STUDY AIMS:The initial prevalence estimates of long COVID exhibited significant heterogeneity. In Switzerland, early findings estimated a 39-53% prevalence of long COVID symptoms among adult patients who tested positive for SARS-CoV-2. However, studies conducted in a primary care setting suggested a significantly lower burden of care, with long COVID accounting for less than 1% of family medicine consultations. The objective of this study was to estimate the incidence of long COVID-related consultations in Swiss family medicine practices, in order to guide health services planning. METHODS:This repeat cross-sectional study was conducted using the data collected by family physicians (general internists and paediatricians) within the Swiss Sentinella network, part of the epidemiological surveillance system managed by the Federal Office of Public Health. Data was collected between August 2021 and April 2023 via monthly reports of doctors' activity over the past four weeks. Long COVID-related consultations were defined as visits where physicians recorded symptoms or conditions linked to post-acute SARS-CoV-2 effects, based on clinical definitions at the time. Doctor characteristics were measured and analysed for associations with monthly median incidence rates of long COVID-related consultations. RESULTS:181 family practices provided data for at least one month during the study (154 general internists and 27 paediatricians): 85% of doctors were general internists, 32% were women and 74% worked in an urban area. The median incidence of monthly long COVID-related consultations was 3/1000 consultations for general internists and 0/1000 consultations for paediatricians. Multivariable ordinal logistic regression showed that internists were significantly more likely to report long COVID-related consultations compared to paediatricians. Also, physicians in central Switzerland were more likely to have a higher median incidence of long COVID-related consultations in comparison to those in other regions. CONCLUSIONS:Our study shows that the incidence of long COVID-related consultations in Swiss family medicine is markedly lower than expected, considering the estimated prevalence of long COVID post-SARS-CoV-2 infection. This discrepancy may result from potential biases in earlier studies, epidemiological variations and diagnostic challenges. These findings underscore the need for improved diagnostic criteria and enhanced support for primary care providers in recognising long COVID and facilitating referrals for more severely affected patients.

INTRODUCTION:Lesbian, gay, bisexual, transgender or non-binary and intersex (LGBTI) populations experience persistent health inequities, including poorer mental and physical health outcomes and higher unmet healthcare needs compared with non-LGBTI populations. These inequities are partly attributable to insufficient training of primary care physicians (PCPs) in LGBTI health. However, evidence on effective and scalable training interventions for PCPs remains limited, particularly outside North America. This study evaluates the effectiveness of a self-directed e-learning programme-Improving Care and Access for Rainbow Equity (I-CARE)-designed to improve PCPs' knowledge, attitudes, skills and behaviours related to LGBTI health. METHODS AND ANALYSIS:We will conduct a type I effectiveness-implementation hybrid, two-arm, parallel-group, superiority randomised controlled trial among PCPs practising in French-speaking Switzerland. Eligible physicians will be randomly assigned (1:1) to either the I-CARE programme (intervention) or an e-learning programme on motivational interviewing (control) matched for format and duration. Outcomes will be measured at baseline, immediately postintervention and at the 3-month follow-up. The primary outcomes are knowledge and attitudes towards LGBTI patients assessed at the postintervention time point using validated scales. Superiority will be declared if the intervention group is statistically significantly superior to the control group on at least one primary outcome and statistically significantly inferior on neither primary outcome. Secondary outcomes include skills, self-reported behaviours and the presence of LGBTI-inclusive environmental cues. Effectiveness will be analysed using generalised estimating equations. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. ETHICS AND DISSEMINATION:Participants will provide electronic informed consent. All study data will be managed and stored on secure servers hosted by the Lausanne University Hospital (CHUV). All information will be handled in strict accordance with the Swiss Federal Act on Data Protection. The project was approved by the Central Ethics Commission of the University of Lausanne on 7 July 2025 (C_Services centraux_052025_00018). Study findings will be disseminated through peer-reviewed scientific publications and lay summaries intended for the public, Swiss PCPs and LGBTI communities. TRIAL REGISTRATION NUMBER:ISRCTN93781961 (11 March 2026, updated 14 July 2026).

Antimicrobial resistance—partly driven by inappropriate antibiotic consumption—is a major public health threat. Point-of-care (POC) procalcitonin testing can reduce antibiotic prescribing safely. Within an implementation-effectiveness trial, we conducted a two-phase participatory context analysis to identify and prioritise determinants of POC procalcitonin adoption, implementation and continued use in Swiss primary care. First, we conducted 32 semi-structured interviews with 34 participants, including physicians, representatives of medical organisations, patient representatives and other stakeholders. By coding transcripts deductively using the Consolidated Framework for Implementation Research and inductively, we identified 86 potential determinants. Second, in a focus group with ten ImpPro research team members, 15 determinants were identified as ‘not requiring change’, and ten were considered ‘unchangeable’. Among the remaining 61 determinants, 41 were prioritised through dot-voting and group discussion. These key implementation determinants were inductively grouped into eight themes. The themes with the highest priority were: (1) physicians’ awareness, knowledge, and access to education regarding POC procalcitonin, (2) scientific evidence supporting POC procalcitonin-guided antibiotic prescribing, (3) physician motivation and (4) endorsement of POC procalcitonin by credible organisations and experts. Addressing these determinants will likely require a tailored, multifaceted (combining several unique strategies), and multilevel (targeting different levels of the system) implementation strategy.

INTRODUCTION: Inappropriate antibiotic prescribing drives antimicrobial resistance. Although the Swiss Society of Infectious Diseases has introduced national guidelines for common infectious diseases starting from 2019, it remains unclear whether family physicians and paediatricians adhere to them and what factors influence their prescriptions. The aims of this study were to assess whether Swiss family physicians and paediatricians make appropriate antibiotic choices in accordance with national guidelines and to identify physician- and patient-related factors associated with the prescribing of not-recommended antibiotic choices for specific indications. METHODS: A cross-sectional study analysed the choice of antibiotics (2017–2022) by indication from a sentinel physician surveillance network, comparing them to adult (16+) and paediatric national guidelines. Indications included pharyngitis, sinusitis, otitis media, pneumonia, chronic obstructive pulmonary disease exacerbation (adults only) and upper and lower urinary tract infections (adult females only). Descriptive analysis and pre- and post-guideline comparisons were conducted. A multilevel logistic regression model assessed factors influencing prescribing of not-recommended antibiotics across several clinical indications. RESULTS: A total of 52,098 observations were analysed. The overall proportion of not-recommended antibiotic prescriptions was 18% for adults and 19% for children. The proportion of not-recommended antibiotics ranged from 8% (lower urinary tract infection) to 39% (sinusitis) in adults, and from 5% (sinusitis) to 38% (pharyngitis) in children. The proportion of not-recommended antibiotics decreased following guideline implementation for all indications for children and for sinusitis (48% vs 39%) and pneumonia (19% vs 15%) for adults. A multilevel model revealed that certain clinical indications – such as pharyngitis – were associated with higher odds of prescribing not-recommended antibiotics. Additionally, family physicians (compared to paediatricians), older physician age and physicians’ perception of a favourable patient attitude to the antibiotic were also linked to increased prescribing of not-recommended antibiotics. CONCLUSIONS: Swiss family physicians and paediatricians show high levels of non-adherence to national guidelines across several indications, with limited change post-guideline implementation. Certain demographic characteristics of physicians and patient behaviour exacerbate these inappropriate prescribing habits. These insights indicate the need to enhance guideline dissemination and adoption by considering physicians’ needs.

INTRODUCTION:Antimicrobial resistance is a major global health threat, driven largely by the misuse and overuse of antibiotics. Point-of-care (POC) tests for inflammatory biomarkers like procalcitonin (PCT) have shown promise in reducing unnecessary antibiotic prescriptions. The hybrid type II ImpPro trial aims to evaluate the implementation and effectiveness of POC-PCT on antibiotic prescriptions by primary care physicians (PCP) in French-speaking Switzerland. Implementation is planned to include a multifaceted strategy delivered mainly, but not exclusively, via PCP quality circles. Currently, little guidance exists on how to best tailor the implementation strategies to a specific context. This study protocol describes the comprehensive approach taken within ImpPro to develop a multifaceted and multilevel strategy for POC-PCT implementation. METHODS AND ANALYSIS:Our mixed-methods participatory implementation research study consists of four phases: (1) determinant identification; (2) determinant prioritisation; (3) implementation strategy ideation and (4) implementation strategy selection and refinement. All phases of the study will be guided by well-established implementation theories, models and frameworks. For 1, to identify the possible barriers and facilitators for implementation, we will conduct semistructured interviews with stakeholders followed by deductive coding using the updated Consolidated Framework for Implementation Research and inductive thematic analysis. In 2, to identify the key determinants, we will conduct online focus group discussions and vote on the importance and changeability of determinants. In 3, we will conduct interviews and an expert brainstorming session, followed by deductively coding implementation ideas according to the Expert Recommendations for Implementing Change compilation. In 4, we will conduct focus group discussions with experts and stakeholders about the APEASE criteria (ie, affordability, practicability, (cost-)effectiveness, acceptability, side effects and safety and equity) of these strategies, followed by a rapid data analysis approach to select the implementation strategies. ETHICS AND DISSEMINATION:This study does not fall within the scope of the Human Research Act, and the necessity for a formal evaluation was waived from the Cantonal Ethics Committee (Req-2023-00392). The results of our study will be shared among the Antimicrobial Stewardship in Ambulatory Care Platform network, published in peer-reviewed scientific journals, and will be presented at international and national conferences.

Background: With most antibiotic prescriptions occurring in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by primary care physicians (PCPs). Aim: The main objective of this study was to evaluate the present awareness about, use of, and perceived acceptability, appropriateness, and feasibility of a broad range of interventions. Design & setting: A cross-sectional survey was distributed to Swiss PCPs from December 2023 to February 2024. Method: The survey focused on eight AMS interventions: shared decision-making tools, factsheets for physicians, Swiss Federal Office of Public Health (FOPH) information material, national antibiotic guidelines website, audit and feedback, communication skills training, as well as the use of point-of-care C-reactive protein (POC-CRP) and procalcitonin (POC-PCT) to guide prescription. PCPs' perceived acceptability, appropriateness, and feasibility were assessed using 5-point Likert scales. General expectations regarding AMS were evaluated via qualitative analysis of free-text answers. Results: Out of 7456 potentially eligible primary care physicians, 355 PCPs answered at least one question (response rate 4.7%). PCPs were most aware of biomarkers to guide antibiotic prescription in respiratory tract infections (RTIs), such as POC-PCT (67.6%) and POC-CRP (61.1%); the FOPH awareness campaign (57.3%); and the national guidelines website (52.7%). All interventions were rated as acceptable, appropriate, and feasible, with respective mean scores out of five of 3.89, 3.91, and 3.81. Conclusion: Despite the high perceived acceptability, appropriateness, and feasibility of AMS interventions available for RTIs, their real-life impact may be hindered by insufficient awareness. Additional promotion of those tools could increase their uptake by physicians.

The COVID-19 pandemic underscored the differential impact of infectious diseases across population groups, with gender and sex identified as important dimensions influencing transmission and health outcomes. Sex-related biological factors, such as differences in immune response and comorbidities, contribute to men's heightened severity risks, while gender norms and roles influence exposure patterns, adherence to prevention measures, and healthcare access, influencing women's higher reported infection rates in certain contexts. Despite widely observed gender/sex disparities, infectious disease models frequently overlook gender and sex as key dimensions, leading to gaps in understanding and potential blind spots in public health interventions. This paper develops a conceptual framework based on the Susceptible-Exposed-Infectious-Recovered/Deceased (SEIR/D) compartmental model to map pathways through which gender and sex may influence susceptibility, exposure, transmission, recovery, and mortality. Using a narrative review of modelling, epidemiological, and clinical studies, this framework identifies and characterises the main social and biological mechanisms on this matter-including gendered occupational exposure, differential adherence to preventive measures, and disparities in healthcare-seeking behaviour-alongside sex-based differences in immune response and disease severity. The framework also examines potential gender-related variations in epidemiological surveillance data, highlighting disparities in testing uptake and hospitalisation referrals that could influence model outputs. By synthesising these insights, this paper provides a theoretical foundation for integrating gender and sex into infectious disease models. It advocates for interdisciplinary collaboration between modellers, social scientists, and clinicians to advance gender- and sex-sensitive modelling approaches. Accounting for gender and sex can enhance predictive accuracy, inform intervention strategies, and promote health equity in pandemic response.

Background The COVID-19 pandemic has been a challenge for health-care systems and antibiotic stewards as uncertainty regarding treatment and bacterial coinfections raised concern. Methods This retrospective observational study examined the association of the pandemic on outpatient antibiotic sales and prescriptions in Switzerland using interrupted time series (ITS) analyses. Data from IQVIA™ and the Sentinella Network were used to analyze antibiotic consumption and prescription patterns over a 72-month period from January 2018 to December 2023, divided into pre-pandemic, pandemic, and post-pandemic periods. Results Antibiotic consumption decreased during the pandemic and returned to pre-pandemic levels in the post-pandemic period. A decrease in level was most pronounced in the French-speaking region (−2.82 defined daily doses per 1,000 inhabitants per day (DID) per month, 95 %CI [−4.34, −1.30], p < 0.001) and the Italian-speaking region (−2.80 DID per month, 95 %CI [−4.78, −0.82], p < 0.01), followed by the German-speaking region (−1.72 DID per month, 95 %CI [−2.71, −0.74], p < 0.01). Similarly, in the ITS, the relative change of model estimates in antibiotic prescriptions by GPs and pediatricians for upper respiratory tract infections, was of −36.0 % and −50.3 % resp. in the pandemic period and +10.1 % and −2.6 % in the post-pandemic period compared with the pre-pandemic period. Conclusions A decrease of antibiotic prescriptions was observed in GPs and pediatricians during the COVID-19 pandemic, followed by a return to pre-pandemic levels. The patterns in antibiotic prescriptions aligned with the epidemiology of respiratory infections and demonstrated a pronounced association with the implementation and subsequent removal of non-pharmaceutical interventions.

Objectives:This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age.Methods:We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]).Results:Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women’s mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20–0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41–1.06).Conclusion:Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.

Antimicrobial resistance comes with high morbidity and mortality burden, and ultimately high impact on healthcare and social costs. Efficient strategies are needed to limit antibiotic overuse. This paper investigates the cost-effectiveness of testing patients with lower respiratory tract infection with procalcitonin, either at the point-of-care only or combined with lung ultrasonography. These diagnostic tools help detect the presence of bacterial pneumonia, guiding prescription decisions. The clinical responses of these strategies were studied in the primary care setting. Evidence is needed on their cost-effectiveness. We used data from a cluster-randomized bi-centric clinical trial conducted in Switzerland and estimated patient-level costs using data on resource use to which we applied Swiss tariffs. Combining the incremental costs of the two strategies and the reduction in the 28-days antibiotic prescription rate (APR) compared to usual care, we calculated Incremental Cost-Effectiveness Ratios (ICER). We also used the Cost-Effectiveness Acceptability Curve as an analytical decision-making tool. The robustness of the findings is ensured by Probabilistic Sensitivity Analysis and scenario analysis. In the base case scenario, the ICER compared to usual care is 2.3 per percentage point (pp) reduction in APR for the procalcitonin group, and4.4 for procalcitonin-ultrasound combined. Furthermore, we found that for a willingness to pay per patient of more than 2 per pp reduction in the APR, procalcitonin is the strategy with the highest probability to be cost-effective. Our findings suggest that testing patients with respiratory symptoms with procalcitonin to guide antibiotic prescription in the primary care setting represents good value for money.

Antimicrobial resistance (AMR) is directly driven by inappropriate use of antibiotics. Although the majority of antibiotics (an estimated 80%) are consumed in primary care settings, antimicrobial stewardship (AMS) activities in primary care remain underdeveloped and factors influencing their implementation are poorly understood. This can result in promising stewardship activities having little-to-no real-world impact. With this narrative review, we aim to identify and summarize peer-reviewed literature reporting on (1) the nature and impact of AMS interventions in primary care and (2) the individual and contextual factors influencing their implementation. Reported activities included AMS at different contextual levels (individual, collective and policy). AMS activities being often combined, it is difficult to evaluate them as stand-alone interventions. While some important individual and contextual factors were reported (difficulty to reach physicians leading to a low uptake of interventions, tight workflow of physicians requiring implementation of flexible and brief interventions and AMS as a unique opportunity to strengthen physician-patients relationship), this review identified a paucity of information in the literature about the factors that support or hinder implementation of AMS in primary care settings. In conclusion, identifying multilevel barriers and facilitators for AMS uptake is an essential step to explore before implementing primary care AMS interventions.

Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR−) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR− of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR− (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs.

Background: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28. Aim: To explore the factors associated with the overruling of initial procalcitonin guidance. Design and Setting: Secondary analysis of a cluster randomized trial in which patients with an LRTI were included. Method: Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering. Results: Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03–3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32–9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34–23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18–4.37); and the GP’s number of years of experience (aOR per year 1.05, 1.01–1.09). Conclusions: Overruling of procalcitonin guidance was associated with GPs’ socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship.

Objectives We aimed to explore the acceptance and opinions of general practitioners (GPs) on the use of procalcitonin point-of-care and lung ultrasonography for managing patients with lower respiratory tract infections in primary care. We suppose that there are several factors that can influence the physician’s antibiotic prescribing decision, and the implementation of a new tool will only be possible when it can be inserted into the physician’s daily practice, helping him/her in the decision-making process. Design Semistructured interviews; data analysis using the grounded theory method. Setting Lausanne, Switzerland. Participants 12 GPs who participated in the randomised clinical trial UltraPro, which evaluated the impact of the use of procalcitonin only or an algorithm combining procalcitonin and lung ultrasonography on antibiotic prescription. Results GPs had mostly positive attitudes towards the use of point-of-care procalcitonin in lower respiratory tract infections and uncertainties regarding the usefulness of ultrasonography. Physicians’ prescribing decisions result from interactions between three kinds of TrustS (core category): ‘self-confidence’, ‘trust in the results’ and ‘trust in the doctor–patient relationship’. Procalcitonin reinforced the three levels of trust, while ultrasonography only strengthened the physician–patient relationship. To facilitate implementation of procalcitonin, physicians pointed out the need of coverage by insurance and of clear guidelines describing the targeted patient population. Conclusions Our data show that there is a preference for the implementation of procalcitonin rather than lung ultrasonography for the management of patients with lower respiratory tract infections in primary care. Coverage by insurance plans and updated guidelines are prerequisite to the successful implementation of procalcitonin testing in primary care. Trial Registration number NCT03191071