-sectional Swiss study recruited in primary care settings. Self-perceived HRQoL was assessed EQ-5D-3L instrument, composed 1) questionnaire on five dimensions mobility, self-care, usual activities, pain/discomfort, anxiety/depression (EQ-5D...
<h3>PURPOSE</h3> Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in undergoing antihypertensive treatment is associated 1-year changes cognitive/daily functioning or quality of life (QoL) persons aged ≥75 years without problems. <h3>METHODS</h3> analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) follow-up. Stratified by...
Multimorbid patients may experience a high burden of treatment. This has negative impact on treatment adherence, health outcomes and care costs. The objective our study was to identify factors associated with the self-perceived multimorbid in primary compare them GPs assessment this burden. A cross sectional general practices, 100 Switzerland up 10 per GP. Patients reported their using Treatment Burden Questionnaire (TBQ, possible score 0–150), whereas evaluated Visual Analog Scale (VAS)...
Abstract Background General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm health. However, deprescribing can be challenging for physicians. This study investigates GPs’ decisions in 31 countries. Methods In this case vignette study, GPs were invited to participate an online survey containing three clinical cases of oldest-old multimorbid patients with potentially polypharmacy. Patients differed terms...
Strategies for the involvement of primary care in management patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes physicians (PCPs) when managing dementia: (i) most popular cognitive tests, (ii) who had right initiate continue cholinesterase inhibitor memantine treatment, and (iii) relationship between permissiveness these rules/guidelines PCP's approach investigations assessment.Key informant survey.Primary practices 25 European...
Cancer survival and stage of disease at diagnosis treatment vary widely across Europe. These differences may be partly due to variations in access investigations specialists. However, evidence explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses system factors potentially influencing PCPs' decision-making when consulting with patients who have cancer, these between European countries.Based on a...
Dementia is often underdiagnosed in general practice, which may be based on practitioners' (GPs') knowledge and emotional factors as well external problems. This study aimed to describe GPs' attitudes toward early diagnosis of dementia. Cross-sectional postal survey Switzerland 2017. Members the Swiss Association General Practitioners (N = 4460) were asked participate survey. The questionnaire assessed attitudes, enablers barriers dementia post-diagnostic intervention strategies. Exploratory...
Objective To identify factors associated with health literacy in multimorbid patients. Design A nationwide cross-sectional study Switzerland. Univariate and multivariate linear regressions were calculated to variables literacy. multiple imputation approach was used deal missing values. Participants Multimorbid patients recruited primary care settings (n=888), above 18 years old suffering from at least 3 of 75 chronic conditions on a predefined list based the International Classification...