BackgroundEvidence-based practice (EBP) is described as the integration of the following 3 main dimensions in health professionals' decision making: best currently available research evidence, professional expertise, and patient's values and circumstances. Barriers to EBP at an individual level have been assessed using questionnaires. Knowing which EBP dimensions are actually explored in these questionnaires is essential to promote EBP and its adoption.ObjectiveThe aim of this review was to identify and describe questionnaires that have been used among dietitians to evaluate knowledge, skills, attitudes, and/or behaviors related to EBP, and to perform a content analysis of these, drawn on the EBP dimensions explored.MethodsQuestionnaires were identified through a systematic review in MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (last search was November 2022). Eligibility criteria were studies using, evaluating, or developing questionnaires meant to evaluate knowledge, skills, attitudes, and/or behaviors related to EBP among dietitians. The content analysis was conducted to identify the EBP dimensions explored (ie, research evidence, professional expertise, and/or patient's values and circumstances). Questionnaire items were categorized as follows: 1 sole EBP dimension, a combination of dimensions, or no identifiable dimension.ResultsThirty reports (25 studies) were included. The analysis of the 847 items extracted from the 25 questionnaires used showed that the main EBP dimension explored was the integration of research evidence into decision making, found in 75% of items, solely or in combination with another dimension. Professional expertise was explored in 18% of the items, patient's values and circumstances were found in 3%, and the combination of these 3 dimensions was found in <1%.ConclusionsThe important imbalance of explored EBP dimensions in the questionnaires used may lead to a partial and misleading evaluation that prevents efficient strategies to foster EBP. There is an important need to develop more integrative and accurate evaluations of EBP targeting dietitians to promote and develop high-quality dietetics practice.

The introduction of a new technology for the management of diabetes raises questions about their actual use. This is the case with the Freestyle Libre sensor, a tool that measures the interstitial glucose levels. Some studies have provided recommendations about its use, but little is known about how users learn to use it in the daily management of the disease. This ethnographic research explores this issue in the context of a summer camp for young people living with diabetes. The results describe three different levels (material, epistemic and moral) at which learning occurs. They show that its use requires an active appropriation process, the importance of a setting that promotes interactions between the participants and that the features of the tend to reconfigure the expert-lay person relationship.

Nouvelle technologie de gestion du diabète : apprendre ensemble et en situation L'introduction d'une nouvelle technologie de gestion du diabète soulève des questions sur son usage effectif.C'est le cas du capteur FreeStyle Libre, un outil mesurant la glycémie inter stitielle.Des études ont fourni des recommandations sur son usage, mais on en sait peu sur la manière dont les usagerères apprennent à l'utiliser dans la gestion quotidienne du diabète.Cette recherche ethnographique étudie cette question dans le cadre d'un camp d'été pour jeunes vivant avec un diabète.Les résultats décrivent trois niveaux différents (matériel, épistémique et moral) auxquels cet apprentissage se réalise.Ils montrent que son usage requiert un travail d'appropriation actif, l'intérêt d'un dispositif qui favorise les interactions entre participantes et que les caractéristiques de l'outil tendent à reconfigurer la relation expertprofane. New technology of diabetes management : learning together and in situationThe introduction of a new technology for the management of diabetes raises questions about their actual use.This is the case with the Freestyle Libre sensor, a tool that measures the interstitial glucose levels.Some studies have provided recommendations about its use, but little is known about how users learn to use it in the daily management of the disease.This ethnographic research explores this issue in the context of a summer camp for young people living with diabetes.The results describe three different levels (material, epistemic and moral) at which learning occurs.They show that its use requires an active appropriation process, the importance of a setting that promotes interactions between the participants and that the features of the tend to reconfigure the expert-lay person relationship.

Background Most claims-based frailty instruments have been designed for group stratification of older populations according to the risk of adverse health outcomes and not frailty itself. We aimed to develop and validate a tool based on one-year hospital discharge data for stratification on Fried's frailty phenotype (FP). Methods We used a three-stage development/validation approach. First, we created a clinical knowledge-driven electronic frailty score (eFS) calculated as the number of deficient organs/systems among 18 critical ones identified from the International Statistical Classification of Diseases and Related Problems, 10th Revision (ICD-10) diagnoses coded in the year before FP assessment. Second, for eFS development and internal validation, we linked individual records from the Lc65+ cohort database to inpatient discharge data from Lausanne University Hospital (CHUV) for the period 2004-2015. The development/internal validation sample included community-dwelling, non-institutionalised residents of Lausanne (Switzerland) recruited in the Lc65+ cohort in three waves (2004, 2009, and 2014), aged 65-70 years at enrolment, and hospitalised at the CHUV at least once in the year preceding the FP assessment. Using this sample, we selected the best performing model for predicting the dichotomised FP, with the eFS or ICD-10-based variables as predictors. Third, we conducted an external validation using 2016 Swiss nationwide hospital discharge data and compared the performance of the eFS model in predicting 13 adverse outcomes to three models relying on well-designed and validated claims-based scores (Claims-based Frailty Index, Hospital Frailty Risk Score, Dr Foster Global Frailty Score). Findings In the development/internal validation sample (n = 469), 14.3% of participants (n = 67) were frail. Among 34 models tested, the best-subsets logistic regression model with four predictors (age and sex at FP assessment, time since last hospital discharge, eFS) performed best in predicting the dichotomised FP (area under the curve=0.71; F1 score=0.39) and one-year adverse health outcomes. On the external validation sample (n = 54,815; 153 acute care hospitals), the eFS model demonstrated a similar performance to the three other claims-based scoring models. According to the eFS model, the external validation sample showed an estimated prevalence of 56.8% (n = 31,135) of frail older inpatients at admission. Interpretation The eFS model is an inexpensive, transportable and valid tool allowing reliable group stratification and individual prioritisation for comprehensive frailty assessment and may be applied to both hospitalised and community-dwelling older adults. Copyright (C) 2021 The Authors. Published by Elsevier Ltd.

Objective To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain. Methods We searched for all randomized or quasi-randomized controlled trials that included adults (>= 18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias. Results We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I-2 = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality. Conclusions Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.

Purpose: One-third of older inpatients experience adverse-drug events (ADEs), which increase their mortality and morbidity, and health care use and costs. In particular, antithrombotic drugs are among the most at-risk medications in this population. Reporting systems have been implemented at national, regional, and provider levels to monitor ADEs and design prevention strategies. Because of their well-known limitations, automated detection technologies based on electronic medical records (EMR) are currently being developed to detect routinely or predict ADEs. Aim: This study aims to develop and validate an automated detection tool for the monitoring of antithrombotic-related ADEs using EMRs from four large Swiss hospitals. We aim to assess cumulative incidences of hemorrhages and thromboses in older inpatients associated with the prescription of antithrombotic drugs, identify triggering factors, and propose improvements for clinical practice. Method: This collaborative and interdisciplinary project is a multicenter, cross-sectional study based on 2015-2016 EMR data from four large hospitals in Switzerland: Lausanne, Geneva, and Zürich University hospitals, and Baden Cantonal hospital. We have included older inpatients aged ≥65 years who stayed at one of the four hospitals during 2015 or 2016, received at least one antithrombotic drug during their stay, and signed or were not opposed to a general consent for participation in research. First, expert clinical pharmacists have selected a list of relevant antithrombotic drugs along with their side effects and risk and confounding factors. Second, administrative, clinical, prescription, and laboratory data available in the form of free texts and structured data have been extracted from study participants’ EMRs. Third, several automated rule-based and machine learning-based algorithms are currently being developed, allowing to identify hemorrhage and thromboembolic events and their triggering factors from extracted information. Finally, we plan to validate the developed detection tools (one per ADE type) through manual medical record review. Performance metrics for assessing internal validity will comprise the area under the receiver operating curve (AUC), F1-Score, sensitivity, specificity, and positive and negative predictive values. Relevance/Application: The project will allow the introduction of measures to improve safety in the prescribing of antithrombotic drugs, which today remains among the drugs most involved in adverse drug events. The findings will be implemented in clinical practice by means of indicators of adverse events for risk management, and training for healthcare professionals; the tools and methodologies developed will be disseminated for new research in this field. Conclusion: The increased performance of natural language processing as an important complement to structured data will bring existing tools to another level of efficiency in the detection of ADEs. Currently, such systems are not available in Switzerland and nor can “ready-made” systems from other countries be adapted since they are language dependent.

Self-management of type 1 diabetes (T1D) is a difficult task that involves different actions and decisions and requires various types of knowledge. Nowadays, it can be done partly autonomously, using a mobile digital device that measures the level of blood glucose. The FreeStyle Libre, launched on the Swiss market in 2016, is one such device. Drawing on Science and Technology Studies and adopting a sociocultural approach to learning, the present study investigated how healthcare professionals and young people living with T1D learned to use this new device during a summer camp. Based on field observations and interviews, results showed that through the mediation of others, an appropriation space was created. Through distributed expertise involving different actors, practices and types of knowledge, the users learned technical and procedural knowledge, and much more besides. In particular, they learned to cope with uncertainty, sidestep obstacles, and trust the device, gaining knowledge about diabetes itself in the process and grasping the potential contribution of the new data provided by this device to therapeutic decisions. By drawing on an explicit theory of learning that considers learning to be a context-bound activity, the present study will inspire the development of new practices in health education.

Health professionals are increasingly urged to act to protect individuals and populations against the negative effects of climate and environment change on health. However, the amount of evidence supporting initiatives to that end is unknown. We explored the literature examining the awareness, preparedness, and role of healthcare professionals to inform about the impact of climate change on health on the one hand, and literature about the effectiveness of interventions mediated by health professionals aiming at reducing the environmental impact of human activities on the other hand. We included 137 articles published between 2000 and 2020, mostly in general medical and nursing journals. The typical article was a perspective, commentary, or other special article aimed at alerting readers about the impact of climate and environment change on health. We identified 22 studies, of which only two reported interventions. Despite increasing efforts of health professionals to address climate and environment change and related health risks, health literature supporting such efforts remains scarce, and studies assessing the effectiveness of interventions are lacking. We need appropriate evidence to indicate which interventions should be prioritized, considering that the association of health issues with climate and environment change could constitute an effective lever for change.

Background The prevalence of complementary and alternative medicine (CAM) use and the modalities used by pediatric oncology patients vary widely across studies. In addition, the changes in the use of CAM over the course of treatment are understudied. Thus, this study aimed to explore (1) CAM use by pediatric oncology patients in relation to specific time intervals and (2) communication about CAM use between parents and oncologists. Methods This retrospective cross-sectional study was conducted among parents of children diagnosed with cancer at a Swiss pediatric hematology-oncology center by means of an online questionnaire. Questions were related to their child’s CAM use over different time intervals, sources of information about CAM use, and communication with the oncologists. Results Among 140 respondents, CAM was used by 54.3% of patients before diagnosis and 69.3% of patients after diagnosis. During each defined time interval, between 50 and 58.8% of the patients used at least one CAM. Homeopathy was the most popular CAM modality used during oncology treatment, during the first year after treatment, and between 1 and 5 years after the end of treatment. Osteopathy was the most popular CAM ≥5 years after the end of oncology treatment. Forty percent of respondents did not discuss CAM with their oncologist. Conclusions The high prevalence of CAM use and the different trends of use during the oncology care pathway and afterward underline the need to increase communication about CAM in the pediatric oncology setting, notably regarding benefits and risks of interaction with oncology treatment.

IntroductionPostpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes.Materials and methodsWe analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014-2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic health records by text mining discharge letters and operative reports and calculating drop in hemoglobin from laboratory tests. Diagnostic and procedure codes were used to identify cases in hospital discharge data. A sample of 334 charts was reviewed manually to provide a reference-standard and evaluate the accuracy of the other detection methods.ResultsSensitivities of detection algorithms based on electronic health records and hospital discharge data were 95.2% (95% CI: 92.6% 97.8%) and 38.2% (33.3% to 43.0%), respectively for postpartum hemorrhage, and 87.5% (85.2% to 89.8%) and 36.2% (26.3% to 46.1%) for severe postpartum hemorrhage. Postpartum hemorrhage cumulative incidence based on electronic health records decreased from 15.6% (13.1% to 18.2%) to 8.5% (6.7% to 10.5%) from the beginning of 2014 to the end of 2016, with an average of 12.5% (11.8% to 13.3%). The cumulative incidence of severe postpartum hemorrhage remained at approximately 4% (3.5% to 4.4%). Hospital discharge data-based algorithms provided significantly underestimated incidences.ConclusionsHospital discharge data is not accurate enough to assess the incidence of postpartum hemorrhage at hospital or national level. Instead, automated algorithms based on structured and textual data from electronic health records should be considered, as they provide accurate and timely estimates for monitoring and improvement in obstetrical safety. Furthermore, they have the potential to better code for postpartum hemorrhage thus improving hospital reimbursement.

Scarce data exist on the use of complementary and alternative medicine (CAM) by asylum seekers in Switzerland and their perception of discrimination. A cross-sectional study assessed the prevalence and type of CAM used by asylum seekers in one region of Switzerland and evaluated their self-perceived discrimination. Among the 61 asylum seekers who participated, lifetime prevalence of CAM use was 46%, with 28% reporting its use during the last year. Herbal medicine was the most frequently used CAM. Self-perceived discrimination was reported by 36% of asylum seekers, mainly related to their national origins. CAM users had a tendency to report more discrimination than non-users (44% vs. 30%). CAM use is prevalent among asylum seekers. Considering the importance of herbal medicine use and that only half of the respondents disclosed CAM use to their physician, clinicians should ask about it, notably because of potential risks of herb–drug interaction.

RATIONALE, AIMS AND OBJECTIVESPressure ulcers may have severe impacts on the quality of life of patients, including pain, low mood and restrictions in performing daily life and social life activities. In Switzerland, 4% of patients develop hospital-acquired pressure ulcers. Six hospitals teamed up with the Vaud Hospital Federation (Switzerland) in a Breakthrough Collaborative, with the goal of reducing hospital-acquired pressure ulcers by 50%. The aim of this study was to assess the actual reduction.METHODSA multimodal set of interventions was deployed in all wards except obstetrics and gynaecology, over 18 months starting in October 2016, including systematic risk assessment, use of a prevention bundle, education through e-learning, measurement and feedback, patient engagement and promotion of a safety culture. All six hospitals monitored compliance with the use of the risk assessment, bundle application and patient involvement aspects. A safety calendar was implemented in all wards, for recording and visually displaying the numbers of new patients with pressure ulcers, as well as the presence of such ulcers upon admission and their category.RESULTSCompliance with performing Braden risk assessments rose from 39% at baseline to 61% by the end of the collaborative (P < .001), prevention bundle compliance from 2% to 30% (P < .001%) and documented patient engagement from 2% to 21% (P < .001%). The percentage of days where one or more patient was reported as having developed one or more pressure ulcers in the ward decreased from 8.21% to 4.18%, a 49% reduction (P < .001) which amounts to preventing 1124 new patients from developing one or more pressure ulcers during the collaborative.CONCLUSIONSThe Breakthrough Collaborative using a multimodal improvement approach combined with measurement and feedback was associated with a statistically and clinically significant improvement in compliance to best practice and with a reduction of hospital-acquired pressure ulcers by half.

Background: Inflammatory bowel disease (IBD) needs early interventions and an individual specialist–patient relationship. Distance from a tertiary IBD center might affect patient’s disease course and outcome. We investigated whether the patient-to-specialist distance has an impact on the disease course using the well-defined patient collective of the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). Methods: Patient’s home address at diagnosis (postal zip code) was extracted from the SIBDCS database. Distance between each zip code and the nearest located IBD specialist center was calculated and classified into the following three sections based on proximity: <10 km (group 1); 10–35 km (group 2); >35 km (group 3). Results: Our study included in total 408 IBD patients [234 Crohn’s disease (CD), 154 ulcerative colitis (UC), 20 IBD unclassified (IBDU)]. Median age was lowest in group 2 at diagnosis (G1: 28 years; G2: 21 years, G3: 26 years, p < 0.01). The diagnostic delay did not differ between groups. CD patients in group 1 were treated more often with anti-tumor necrosis factor (TNF) agents (72% versus 56%, p = 0.04) and 5-aminosalicylates (44% versus 28%, p = 0.04) than in group 3. UC/IBDU patients in group 1 were treated more often with corticosteroids than patients in group 3 (83% versus 58%, p < 0.01). The occurrence of IBD-related surgeries did not differ between groups. Conclusions: Patient-to-specialist distance might affect drug treatment. However, disease course and the need for IBD-related surgery does not seem to be associated with a longer distance to specialist care in Switzerland.

La Suisse et la France ne contribuent pas aux comparaisons internationales de l'OCDE sur la sécurité des arthroplasties de hanche (PTH) et de genou (PTG) utilisant les taux standardisés de thromboses veineuses profondes (TVP) ou d'embolies pulmonaires (EP) à 30 jours. L'objectif principal de cette étude était d'estimer et de comparer les taux hospitaliers standardisés d'évènements indésirables (TSEI) thromboemboliques et hémorragiques survenant après une PTH/PTG primaire programmée chez les patients âgés hospitalisés en Suisse et en France. Nous avons mené deux études transversales basées sur des données médico-administratives nationales chaînées (période 2011–2014) de participants (≥ 65 ans) hospitalisés entre le 01/01/2012 et le 30/11/2014 pour PTH/PTG. Les événements indésirables (EI) ont inclus les TVP et EP, les hémorragies, et les EI thromboemboliques artériels (ETEA). Pour chaque pays et hôpital, nous avons mesuré les taux observés d'EI intra-hospitaliers à 30 jours, puis estimé les TSEI au moyen de modèles logistiques hiérarchiques ajustées sur des scores de risque spécifiques, et enfin comparé les distributions des TSEI hospitaliers entre Suisse et France. Entre 2011 et 2015, 45 817 et 373 671 séjours pour PTH ou PTG ont été réalisés dans 128 et 1053 hôpitaux suisses et français, respectivement. En Suisse, les TSEI médians à 30 jours après PTH/PTG simple étaient de 0,43 %/0,93 % pour les TVP, 0,32 %/0,45 % pour les EP, 4,17 %/4,30 % pour les hémorragies, 1,06 %/1,45 % pour les hémorragies sévères, et 0,67 %/0,56 % pour les ETEA. Ces taux étaient tous plus faibles en France sauf pour la TVP : 1,12 %/3,54 % pour les TVP, 0,19 %/0,35 % pour les EP, 3,52 %/3,84 % pour les hémorragies, 0,21 %/0,38 % pour les hémorragies sévères, et 0,44 %/0,40 % pour les ETEA. La variabilité inter-hôpitaux était plus élevée en France qu'en Suisse. La Suisse et la France pourraient contribuer aux indicateurs OCDE mesurant les taux de TVP et EP à 30 jours après PTH/PTG. La comparabilité internationale devrait aussi être améliorée par une meilleure prise en compte des profils de risque individuels des patients.

This article focuses on the ways in which a flash glucose monitoring system, FreeStyle Libre®, is introduced and used by people living with type 1 diabetes, their relatives and healthcare professionals. It draws on a multi-sited ethnography in a variety of clinical and daily situations, and on interviews with caregivers and people living with diabetes. We explore how the users develop knowledge-in-practice, and consider the use of self-management technologies to be largely dependent on locally grounded and situated care acts, and resulting from the relational, pragmatic and creative maneuvering of technology-in-practice. Our findings show that adjustments between users, their bodies and the technology are required, and show the reflexive work and practices of patients and relatives who learn to use the device in a proper way. Moreover, we reveal that practitioners see this technology as a tool that not only improves self-care practices but also clinical practices, and that wearing and using this new medical device may become a moral injunction for self-improvement. Our results illustrate the techno-social reconfigurations at work and the development of new ways of feeling, thinking and acting in diabetes (self-) care.

BACKGROUND:Osteopathy is commonly used for spinal pain, but knowledge about back pain management by osteopaths is scarce.OBJECTIVE:The aim of this study was to survey osteopaths across the French-speaking part of Switzerland about the scope of their practice and their management of patients with back pain.DESIGN:This cross-sectional observational study was based on an online survey conducted from March to June 2017. Setting and participants: All registered osteopaths of the French-speaking part of Switzerland were asked to complete the survey. Outcome measures: In addition to descriptive statistics (practice characteristics, patients' profiles, scope of treatment modalities, health promotion, research, and osteopathic practice), we explored variables associated with osteopaths' practice, such as age and gender.RESULTS:A total of 241 osteopaths completed the questionnaire (response rate: 28.8%). Almost two thirds of osteopaths were female. Ages ranged from 25 to 72 years with an overall mean of 42.0 (SD 10.7) years. Male osteopaths reported more weekly working hours than female osteopaths did (38.2 [SD 11.0] vs 31.6 [SD 8.9], respectively, p<0.001). Almost a third (27.8%,) of osteopaths could arrange an appointment for acute conditions on the same day and 62.0% within a week. Acute or subacute spinal conditions, mainly low back and neck pain, were the most frequent conditions seen by our respondents. For 94.4% of osteopaths, one to three consultations were required for the management of such conditions.CONCLUSION:Osteopaths play a role in the management of spinal conditions, especially for acute problems. These findings, combined with short waiting times for consultations for acute conditions, as well as prompt management capabilities for acute low back and acute neck pain, support the view that the osteopathic profession constitutes an added value to primary care.

Background: Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. Method : In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient's demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient's quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients' healthcare use. Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28–98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62–0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28–0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59–3.90). The number of contacts with a GP (median 11 (IQR 7-16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83–0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02–1.10). Conclusion : Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.

BACKGROUND: Over the last three decades, the use of outpatient surgery has been steadily increasing. Simultaneously, there has been an inciting movement to measure and improve healthcare quality and safety. Nevertheless, anaesthesia-related morbidity remains significant. We aimed to evaluate the incidence of intraoperative adverse events (IAEs) occurring during outpatient surgery. METHODS: We used data from the Anaesthesia Databank Switzerland (ADS), a voluntary register. We assessed the overall and specific incidence of IAEs, according to a predefined list of technical, cardiovascular, organisational, respiratory, and general incidents in Switzerland between 2000 and 2016. Primary and secondary outcomes were modelled using multi-level logistic regression analysis, and the time trend on the probabilities of events was assessed. RESULTS: Between 2000 and 2016, 289,948 outpatient anaesthesia procedures were performed. During this period, the estimated probability of overall intraoperative adverse events decreased from 10.8% to 6.3%, and from 2.3% to 1.4% for technical incidents, from 3.0% to 2.2% for cardiovascular, from 1.6% to 1.3% for organisational, from 0.9% to 0.7% for general, and from 1.1% to 0.7% for respiratory incidents. CONCLUSIONS: The occurrence of intraoperative adverse events in ambulatory anaesthesia has continuously decreased between 2000 and 2016. This trend is essentially attributable to a reduction in the incidence of technical, cardiovascular and organisational events.