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Hempel-Bruder C, Syrogiannouli L, Schneider R, Bissig S, Senn O, Tal K, Bulliard JL, Ducros C, Schmid CPR, Auer R, Selby K. Colorectal cancer testing rates after implementation of an organised screening programme in Vaud, Switzerland. Swiss Med Wkly 2023; 153:40054. [PMID: 37080194 DOI: 10.57187/smw.2023.40054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
AIMS OF THE STUDY Canton Vaud, Switzerland, implemented an organised colorectal cancer screening programme with colonoscopy and faecal occult blood tests in 2015, 4 to 6 years ahead of neighbouring cantons. Before its implementation, nearly half of Swiss citizens were already up to date with screening, primarily from opportunistic colonoscopies. We hypothesised that earlier implementation of an organised programme would be associated with greater increases in colorectal cancer testing rates. METHODS We analysed Swiss health insurance claim data from CSS, a Swiss health insurer covering 16% of the Swiss population and 10% of canton Vaud. We stratified 50-69-year-olds into groups from Vaud, its four neighbouring cantons (Fribourg, Geneva, Neuchâtel and Valais), and the rest of Switzerland. We analysed overall, faecal occult blood test and colonoscopy testing rates for each year between 2010 and 2018. RESULTS The overall testing rate increased from 7.6% in 2010 to 11.6% in 2018 (+4.0%) in Vaud, from 6.1% to 9.3% (+3.2%) in neighbouring cantons and from 7.4% to 8.6% (+1.2%) in the rest of Switzerland. The faecal occult blood test rate increased between 2016 and 2018 from 2.9% to 4.1% (+1.2%) in Vaud and from 1.7% to 2.6% (+0.9%) in neighbouring cantons, but it decreased from 3.1% to 1.5% (-1.6%) in the rest of Switzerland. The colonoscopy rate increased in all cantons, from 4.7% to 7.5% in Vaud (+2.8%), from 4.4% to 6.7% in neighbouring cantons (+2.3%) and from 4.3% to 7.1% in the rest of Switzerland (+2.8%). By 2018, 40% of faecal occult blood tests and 26% of colonoscopies in Vaud occurred in the organised programme. Those who completed an faecal occult blood test within the Vaud programme were younger, had fewer comorbidities and were more likely to have a high-deductible health plan than those tested outside the programme. CONCLUSIONS Colorectal cancer testing rates increased between 2010 and 2018, with greater absolute increases in Vaud than in neighbouring cantons or the rest of Switzerland. Faecal occult blood test use increased in both Vaud and neighbouring cantons, possibly reflecting changes in testing patterns by general practitioners. By 2018, 40% of colonoscopies and 26% of faecal occult blood tests occurred within the screening programme.
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Affiliation(s)
- Christina Hempel-Bruder
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Rémi Schneider
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sarah Bissig
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Cyril Ducros
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Reto Auer
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Scharf T, Hügli C, Martin Y, Tal K, Biller-Andorno N, Dvořák C, Bulliard JL, Ducros C, Selby K, Auer R. Association between the colorectal cancer screening status of primary care physicians and their patients: Evidence from the Swiss Sentinella practice-based research network. Prev Med Rep 2023; 32:102140. [PMID: 36865393 PMCID: PMC9971517 DOI: 10.1016/j.pmedr.2023.102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Swiss health insurance reimburses screening for colorectal cancer (CRC) with either colonoscopy or fecal occult blood test (FOBT). Studies have documented the association between a physician's personal preventive health practices and the practices they recommend to their patients. We explored the association between CRC testing status of primary care physicians (PCP) and the testing rate among their patients. From May 2017 to September 2017, we invited 129 PCP who belonged to the Swiss Sentinella Network to disclose their CRC test status and whether they had been tested with colonoscopy or FOBT/other methods. Each participating PCP collected demographic data and CRC testing status from 40 consecutive 50- to 75-year-old patients. We analyzed data from 69 (54%) PCP 50 years or older and 2623 patients. Most PCP were men (81%); 75% were tested for CRC (67% with colonoscopy and 9% with FOBT). Mean patient age was 63; 50% were women; 43% had been tested for CRC (38%, 1000/2623 with colonoscopy and 5%, 131/2623, with FOBT or other non-endoscopic test). In multivariate adjusted regression models that clustered patients by PCP, the proportion of patients tested for CRC was higher among PCP tested for CRC than among PCP not tested (47% vs 32%; OR 1.97; 95% CI 1.36 to 2.85). Since PCP CRC testing status is associated with their patients CRC testing rates, it informs future interventions that will alert PCPs to the influence of their health decisions and motivate them to further incorporate the values and preferences of their patients in their practice.
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Affiliation(s)
- Tamara Scharf
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- Corresponding author.
| | - Claudia Hügli
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Yonas Martin
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | | | | | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Cyril Ducros
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
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Schneider R, Syrogiannouli L, Bissig S, Scharf T, Bulliard JL, Ducros C, Del Giovane C, Tal K, Zwahlen M, Selby K, Auer R. Ten-year changes in colorectal cancer screening in Switzerland: The Swiss Health Interview Survey 2007, 2012 and 2017. Prev Med Rep 2022; 27:101815. [PMID: 35656207 PMCID: PMC9152794 DOI: 10.1016/j.pmedr.2022.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/13/2022] [Accepted: 04/30/2022] [Indexed: 11/08/2022] Open
Abstract
Colorectal Cancer testing rate increased in Switzerland from 2007 to 2017. Colonoscopies are the first screening methods used in Switzerland. Low CRC screening rate is associated with age 50–59, high-deductible and basic insurance coverage. There is regional disparities in CRC screening rate in Switzerland.
Recent recommendations for colorectal cancer (CRC) screening suggest fecal occult blood test (FOBT) or colonoscopy. Since 2013, mandatory health insurance in Switzerland reimburse CRC screening. We set out to determine if CRC testing rate and type of CRC screening changed in Switzerland from 2007 to 2017 and between the three main language regions. We extracted data on 50–75-year-olds from the Swiss Health Interview Survey (SHIS) 2007, 2012 and 2017 to determine rates of self-reported testing with FOBT within last 2 years and colonoscopy within last 10 years. We estimated prevalence ratio (PR) in multivariate-adjusted logistic regression models and compared rates in German-, French- and Italian-speaking regions, adjusting for sociodemographic, self-rated health and insurance variables. Overall testing rates (FOBT or colonoscopy) increased in all regions from 2007 to 2017 (German-speaking 33.6% to 48.3%; French-speaking 30.8% to 48.8%; Italian-speaking 37.9% to 46.8%), mainly because of an increase in colonoscopy rate for screening reasons (p < 0.001 in all regions). Rates of FOBT testing fell significantly in the German-speaking region (11.9% to 4.4%, p < 0.001), but not in the Italian- (13.9% to 8.5%, p = 0.052) and French-speaking regions (7.6% to 7.4%, p = 0.138). Overall CRC testing rate rose from 33.2% in 2007 to 48.4% in 2017, mainly because of an increase of colonoscopy rate for screening reasons. Coverage remains below the 65% target of European guidelines. Organized screening programs encouraging FOBT screening could contribute to further increasing the CRC testing rate.
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Schneider R, Näpflin M, Syrogiannouli L, Bissig S, Tal K, Bulliard JL, Ducros C, Senn O, Selby K, Bähler C, Blozik E, Auer R. Change in Colorectal Cancer Tests Submitted for Reimbursement in Switzerland 2012-2018: Evidence from Claims Data of a Large Insurance. Int J Public Health 2021; 66:1604073. [PMID: 34744596 PMCID: PMC8565273 DOI: 10.3389/ijph.2021.1604073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Guidelines recommend colorectal cancer (CRC) screening by fecal occult blood test (FOBT) or colonoscopy. In 2013, Switzerland introduced reimbursement of CRC screening by mandatory health insurance for 50-69-years-olds, after they met their deductible. We hypothesized that the 2013 reimbursement policy increased testing rate. Methods: In claims data from a Swiss insurance, we determined yearly CRC testing rate among 50-75-year-olds (2012–2018) and the association with socio-demographic, insurance-, and health-related covariates with multivariate-adjusted logistic regression models. We tested for interaction of age (50–69/70–75) on testing rate over time. Results: Among insurees (2012:355′683; 2018:348′526), yearly CRC testing rate increased from 2012 to 2018 (overall: 8.1–9.9%; colonoscopy: 5.0–7.6%; FOBT: 3.1–2.3%). Odds ratio (OR) were higher for 70–75-year-olds (2012: 1.16, 95%CI 1.13–1.20; 2018: 1.05, 95%CI 1.02–1.08). Deductible interacted with changes in testing rate over time (p < 0.001). The increase in testing rate was proportionally higher among 50-69-years-olds than 70-75-year-olds over the years. Conclusions: CRC testing rate in Switzerland increased from 2012 to 2018, particularly among 50-69-years-olds, the target population of the 2013 law. Future studies should explore the effect of encouraging FOBT or waiving deductible.
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Affiliation(s)
- Rémi Schneider
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Markus Näpflin
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Lamprini Syrogiannouli
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Sarah Bissig
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Kali Tal
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Cyril Ducros
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Oliver Senn
- Institut für Hausarztmedizin, Universitätsklinikum Zürich, Zürich, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Reto Auer
- Berner Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bern, Bern, Switzerland
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Martellucci CA, Flacco ME, Morettini M, Giacomini G, Palmer M, Fraboni S, Pasqualini F. Wide variability in colorectal cancer screening uptake by general practitioner: Cross-sectional study. J Med Screen 2021; 29:21-25. [PMID: 34369814 DOI: 10.1177/09691413211035795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Despite several interventions, colorectal cancer (CRC) screening uptake remains below acceptable levels in Italy. Among the potential determinants of screening uptake, only a few studies analysed the role of general practitioners (GPs). The aim was to evaluate the variation in screening uptake of the clusters of subjects assisted by single GPs. SETTING Ancona province, Central Italy. METHODS Cross-sectional study, including all residents aged 50-69 years, who were offered the public screening programme with biannual faecal immunochemical tests. Demographic (of all GPs) and screening data (of all eligible residents) for years 2018-2019 were collected from the official electronic datasets of the Ancona Local Health Unit. The potential predictors of acceptable screening uptake, including GP's gender, age, and number of registered subjects, were evaluated using random-effect logistic regression, with geographical area as the cluster unit. RESULTS The final sample consisted of 332 GP clusters, including 120,178 eligible subjects. The overall province uptake was 38.0% ± 10.7%. The uptake was lower than 30% in one-fifth of the GP clusters, and higher than 45% in another fifth. At multivariable analysis, the significant predictors of uptake were younger GP age (p = 0.010) and lower number of registered subjects (p < 0.001). None of the GP clusters with 500 subjects or more showed an uptake ≥45%. CONCLUSIONS The wide variation across GPs suggests they might substantially influence screening uptake, highlighting a potential need to increase their commitment to CRC screening. Further research is needed to confirm the role of the number of registered subjects.
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Affiliation(s)
| | - Maria E Flacco
- Department of Medical Sciences, 9299University of Ferrara, University of Ferrara, Ferrara, Italy
| | - Margherita Morettini
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
| | - Giusi Giacomini
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
| | - Matthew Palmer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Stefania Fraboni
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
| | - Francesca Pasqualini
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
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Blackman EL, Ragin C, Jones RM. Colorectal Cancer Screening Prevalence and Adherence for the Cancer Prevention Project of Philadelphia (CAP3) Participants Who Self-Identify as Black. Front Oncol 2021; 11:690718. [PMID: 34395256 PMCID: PMC8363251 DOI: 10.3389/fonc.2021.690718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Colorectal cancer is the third leading cause of cancer-related deaths among Black men and women. While colorectal cancer screening (CRCS) reduces mortality, research assessing within race CRCS differences is lacking. This study assessed CRCS prevalence and adherence to national screening recommendations and the association of region of birth with CRCS adherence, within a diverse Black population. Methods Data from age-eligible adults, 50–75 years, (N = 357) participating in an ongoing, cross-sectional study, was used to measure CRCS prevalence and adherence and region of birth (e.g., Caribbean-, African-, US-born). Prevalence and adherence were based on contemporaneous US Preventive Services Task Force guidelines. Descriptive statistics were calculated and adjusted prevalence and adherence proportions were calculated by region of birth. Adjusted logistic regression models were performed to assess the association between region of birth and overall CRCS and modality-specific adherence. Results Respondents were 69.5% female, 43.3% married/living with partner, and 38.4% had <$25,000 annual income. Overall, 78.2% reported past CRCS; however, stool test had the lowest prevalence overall (34.6%). Caribbean (95.0%) and African immigrants (90.2%) had higher prevalence of overall CRCS compared to US-born Blacks (59.2%) (p-value <0.001). African immigrants were five times more likely to be adherent to overall CRCS compared to US-born Blacks (OR = 5.25, 95% CI 1.34–20.6). Immigrants had higher odds of being adherent to colonoscopy (Caribbean OR = 6.84, 95% CI 1.49–31.5; African OR = 7.14, 95% CI 1.27–40.3) compared to US-born Blacks. Conclusions While Caribbean and African immigrants have higher prevalence and adherence of CRCS when compared US-born Blacks, CRCS is still sub-optimal in the Black population. Efforts to increase CRCS, specifically stool testing, within the Black population are warranted, with targeted interventions geared towards US-born Blacks.
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Affiliation(s)
- Elizabeth L Blackman
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States.,Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health System, Philadelphia, PA, United States.,African Caribbean Cancer Consortium, Philadelphia, PA, United States
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health System, Philadelphia, PA, United States.,African Caribbean Cancer Consortium, Philadelphia, PA, United States
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States.,Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health System, Philadelphia, PA, United States
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7
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Bähler C, Brüngger B, Ulyte A, Schwenkglenks M, von Wyl V, Dressel H, Gruebner O, Wei W, Blozik E. Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study. BMC Public Health 2021; 21:23. [PMID: 33402140 PMCID: PMC7786957 DOI: 10.1186/s12889-020-10079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background We examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults. Methods The study is based on health insurance claims data of the Helsana Group. The Helsana Group is one of the largest health insurers in Switzerland, insuring approximately 15% of the entire Swiss population across all regions and age groups. We assessed proportions of the eligible populations receiving colonoscopy/fecal occult blood testing (FOBT), mammography, or prostate-specific antigen (PSA) testing in the years 2014, 2016, and 2018, and calculated average marginal effects of individual, temporal, regional, insurance-, supply-, and system-related variables on testing utilization using logistic regression. Results Overall, 8.3% of the eligible population received colonoscopy/FOBT in 2014, 8.9% in 2016, and 9.2% in 2018. In these years, 20.9, 21.2, and 20.4% of the eligible female population received mammography, and 30.5, 31.1, and 31.8% of the eligible male population had PSA testing. Adjusted testing utilization varied little between 2014 and 2018; there was an increasing trend of 0.8% (0.6–1.0%) for colonoscopy/FOBT and of 0.5% (0.2–0.8%) for PSA testing, while mammography use decreased by 1.5% (1.2–1.7%). Generally, testing utilization was higher in French-speaking and Italian-speaking compared to German-speaking region for all screening types. Cantonal programs for breast cancer screening were associated with an increase of 7.1% in mammography utilization. In contrast, a high density of relevant specialist physicians showed null or even negative associations with screening utilization. Conclusions Variation in cancer screening utilization was modest over time, but considerable between regions. Regional variation was highest for mammography use where recommendations are debated most controversially, and the implementation of programs differed the most. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10079-8.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland. .,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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8
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Maire M, Linder S, Dvořák C, Merlo C, Essig S, Tal K, Del Giovane C, Syrogiannouli L, Duss SB, Heinzer R, Nissen C, Bassetti CLA, Auer R. Prevalence and management of chronic insomnia in Swiss primary care: Cross‐sectional data from the “Sentinella” practice‐based research network. J Sleep Res 2020; 29:e13121. [DOI: 10.1111/jsr.13121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/09/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Micheline Maire
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Stefanie Linder
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Charles Dvořák
- Sentinella ‐ Swiss Epidemiological System Federal Office of Public Health FOPH Bern Switzerland
| | - Christoph Merlo
- Sentinella ‐ Swiss Epidemiological System Federal Office of Public Health FOPH Bern Switzerland
- Institute of Primary and Community Care Lucerne Switzerland
| | - Stefan Essig
- Sentinella ‐ Swiss Epidemiological System Federal Office of Public Health FOPH Bern Switzerland
- Institute of Primary and Community Care Lucerne Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | | | - Simone B. Duss
- Department of Neurology Sleep‐Wake‐Epilepsy Center University Hospital (Inselspital) and University of Bern Bern Switzerland
| | - Raphael Heinzer
- Pulmonary Department Center for Investigation and Research in Sleep University Hospital of Lausanne Lausanne Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and PsychotherapyUniversity of Bern Switzerland
| | - Claudio L. A. Bassetti
- Department of Neurology Sleep‐Wake‐Epilepsy Center University Hospital (Inselspital) and University of Bern Bern Switzerland
- Neurology Department Sechenov First Moscow State Medical University Moscow Russia
| | - Reto Auer
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
- Center for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
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9
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Ulyte A, Wei W, Dressel H, Gruebner O, von Wyl V, Bähler C, Blozik E, Brüngger B, Schwenkglenks M. Variation of colorectal, breast and prostate cancer screening activity in Switzerland: Influence of insurance, policy and guidelines. PLoS One 2020; 15:e0231409. [PMID: 32298325 PMCID: PMC7162274 DOI: 10.1371/journal.pone.0231409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
Variation in utilization of healthcare services is influenced by patient, provider and healthcare system characteristics. It could also be related to the evidence supporting their use, as reflected in the availability and strength of recommendations in clinical guidelines. In this study, we analyzed the geographic variation of colorectal, breast and prostate cancer screening utilization in Switzerland and the influence of available guidelines and different modifiers of access. Colonoscopy, mammography and prostate specific antigen (PSA) testing use in eligible population in 2014 was assessed with administrative claims data. We ran a multilevel multivariable logistic regression model and calculated Moran's I and regional level median odds ratio (MOR) statistics to explore residual geographic variation. In total, an estimated 8.1% of eligible persons received colonoscopy, 22.3% mammography and 31.3% PSA testing. Low deductibles, supplementary health insurance and enrollment in a managed care plan were associated with higher screening utilization. Cantonal breast cancer screening programs were also associated with higher utilization. Spatial clustering was observed in the raw regional utilization of all services, but only for prostate cancer screening in regional residuals of the multilevel model. MOR was highest for prostate cancer screening (1.24) and lowest for colorectal cancer screening (1.16). The reasons for the variation of the prostate cancer screening utilization, not recommended routinely without explicit shared decision-making, could be further investigated by adding provider characteristics and patient preference information. This first cross-comparison of different cancer screening patterns indicates that the strength of recommendations, mediated by specific health policies facilitating screening, may indeed contribute to variation.
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Affiliation(s)
- Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Caroline Bähler
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
- Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany
| | - Beat Brüngger
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
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Martin Y, Braun LA, Janggen MA, Tal K, Biller-Andorno N, Ducros C, Selby K, Auer R, Rohrbasser A. Offering patients a choice for colorectal cancer screening: a quality improvement pilot study in a quality circle of primary care physicians. BMJ Open Qual 2019; 8:e000670. [PMID: 31673642 PMCID: PMC6797289 DOI: 10.1136/bmjoq-2019-000670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 09/15/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Guidelines recommend primary care physicians (PCPs) offer patients a choice between colonoscopy and faecal immunochemical test (FIT) for colorectal cancer (CRC) screening. Patients choose almost evenly between both tests but in Switzerland, most are tested with colonoscopy while screening rates are low. A quality circle (QC) of PCPs is an ideal site to train physicians in shared decision-making (SDM) that will help more patients decide if they want to be tested and choose the test they prefer. Objective Systematically assess CRC screening status of eligible 50–75 y.o. patients and through SDM increase the proportion of patients who have the opportunity to choose CRC screening and the test (FIT or colonoscopy). Methods Working through four Plan-Do-Study-Act (PDSA) cycles in their QC, PCPs adapted tools for SDM and surmounted organisational barriers by involving practice assistants. Each PCP included 20, then 40 consecutive 50–75 y.o. patients, repeatedly reported CRC status as well as the proportion of eligible patients with whom CRC screening could be discussed and patients’ decisions. Results 9 PCPs initially included 176, then 320 patients. CRC screening status was routinely noted in the electronic medical record and CRC screening was implemented in daily routine, increasing eligible patients’ chance to be offered screening. Over a year, screening rates trended upwards, from 37% to 40% (p=0.46) and FIT use increased (2%–7%, p=0.008). Initially, 7/9 PCPs had no patient ever tested with FIT; after the intervention, only 2/8 recorded no FIT tests. Conclusions Through data-driven PDSA cycles and significant organisational changes, PCPs of a QC systematically collected data on CRC screening status and implemented SDM tools in their daily routine. This increased patients’ chance to discuss CRC screening. The more balanced use of FIT and colonoscopy suggests that patients’ values and preferences were better respected.
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Affiliation(s)
- Yonas Martin
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leo Alexander Braun
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Marc-Andrea Janggen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nikola Biller-Andorno
- Institute for Biomedical Ethics and History of Medicine (IBME), University of Zurich, Zurich, Switzerland
| | - Cyril Ducros
- Foundation for Cancer Screening of the Canton of Vaud (FVDC), Lausanne, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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