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Podmore C, Selby K, Jensen CD, Zhao WK, Weiss NS, Levin TR, Schottinger J, Doubeni CA, Corley DA. Colorectal Cancer Screening After Sequential Outreach Components in a Demographically Diverse Cohort. JAMA Netw Open 2024; 7:e245295. [PMID: 38625704 PMCID: PMC11022110 DOI: 10.1001/jamanetworkopen.2024.5295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/31/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Organized screening outreach can reduce differences in colorectal cancer (CRC) incidence and mortality between demographic subgroups. Outcomes associated with additional outreach, beyond universal outreach, are not well known. Objective To compare CRC screening completion by race and ethnicity, age, and sex after universal automated outreach and additional personalized outreach. Design, Setting, and Participants This observational cohort study included screening-eligible individuals aged 50 to 75 years assessed during 2019 in a community-based organized CRC screening program within the Kaiser Permanente Northern California (KPNC) integrated health care delivery setting. For KPNC members who are not up to date with screening by colonoscopy, each year the program first uses automated outreach (mailed prescreening notification postcards and fecal immunochemical test [FIT] kits, automated telephone calls, and postcard reminders), followed by personalized components for nonresponders (telephone calls, electronic messaging, and screening offers during office visits). Data analyses were performed between November 2021 and February 2023 and completed on February 5, 2023. Exposures Completed CRC screening via colonoscopy, sigmoidoscopy, or FIT. Main Outcomes and Measures The primary outcome was the proportion of participants completing an FIT or colonoscopy after each component of the screening process. Differences across subgroups were assessed using the χ2 test. Results This study included 1 046 745 KPNC members. Their mean (SD) age was 61.1 (6.9) years, and more than half (53.2%) were women. A total of 0.4% of members were American Indian or Alaska Native, 18.5% were Asian, 7.2% were Black, 16.2% were Hispanic, 0.8% were Native Hawaiian or Other Pacific Islander, and 56.5% were White. Automated outreach significantly increased screening participation by 31.1%, 38.1%, 29.5%, 31.9%, 31.8%, and 34.5% among these groups, respectively; follow-up personalized outreach further significantly increased participation by absolute additional increases of 12.5%, 12.4%, 13.3%, 14.4%, 14.7%, and 11.2%, respectively (all differences P < .05 compared with White members). Overall screening coverage at the end of the yearly program differed significantly among members who were American Indian or Alaska Native (74.1%), Asian (83.5%), Black (77.7%), Hispanic (76.4%), or Native Hawaiian or Other Pacific Islander (74.4%) compared with White members (82.2%) (all differences P < .05 compared with White members). Screening completion was similar by sex; older members were substantially more likely to be up to date with CRC screening both before and at the end of the screening process. Conclusions and Relevance In this cohort study of a CRC screening program, sequential automated and personalized strategies each contributed to substantial increases in screening completion in all demographic groups. These findings suggest that such programs may potentially reduce differences in CRC screening completion across demographic groups.
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Affiliation(s)
- Clara Podmore
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Kevin Selby
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Shoreline
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Joanne Schottinger
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland
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2
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Durand MA, Selby K, Okan Y. Visualisation of evidence for shared decision making. BMJ Evid Based Med 2024; 29:117-120. [PMID: 37968088 DOI: 10.1136/bmjebm-2023-112565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Marie-Anne Durand
- Centre d'Epidémiologie et de Recherche en santé des Populations, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kevin Selby
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
| | - Yasmina Okan
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
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3
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Plate A, Di Gangi S, Garzoni C, Selby K, Pichierri G, Senn O, Neuner-Jehle S. Patient leaflets on respiratory tract infections did not improve shared decision making and antibiotic prescriptions in a low-prescriber setting. Sci Rep 2024; 14:4978. [PMID: 38424442 PMCID: PMC10904372 DOI: 10.1038/s41598-024-55166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
Patient information leaflets can reduce antibiotic prescription rates by improving knowledge and encouraging shared decision making (SDM) in patients with respiratory tract infections (RTI). The effect of these interventions in antibiotic low-prescriber settings is unknown. We conducted a pragmatic pre-/post interventional study between October 2022 and March 2023 in Swiss outpatient care. The intervention was the provision of patient leaflets informing about RTIs and antibiotics use. Main outcomes were the extent of SDM, antibiotic prescription rates, and patients' awareness/knowledge about antibiotic use in RTIs. 408 patients participated in the pre-intervention period, and 315 patients in the post- intervention period. There was no difference in the extent of SDM (mean score (range 0-100): 65.86 vs. 64.65, p = 0.565), nor in antibiotic prescription rates (no prescription: 89.8% vs. 87.2%, p = 0.465) between the periods. Overall awareness/knowledge among patients with RTI was high and leaflets showed only a small effect on overall awareness/knowledge. In conclusion, in an antibiotic low-prescriber setting, patient information leaflets may improve knowledge, but may not affect treatment decisions nor antibiotic prescription rates for RTIs.
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Affiliation(s)
- Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital Zürich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich and University Hospital Zürich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Christian Garzoni
- mediX Ticino and Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Giuseppe Pichierri
- Institute of Primary Care, University of Zurich and University Hospital Zürich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zürich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich and University Hospital Zürich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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4
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Gouveia A, Surchat C, Von Plessen C, Kokkinakis I, Gaillard L, Selby K, Tan R, Bodenmann P. [2023 scientific breakthroughs in ambulatory general internal medicine]. Rev Med Suisse 2024; 20:207-211. [PMID: 38299948 DOI: 10.53738/revmed.2024.20.859.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The timing of taking antihypertensive medication does not have an impact on the cardiovascular plan. Geniculate block is an alternative to oral analgesic treatment for knee osteoarthritis. Feedback and audits are ineffective in reducing the inappropriate prescription of antibiotics in Switzerland. The intervention of community health professionals in collaboration with general practitioners allows for the control of arterial hypertension. In the case of peripheral facial paralysis, it is relevant to systematically consider performing magnetic resonance imaging. Aspirin is an alternative to enoxaparin in thromboembolic prophylaxis after surgery for a traumatic fracture. Walking 8,000 steps a few days a week reduces mortality. Opioids are not effective for acute neck and lower back pain.
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Affiliation(s)
- Alexandre Gouveia
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston
| | - Caroline Surchat
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Christian Von Plessen
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | | | - Lionel Gaillard
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Rainer Tan
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
- Institut tropical et santé publique suisse, Kreuzstrasse 2, 4123 Allschwil
| | - Patrick Bodenmann
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
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5
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Bongard C, Rey Cobo J, Messe R, Noirez L, Lovis A, Krueger T, Peters S, Pozzessere C, Selby K, von Garnier C. [Lung cancer screening : towards the implementation of a pilot project in Switzerland]. Rev Med Suisse 2023; 19:2165-2171. [PMID: 37966148 DOI: 10.53738/revmed.2023.19.850.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Lung cancer is responsible for one in five cancer-related deaths. Screening for lung cancer using low-dose chest CT (LDCT) is supported by several international studies targeting the at-risk population as part of an organised programme. Given the organisational challenges for the healthcare systems of the countries concerned, this involves setting up pilot screening projects. This requires close collaboration between the players involved, with a multidisciplinary approach structured around the participant, aiming to offer the expertise of the pulmonologist and the radiologist on the LDCT performed, interpreted with the help of artificial intelligence. Here we set out the elements needed to develop a screening programme, starting with the implementation of a pilot project.
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Affiliation(s)
- Cédric Bongard
- Service de pneumologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Juliana Rey Cobo
- Service de pneumologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Romain Messe
- Service de pneumologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Leslie Noirez
- Service de pneumologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Alban Lovis
- Service de pneumologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Thorsten Krueger
- Service de chirurgie thoracique, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Solange Peters
- Service d'oncologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Chiara Pozzessere
- Service de radiodiagnostique et radiologie interventionnelle, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Kevin Selby
- Département des policliniques, Unisanté, 1011 Lausanne
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6
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Bresalier RS, Senore C, Young GP, Allison J, Benamouzig R, Benton S, Bossuyt PMM, Caro L, Carvalho B, Chiu HM, Coupé VMH, de Klaver W, de Klerk CM, Dekker E, Dolwani S, Fraser CG, Grady W, Guittet L, Gupta S, Halloran SP, Haug U, Hoff G, Itzkowitz S, Kortlever T, Koulaouzidis A, Ladabaum U, Lauby-Secretan B, Leja M, Levin B, Levin TR, Macrae F, Meijer GA, Melson J, O'Morain C, Parry S, Rabeneck L, Ransohoff DF, Sáenz R, Saito H, Sanduleanu-Dascalescu S, Schoen RE, Selby K, Singh H, Steele RJC, Sung JJY, Symonds EL, Winawer SJ. An efficient strategy for evaluating new non-invasive screening tests for colorectal cancer: the guiding principles. Gut 2023; 72:1904-1918. [PMID: 37463757 PMCID: PMC10511996 DOI: 10.1136/gutjnl-2023-329701] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE New screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. DESIGN A formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles. RESULTS Twelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test's ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase III prospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IV studies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence. CONCLUSION New non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact.
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Affiliation(s)
- Robert S Bresalier
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlo Senore
- Epidemiology and screening unit, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte, Turin, Italy
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - James Allison
- Internal Medicine/Division of Gastroenterology, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Robert Benamouzig
- Gastroenterology & Digestive Oncology Department, Hôpital Avicenne University Paris Nord La Sorbonne, Bobigny, France
| | - Sally Benton
- Department of Clinical Biochemistry and NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Luis Caro
- Carrera de especialista de Endoscopia Digestiva, Institución GEDYT (Gastroenterologia diagnostico y terapéutica), Buenos Aires, Argentina
| | - Beatriz Carvalho
- Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Veerle M H Coupé
- Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Willemijn de Klaver
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Clasine Maria de Klerk
- Department of Gastroenterology and Hepatology C2-310, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology C2-115, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Sunil Dolwani
- Dept of Gastroenterology, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee School of Medicine, Dundee, UK
| | - William Grady
- Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Lydia Guittet
- ERI3 Cancers & Populations, Normandie University, UNICAEN, Caen, France
| | - Samir Gupta
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Ulrike Haug
- Division of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Geir Hoff
- Department of Research, Telemark Hospital, Skien, Norway
- Department of CRC screening, Cancer Registry of Norway, Oslo, Norway
| | - Steven Itzkowitz
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tim Kortlever
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | | | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Beatrice Lauby-Secretan
- Section of Evidence Synthesis and Classification, International Agency for Research on Cancer, Lyon, France
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Bernard Levin
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Finlay Macrae
- Colorectal Medicine and Genetics, The University of Melbourne Department of Medicine Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Gerrit A Meijer
- Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joshua Melson
- High-Risk Clinic for Gastrointestinal Cancers, University of Arizona Cancer Center Division of Gastroenterology, Banner University, Tucson, Arizona, USA
| | - Colm O'Morain
- Gastroenterology, Trinity College Dublin Faculty of Health Sciences, Dublin, Ireland
| | - Susan Parry
- National Bowel Screening Programme, National Screening Unit, Te Whatu Ora Health New Zealand, Auckland, New Zealand
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Linda Rabeneck
- Department of Medicine, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - David F Ransohoff
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Roque Sáenz
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago de Chile, Chile
| | - Hiroshi Saito
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | | | - Robert E Schoen
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kevin Selby
- Department of ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Harminder Singh
- Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | | | - Joseph J Y Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Erin Leigh Symonds
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sidney J Winawer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Morisod K, Martin T, Rawlinson C, Grazioli VS, von Plessen C, Durand MA, Selby K, Le Pogam MA, Bühler N, Bodenmann P. Facing the COVID-19 Pandemic: A Mixed-Method Analysis of Asylum Seekers' Experiences and Worries in the Canton of Vaud, Switzerland. Int J Public Health 2023; 68:1606229. [PMID: 37829084 PMCID: PMC10564980 DOI: 10.3389/ijph.2023.1606229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Objectives: The clinical and social burden of the COVID-19 pandemic were high among asylum seekers (ASs). We aimed to understand better ASs' experiences of the pandemic and their sources of worries. Methods: Participants (n = 203) completed a survey about their worries, sleep disorders, and fear of dying. We also conducted semi-structured interviews with ASs living in a community center (n = 15), focusing on how social and living conditions affected their experiences and worries. Results: ASs in community centers experienced more sleep disorders related to the COVID-19 pandemic than those living in private apartments (aOR 2.01, p = 0.045). Similarly, those with lower education had greater fear for their life due to the COVID-19 pandemic (aOR 2.31, p = 0.015). Qualitative findings showed that sharing living spaces was an important source of worries for ASs and that protective measures were perceived to increase social isolation. Conclusion: Our study highlighted the impact of the COVID-19 pandemic for ASs and the importance of tailoring public health measures to their needs and living conditions.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tiffany Martin
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Cloé Rawlinson
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Department of Ambulatory Care, Center for Primary Care and Public Health, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Direction Générale de la Santé (DGS), Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marie-Anne Durand
- UMR1295 Centre d’Epidémiologie et de Recherche en Santé des Populations (CERPOP), Toulouse, France
- University Center of General Medicine and Public Health, Lausanne, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Kevin Selby
- Department of Ambulatory Care, Center for Primary Care and Public Health, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Nolwenn Bühler
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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8
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Plys E, Bulliard JL, Chaouch A, Durand MA, van Duuren LA, Brändle K, Auer R, Froehlich F, Lansdorp-Vogelaar I, Corley DA, Selby K. Colorectal Cancer Screening Decision Based on Predicted Risk: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46865. [PMID: 37676720 PMCID: PMC10514773 DOI: 10.2196/46865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Incidence of and mortality from colorectal cancer (CRC) can be effectively reduced by screening with the fecal immunochemical test (FIT) or colonoscopy. Individual risk to develop CRC within 15 years varies from <1% to >15% among people aged 50 to 75 years. Communicating personalized CRC risk and appropriate screening recommendations could improve the risk-benefit balance of screening test allocations and optimize the use of limited colonoscopy resources. However, significant uncertainty exists regarding the feasibility and efficacy of risk-based screening. OBJECTIVE We aim to study the effect of communicating individual CRC risk and a risk-based recommendation of the FIT or colonoscopy on participants' choice of screening test. We will also assess the feasibility of a larger clinical trial designed to evaluate the impact of personalized screening on clinical outcomes. METHODS We will perform a pilot randomized controlled trial among 880 residents aged 50 to 69 years eligible to participate in the organized screening program of the Vaud canton, Switzerland. Participants will be recruited by mail by the Vaud CRC screening program. Primary and secondary outcomes will be self-assessed through questionnaires. The risk score will be calculated using the open-source QCancer calculator that was validated in the United Kingdom. Participants will be stratified into 3 groups-low (<3%), moderate (3% to <6%), and high (≥6%) risk-according to their 15-year CRC risk and randomized within each risk stratum. The intervention group participants will receive a newly designed brochure with their personalized risk and screening recommendations. The control group will receive the usual brochure of the Vaud CRC screening program. Our primary outcome, measured using a self-administered questionnaire, is appropriate screening uptake 6 months after the intervention. Screening will be defined as appropriate if participants at high risk undertake colonoscopy and participants at low risk undertake the FIT. We will also measure the acceptability of the risk score and screening recommendations and the psychological factors influencing screening behavior. We will also assess the feasibility of a full-scale randomized controlled trial. RESULTS We expect that a total sample of 880 individuals will allow us to detect a difference of 10% (α=5%) between groups. The main outcome will be analyzed using a 2-tailed chi-squared test. We expect that appropriate screening uptake will be higher in the intervention group. No difference in overall screening uptake is expected. CONCLUSIONS We will test the impact of personalized risk information and screening recommendations on participants' choice of screening test in an organized screening program. This study should advance our understanding of the feasibility of large-scale risk-based CRC screening. Our results may provide insights into the optimization of CRC screening by offering screening options with a better risk-benefit balance and optimizing the use of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05357508; https://www.clinicaltrials.gov/study/NCT05357508. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46865.
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Affiliation(s)
- Ekaterina Plys
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Aziz Chaouch
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Center for Epidemiology and Research in Population Health, UMR1295 Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Luuk A van Duuren
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Karen Brändle
- 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
| | - Florian Froehlich
- Department of Gastroenterology, University Hospital of Basel, Basel, Switzerland
| | | | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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9
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Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland (K.S.)
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire (G.E.)
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (R.J.V.)
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Albers B, Auer R, Caci L, Nyantakyi E, Plys E, Podmore C, Riegel F, Selby K, Walder J, Clack L. Implementing organized colorectal cancer screening programs in Europe-protocol for a systematic review of determinants and strategies. Syst Rev 2023; 12:26. [PMID: 36849979 PMCID: PMC9969690 DOI: 10.1186/s13643-023-02193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND With a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants. METHODS A systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis. DISCUSSION With its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022306580).
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Affiliation(s)
- Bianca Albers
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Laura Caci
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Emanuela Nyantakyi
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Ekaterina Plys
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Clara Podmore
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Franziska Riegel
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Joel Walder
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Selby K, Sedki M, Levine E, Kamineni A, Green BB, Vachani A, Haas JS, Ritzwoller DP, Croswell JM, Ohikere K, Doria-Rose VP, Rendle KA, Chubak J, Lafata JE, Inadomi J, Corley DA. Test performance metrics for breast, cervical, colon and lung cancer screening: a systematic review. J Natl Cancer Inst 2023; 115:375-384. [PMID: 36752508 PMCID: PMC10086636 DOI: 10.1093/jnci/djad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/19/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Multiple quality metrics have been recommended to ensure consistent, high-quality execution of screening tests for breast, cervical, colorectal and lung cancers. However, minimal data exist evaluating the evidence base supporting these recommendations and the consistency of definitions and concepts included within and between cancer types. METHODS We performed a systematic review for each cancer type using MEDLINE, Embase and CINAHL from 2010 to April 2020, to identify guidelines from screening programs or professional organizations containing quality metrics for tests used in breast, cervical, colorectal and lung cancer screening. We abstracted metrics' definitions, target performance levels, and related supporting evidence for test completeness, adequacy (sufficient visualization or collection), accuracy, and safety. RESULTS We identified 11 relevant guidelines with 20 suggested quality metrics for breast cancer, 5 guidelines with 9 metrics for cervical cancer, 13 guidelines with 18 metrics for colorectal cancer, and 3 guidelines with 7 metrics for lung cancer. These included 54 metrics related to adequacy (6), test completeness (3), accuracy (33), and safety (12). Target performance levels were defined for 30 metrics (56%). Ten (19%) were supported by evidence, all from breast and colorectal cancer, with no evidence cited to support metrics from cervical and lung cancer screening. CONCLUSIONS Considerably more guideline-recommended test performance metrics exist for breast and colorectal cancer screening than cervical or lung cancer. The domains covered are inconsistent among cancers and few targets are supported by evidence. Clearer evidence-based domains and targets are needed for test performance metrics. REGISTRATION PROSPERO 2020 CRD42020179139.
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Affiliation(s)
- Kevin Selby
- Center for primary care and public health (Unisanté), Lausanne, Switzerland
| | - Mai Sedki
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emma Levine
- University of California at San Francisco, San Francisco, CA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Debra P Ritzwoller
- Institute for Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Kabiru Ohikere
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Katharine A Rendle
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer Elston Lafata
- Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, USA, USA
| | - John Inadomi
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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14
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Gosteli M, Selby K, Von Plessen C, Agoritsas T, Giguère A, Abreha S, Bilien M, Durand MA. [Can we increase the availability of decision aids in French-speaking Switzerland?]. Rev Med Suisse 2023; 19:186-191. [PMID: 36723644 DOI: 10.53738/revmed.2023.19.812.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Models of shared decision making recommend the use of patient decision aids. Hundreds of such aids exist worldwide but scaling up of their use in French-speaking Switzerland requires their translation to French and their adaptation to the clinical context. We review seven sources of tools that we assume relevant for French-speaking Switzerland. A short survey on a selection of three decision aids of general practitioners in the canton of Vaud confirmed their general interest in using such tools. They preferred a limited amount and a simple presentation of information in the decision aids to facilitate integration in clinical practice. Given the complexity of the required translations and adaptations, the medical community should develop a collaborative approach to lift this important task.
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Affiliation(s)
- Marine Gosteli
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Christian Von Plessen
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Thomas Agoritsas
- Département de médecine, Hôpitaux universitaire de Genève, 1211 Genève
| | - Anik Giguère
- Département de médecine familiale et de médecine d'urgence de l'Université Laval, QC G1V 0A6, Québec, Canada
| | - Samuel Abreha
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Magali Bilien
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Marie-Anne Durand
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne.,CERPOP, Université de Toulouse, Inserm, UPS, Faculté de médecine, 37 allées Jules Guesde, 31000 Toulouse, France.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Hanover, Lebanon, NH 03755, États-Unis
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15
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Gouveia A, Bongard A, Von Plessen C, Velez D, Deillon E, Delorme H, Kokkinakis I, Samusure J, Selby K, Bodenmann P. [2022 scientific breakthroughs in ambulatory general internal medicine]. Rev Med Suisse 2023; 19:167-171. [PMID: 36723640 DOI: 10.53738/revmed.2023.19.812.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In patients aged 65 or older, the risk of dementia decreases with cataract surgery. Mental stress doubles the risk of a cardiac event in patients with stable coronary artery disease. The one-legged stance performance estimates total mortality in patients 50 years or older. Patients with chronic pain benefit from treatment with dronabinol or nabiximols. Salt substitutes are an alternative to regular salt in hypertensive patients aged 60 years or more. The promotion of physical activity in the office is effective in reducing sedentary behavior. Music has a favorable impact on the mental dimensions of quality of life. Colonoscopies performed on patients aged 75 years or more have a higher risk of non-gastrointestinal complications than gastrointestinal complications.
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Affiliation(s)
- Alexandre Gouveia
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Aurelie Bongard
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Christian Von Plessen
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - David Velez
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Eva Deillon
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Helene Delorme
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Ioannis Kokkinakis
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne.,Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Jeremie Samusure
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne.,Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Patrick Bodenmann
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne.,Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
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16
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Morisod K, Durand MA, Selby K, Le Pogam MA, Grazioli VS, Sanchis Zozaya J, Bodenmann P, von Plessen C. Asylum Seekers' Responses to Government COVID-19 Recommendations: A Cross-sectional Survey in a Swiss Canton. J Immigr Minor Health 2022; 25:570-579. [PMID: 36508030 PMCID: PMC9743178 DOI: 10.1007/s10903-022-01436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Asylum seekers face multiple language, cultural and administrative barriers that could result in the inappropriate implementation of COVID-19 measures. This study aimed to explore their knowledge and attitudes to recommendations about COVID-19. We conducted a cross-sectional survey among asylum seekers living in the canton of Vaud, Switzerland. We used logistic regressions to analyze associations between knowledge about health recommendations, the experience of the pandemic and belief to rumors, and participant sociodemographic characteristics. In total, 242 people participated in the survey, with 63% of men (n = 150) and a median age of 30 years old (IQR 23-40). Low knowledge was associated with linguistic barriers (aOR 0.36, 95% CI 0.14-0.94, p = 0.028) and living in a community center (aOR 0.43, 95% CI 0.22-0.85, p = 0.014). Rejected asylum seekers were more likely to believe COVID-19 rumors (aOR 2.81, 95% CI 1.24-6.36, p = 0.013). This survey underlines the importance of tailoring health recommendations and interventions to reach asylum seekers, particularly those living in community centers or facing language barriers.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France ,Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Kevin Selby
- Department Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Javier Sanchis Zozaya
- grid.8515.90000 0001 0423 4662Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,Direction Générale de La Santé (DGS), Lausanne, Switzerland ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Monod S, Moll-François F, Vernez D, Bochud M, Dupraz J, Selby K, Cornuz J. [Risk assessment and management: between epidemiology and social acceptability]. Rev Med Suisse 2022; 18:2112-2119. [PMID: 36350023 DOI: 10.53738/revmed.2022.18.803.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Risk is a well-known concept in medicine and in epidemiology and its approach intend to be rational and measurable. Risk measurement makes it possible to communicate with a patient or a population the risk of occurrence of an event. However, it is often difficult to estimate accurately the probability of occurrence of an adverse event and there is therefore uncertainty. In addition, the notion of risk is not easy to grasp for most people. The same risk can be perceived very differently from one individual to another and this perception and understanding depends on psychological, social, cultural, historical and political factors. Understanding this social dimension of risk in clinical practice or in public health is essential to implement efficient risk management.
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Affiliation(s)
- Stéfanie Monod
- Département épidémiologie et système de santé, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
| | - Fabien Moll-François
- Département épidémiologie et système de santé, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
| | - David Vernez
- Département santé au travail et environnement, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
| | - Murielle Bochud
- Département épidémiologie et système de santé, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
| | - Julien Dupraz
- Département épidémiologie et système de santé, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
| | - Kevin Selby
- Département des policliniques, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
| | - Jacques Cornuz
- Direction générale, Centre universitaire de médecine générale et santé publique (Unisanté), 1010 Lausanne
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18
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Gini A, Selby K. Fecal Immunochemical Tests: The Right Colorectal Cancer Screening Test for the Average-Risk Population? Clin Gastroenterol Hepatol 2022; 20:2216-2217. [PMID: 35390510 DOI: 10.1016/j.cgh.2022.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Andrea Gini
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Hempel-Bruder C, Habfast-Robertson I, Durand MA, Berlin I, Marti J, Khazaal Y, Quinto C, Faouzi M, Selby K. Combining default choices and an encounter decision aid to improve tobacco cessation in primary care patients: protocol for a cluster-randomized trial. BMC Prim Care 2022; 23:246. [PMID: 36151529 PMCID: PMC9508762 DOI: 10.1186/s12875-022-01859-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients' "readiness" to quit, an "opt-in" strategy, but only a minority of tobacco users are ready to quit on a given day. An "opt-out" strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care. METHODS This is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an 'opt-out' approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05. DISCUSSION GP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.
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Affiliation(s)
- Christina Hempel-Bruder
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Inès Habfast-Robertson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
- UMR 1295, CERPOP, University Toulouse III Paul Sabatier, Toulouse, France
| | | | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Yasser Khazaal
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
- Department of Addiction Medicine, CHUV, Lausanne, Switzerland
| | | | - Mohamed Faouzi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland.
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20
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Rousseau S, Lucca I, Selby K. [Nutcracker syndrome: a cause of unexplained hematuria]. Rev Med Suisse 2022; 18:1566-1569. [PMID: 36004658 DOI: 10.53738/revmed.2022.18.792.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hematuria is frequently encountered in clinical practice. Its diagnostic spectrum is wide: urinary tract infection, lithiasis, malignant tumor and nephropathy. In the absence of one of these causes, the nutcracker syndrome must be evoked. It results from compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. Knowing how to diagnose it can avoid morbid consequences (chronic renal disease, renal vein thrombosis). In addition to hematuria, its main symptoms are left lumbago, varicoceles, and orthostatic proteinuria. The clinical picture and complementary examinations (ultrasound-doppler, computed tomography angiography, magnetic resonance angiography, and phlebography) generally allow the diagnosis to be made. Treatment varies according to age and severity of symptoms.
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Affiliation(s)
| | - Ilaria Lucca
- Service d'urologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Kevin Selby
- Unisanté, Centre universitaire de médecine générale et santé publique, 1005 Lausanne
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21
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Bissig S, Syrogiannouli L, Schneider R, Tal K, Selby K, Del Giovane C, Bulliard JL, Senn O, Ducros C, Schmid CP, Marbet U, Auer R. Change in colorectal cancer (CRC) testing rates associated with the introduction of the first organized screening program in canton Uri, Switzerland: Evidence from insurance claims data analyses from 2010 to 2018. Prev Med Rep 2022; 28:101851. [PMID: 35757577 PMCID: PMC9218582 DOI: 10.1016/j.pmedr.2022.101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
First colorectal cancer (CRC) screening program in Switzerland launched in one canton in 2013. Launched in the context of high prevalent opportunistic CRC testing. Led to an increase in fecal occult blood testing and not colonoscopy. Claims data analyses enable estimating the net effect of programs in general population.
The first canton in Switzerland to implement an organized colorectal cancer screening program (OSP) was Uri. Starting in 2013, it offered 50–69-year-olds free testing with colonoscopy every 10 years or fecal occult blood test (FOBT) every 2 years. We tested the association between the OSP and testing rates over time. We analyzed claims data of 50–69-year-olds from Uri and neighboring cantons (NB) provided by a large health insurance and complemented it with data from the OSP. We fitted multivariate adjusted logistic regression models to compare overall testing rates and by method (colonoscopy or FOBT/both) We computed the 2018 rate of the population up-to-date with testing (colonoscopy within 9 years/FOBT within 2 years). Yearly overall testing rates in Uri increased from 8.7% in 2010 to 10.8% in 2018 and from 6.5% to 7.9% in NB. In Uri, the proportion tested with FOBT/both increased from 4.7% to 6.0% but decreased from 2.8% to 1.1% in NB. Testing by FOBT/both increased more between 2015 and 2018 than 2010–2012 in Uri than in NB (OR:2.1[95%CI:1.8–2.4]), it increased less for colonoscopy (OR:0.60[95%CI:0.51–0.70]), with no change in overall CRC testing (OR:0.91[95%CI:0.81–1.02]). In 2018 in Uri, 42.5% were up-to-date with testing (FOBT/both:9.2%, colonoscopy:35.7%); in NBs, 40.7% (FOBT/both:2.7%, colonoscopy:39%). Yearly FOBT rates in Uri were always higher than in NB. Though the OSP in Uri was not associated with a greater increase in overall testing rates, the OSP was associated with increased FOBT.
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Key Words
- AL, Swiss analysis list for laboratory measures
- CRC, colorectal cancer
- FOBT, gFOBT, iFOBT, fecal occult blood test, guaiac or immunochemical based (also called FIT)
- FSO, federal statistics office
- NB, neighboring cantons
- OSP, organized screening program
- PCG, pharmacy based cost groups
- SHS, swiss health survey
- TARMED, Swiss ambulant procedures codes
- Uri, the canton of Uri
- claims data
- colonoscopy
- colorectal cancer
- fecal occult blood test
- health insurance
- organized screening program
- screening
- testing rates
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Affiliation(s)
- Sarah Bissig
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Rémi Schneider
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Kali Tal
- 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
| | - Cinzia Del Giovane
- 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
| | - Oliver Senn
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Cyril Ducros
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christian P.R. Schmid
- CSS Institute for Empirical Health Economics, Tribschenstrasse 21, Lucerne, Switzerland
| | - Urs Marbet
- Division of Gastroenterology and Hepatology Cantonal Hospital of Uri, Altdorf, 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
- Corresponding author at: Institute of primary health care (BIHAM), University of Bern, Mittelstrasse 43, CH - 3012 Bern, Switzerland.
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22
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Cuérel M, Raetzo MA, Selby K, Kherad O. General practitioner agreement and adherence to the Swiss Choosing wisely top 5 list: A cross-sectional survey. Eur J Intern Med 2022; 102:136-137. [PMID: 35465972 DOI: 10.1016/j.ejim.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/16/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mae Cuérel
- Haute Ecole Spécialisée de Suisse Occidentale (HES-SO - HEIG-VD), Switzerland
| | | | - Kevin Selby
- Unisanté and University of Lausanne, Switzerland
| | - Omar Kherad
- Delta network, Health Maintenance Organization, Geneva, Switzerland; Internal medicine division, Hospital de la Tour and University of Geneva, Switzerland.
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23
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Schneiter D, Habfast-Robertson I, Adam A, Hempel-Bruder C, Durand MA, Selby K. [Decision aids for addictions: the example of smoking cessation]. Rev Med Suisse 2022; 18:1149-1153. [PMID: 35678345 DOI: 10.53738/revmed.2022.18.785.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Decision aids (DAs) help patients participate in healthcare decisions by improving knowledge and clarifying values and preferences, thus favoring a more active role in the decision process. DAs exist as a physical support (paper, DVD, audio) or computerized formats. They can be used independently by patients before and after consultations, or with a health professional during consultations. Unisanté has created a DA for use during consultations presenting available smoking cessation aids (www.howtoquit.ch). A local study showed that the DA is considered easy to use and useful by the doctors interviewed. The use of DAs in addictions to other substances, in conjunction with shared decision making, shows a favourable effect on the involvement of patients in their health and therapeutic adherence.
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Affiliation(s)
- Deborah Schneiter
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | | | - Angéline Adam
- Service de médecine des addictions, Département de psychiatrie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | | | - Marie-Anne Durand
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
- CERPOP, Inserm, Université Toulouse III - Paul Sabatier, 31062 Toulouse, France
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, États-Unis
| | - Kevin Selby
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
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24
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Selby K, Durand MA, von Plessen C, Auer R, Biller-Andorno N, Krones T, Agoritsas T, Cornuz J. Shared decision-making and patient and public involvement: Can they become standard in Switzerland? Z Evid Fortbild Qual Gesundhwes 2022; 171:135-138. [PMID: 35610134 DOI: 10.1016/j.zefq.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
The Swiss healthcare system is highly decentralized, making implementation of shared decision making (SDM) and patient and public involvement (PPI) quite slow; nonetheless, change is happening. SDM is now a core communication competency for medical school graduates, as reflected by a dedicated station on the federal exam, and is endorsed by several national societies. Multiple local initiatives are contributing to international best practices, local implementation, and increased capacity. PPI is also gaining momentum, most notably in research, with the development of a national platform for clinical research and inclusion of patients in the evaluation committees for funding. The challenge now is going from example projects by motivated early adopters in academia to making SDM and PPI standard practice.
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Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; CERPOP, Université de Toulouse, Inserm, Université Toulouse III - Paul-Sabatier, Toulouse, France
| | - Christian von Plessen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Department of Clinical Research, University of Southern Denmark, C Odense, Denmark
| | - Reto Auer
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | | | | | | | - Jacques Cornuz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
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25
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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] [What about the content of this article? (0)] [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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26
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Selby K, Marti J, Durand MA. We are all choice architects: using behavioral economics to improve smoking cessation in primary care. J Gen Intern Med 2022; 37:1783-1785. [PMID: 35018565 PMCID: PMC9130388 DOI: 10.1007/s11606-021-07322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,University of Toulouse III Paul Sabatier, Toulouse, France.,Dartmouth University, Lebanon, New Hampshire, USA
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27
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Samusure J, Horisberger D, Diserens C, Ducros C, Auer R, Bodenmann P, Durand MA, Selby K. [Information materials for colorectal cancer screening for citizens with low health literacy]. Rev Med Suisse 2022; 18:616-620. [PMID: 35353458 DOI: 10.53738/revmed.2022.18.775.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For multiple reasons, certain socially disadvantaged populations are more affected by colorectal cancer but have lower screening rates than wealthier populations. The Vaud colorectal cancer screening program (CCR) provides a 20-page decision support tool for the 50-69-year-old population. Three new tools have now been designed specifically for citizens with a low level of health literacy: a simplified 6-page leaflet presenting the choice of a Fecal Occult Blood Test (FIT) and colonoscopy; a 2-page leaflet presenting the detection and screening of 4 common cancers; and a short video presenting the FIT test. By adapting our approach to each individual's level of health literacy, we can ensure a shared decision for all.
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Affiliation(s)
- Jérémie Samusure
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | | | | | - Cyril Ducros
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | - Reto Auer
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
- Institut bernois de médecine de famille (BIHAM), Université de Berne, 3012 Berne
| | - Patrick Bodenmann
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | - Marie-Anne Durand
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
- CERPOP, Université de Toulouse, Inserm, UPS, 5, Allée Antonio-Machado, 31058 Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03766, États-Unis
| | - Kevin Selby
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
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28
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Zorzi M, Battagello J, Selby K, Capodaglio G, Baracco S, Rizzato S, Chinellato E, Guzzinati S, Rugge M. Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer. Gut 2022; 71:561-567. [PMID: 33789965 PMCID: PMC8862019 DOI: 10.1136/gutjnl-2020-322192] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The risk of colorectal cancer (CRC) among subjects with a positive faecal immunochemical test (FIT) who do not undergo a colonoscopy is unknown. We estimated whether non-compliance with colonoscopy after a positive FIT is associated with increased CRC incidence and mortality. METHODS The FIT-based CRC screening programme in the Veneto region (Italy) invited persons aged 50 to 69 years with a positive FIT (>20 µg Hb/g faeces) for diagnostic colonoscopy at an endoscopic referral centre. In this retrospective cohort study, we compared the 10-year cumulative CRC incidence and mortality among FIT positives who completed a diagnostic colonoscopy within the programme (compliers) and those who did not (non-compliers), using the Kaplan-Meier estimator and Cox-Aalen models. RESULTS Some 88 013 patients who were FIT positive complied with colonoscopy (males: 56.1%; aged 50-59 years: 49.1%) while 23 410 did not (males: 54.6%; aged 50-59 years: 44.9%).The 10-year cumulative incidence of CRC was 44.7 per 1000 (95% CI, 43.1 to 46.3) among colonoscopy compliers and 54.3 per 1000 (95% CI, 49.9 to 58.7) in non-compliers, while the cumulative mortality for CRC was 6.8 per 1000 (95% CI, 5.9 to 7.6) and 16.0 per 1000 (95% CI, 13.1 to 18.9), respectively. The risk of dying of CRC among non-compliers was 103% higher than among compliers (adjusted HR, 2.03; 95% CI, 1.68 to 2.44). CONCLUSION The excess risk of CRC death among those not completing colonoscopy after a positive faecal occult blood test should prompt screening programmes to adopt effective interventions to increase compliance in this high-risk population.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | | | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Giulia Capodaglio
- Screening and Health Impact Assessment Unit, Azienda Zero, Padova, Italy
| | | | | | | | | | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
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29
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Gouveia A, Auer S, Baratali L, Deillon E, Kokkinakis I, Leuzinger S, Samusure J, Selby K, Tzartzas K, Favrat B, Bodenmann P. [2021 scientific breakthroughs in ambulatory general internal medicine]. Rev Med Suisse 2022; 18:102-106. [PMID: 35084134 DOI: 10.53738/revmed.2022.18.766.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Psychotherapy diminishes depression relapses when antidepressants are reduced or stopped. Delayed antibiotic therapy is effective and safe while treating community-acquired respiratory infection. Physical rehabilitation after hospitalization due to acute cardiac decompensation is useful in frail patients. Six hours of sleep appears to be associated with a higher risk of dementia in people aged 50-70 years. Patients modify healthcare use after losing their referring physician. Screening for atrial fibrillation in healthy patients aged 65 or older is not beneficial. Physicians' ECG reading skills decrease in the absence of regular training. Patients hospitalized with COVID-19 are often clinically, psychologically, and economically impacted.
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Affiliation(s)
- Alexandre Gouveia
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Silva Auer
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Laïla Baratali
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Eva Deillon
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Ioannis Kokkinakis
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Salomé Leuzinger
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Jérémie Samusure
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département formation, recherche et innovation, Unisanté, 1011 Lausanne
| | - Konstantinos Tzartzas
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Bernard Favrat
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Patrick Bodenmann
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
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30
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Pittet AL, Chevalley AF, Jeannot JG, Khazaal Y, Selby K. [Mobile applications for smoking cessation in primary care]. Rev Med Suisse 2021; 17:2105-2109. [PMID: 34851059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Primary care physicians are in an excellent position to address smoking during routine consultations. To this end, physicians have assessment tools and brief interventions appropriate for the duration of consultations. However, these tools are difficult to use consistently in practice. Mobile applications (apps) aimed at stopping smoking could help solve this problem, provided they meet certain quality criteria. This article provides criteria for evaluating these apps to facilitate their identification and use by clinicians. Five French-speaking apps are described. If integrated into routine Primary Care, these apps could facilitate smoking cessation.
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Affiliation(s)
| | - Anne-Françoise Chevalley
- Docteur en biologie et Psychologue, Fédération suisse des psychologues (FSP), Rue du Coq 1, 1030 Bussigny
| | | | - Yasser Khazaal
- Service de médecine des addictions, Département de psychiatrie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Kevin Selby
- Département des polycliniques, Département formation, recherche et innovation, Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
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Habfast-Robertson I, Hempel-Bruder C, Durand MA, Morin D, Remillard S, Nanchen D, Daeppen JB, Berlin I, Selby K. [Three approaches to doctor-patient communication and prevention : Which model for which situation ?]. Rev Med Suisse 2021; 17:1934-1938. [PMID: 34755943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Doctors learn different communication approaches for use during prevention consultations to promote healthy habits, so as to set up a partnership and to promote patient autonomy. Three of these approaches are shared decision making, when there is more than one reasonable choice, motivational interviewing, principally for behaviour change and therapeutic education, a pedagogical approach helping patients develop skills so that they may have a better management of their chronic illness. This article presents an overview of the commonalities and the differences between these approaches, often considered separately, nevertheless they are complementary and in practice, using elements of all three during a consultation could improve preventative care.
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Affiliation(s)
| | | | - Marie-Anne Durand
- Département formation, recherche et innovation, Unisanté, 1010 Lausanne
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03766, États-Unis
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III - Paul-Sabatier, 118 route de Narbonne, 31062 Toulouse, France
| | - Diane Morin
- Infirmières spécialisées en éducation thérapeutique du patient, CHUV, 1011 Lausanne
| | - Suzette Remillard
- Infirmières spécialisées en éducation thérapeutique du patient, CHUV, 1011 Lausanne
| | - David Nanchen
- Département promotion de la santé et préventions, Unisanté, 1010 Lausanne
| | | | - Ivan Berlin
- Département formation, recherche et innovation, Unisanté, 1010 Lausanne
- Département de pharmacologie, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Kevin Selby
- Département formation, recherche et innovation, Unisanté, 1010 Lausanne
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Gouveia A, Henchoz Y, Selby K, Cornuz J. [Community-based medical practice. New academic teaching through a mass COVID-19 screening]. Rev Med Suisse 2021; 17:1922-1926. [PMID: 34755941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Clusters of COVID-19 cases emerged during the months of December 2020 and January 2021 in the Vaud Alps. This epidemiological situation was worrying, as it appeared before a winter holiday period. In view of this epidemiological risk, the cantonal authorities decided to carry out mass screening in three communes from 5 to 13 February 2021 in addition to the standard measures in place. Seeing an opportunity to create innovative university teaching, Unisanté set up a new course for medical students of the University of Lausanne called Community Medical Practice. This immersion in the practice of public health enabled some thirty students to carry out several activities (clinical, research and epidemiological) in a unique pandemic context.
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Affiliation(s)
- Alexandre Gouveia
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
| | - Yves Henchoz
- Docteur ès Sciences, Département épidémiologie et services de santé, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Policlinique de médecine générale, Département des policliniques, Unisanté, 1011 Lausanne
- Département de formation, recherche et innovation, Unisanté, 1011 Lausanne
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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34
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Selby K. [Not Available]. Rev Med Suisse 2021; 17:1806. [PMID: 34669298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Morisod K, Durand M, Selby K, Le Pogam M, Grazioli V, Sanchis Zozaya J, Bodenmann P, Van Plessen C. Asylum seekers’ and refugees’ understanding of government restrictions during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574750 DOI: 10.1093/eurpub/ckab164.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Asylum seekers and refugees risk poorer public health information and difficulties to follow measures during the COVID-19 pandemic because of language, cultural, administrative barriers and social insecurity. We investigate their attitudes and knowledge about COVID-19 measures.
Methods
A cross-sectional survey conducted between August and October 2020 in the canton of Vaud, Switzerland. The 24 questions covered health literacy, perception of the pandemic, understanding of health measures and adherence to conspiracy theories. The questionnaire was translated into the ten most common languages. It was distributed online through social networks of charitable and public organisations and in paper in asylum centres. Associations between participants responses and their characteristics were studied using multivariable logistic regressions.
Results
The 242 respondents had a mean age of 33 years, 63% were men and 42% had low health literacy. They were 16% asylum seekers, 45% temporarily admitted persons, 12% refugees and 26% rejected asylum seekers. All languages were used.
Self-reported adherence to recommendations was 82%. Respectively, 39% and 31% of participants reported sleep disorders or fear of dying. Adjusted for age, gender, health literacy and French language skills, rejected asylum seekers were less worried about the pandemic (aOR 0.37, p = 0.007) and more sensitive to conspiracy theories (aOR 3.47, p = 0.006) than other respondents. They also reported lower adherence to recommendations (aOR 0.45, p = 0.034).
Conclusions
We contribute new knowledge about a varied group of vulnerable persons under precarious conditions during the COVID-19 pandemic. The network based multi-language survey combining online and center based distribution was useful but also tedious. Our results highlight the low health literacy of asylum seekers and refugees and their deep concerns about the pandemic. Public health messages should be adapted to rejected asylum seekers.
Key messages
Asylum seekers and refugees have deep concerns about the Covid-19 pandemic (including sleep disorders and fear of dying) but a low health literacy. Public health messages should be adapted to socially vulnerable groups, especially rejected asylum seekers.
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Affiliation(s)
- K Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - M Durand
- Geisel School of Medicine, The Dartmouth Institute, Lebanon, USA
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - K Selby
- Department Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - M Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - J Sanchis Zozaya
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - C Van Plessen
- Department of Polyclinics, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Direction Générale de la Santé, Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Joss S, Moser A, Jakob J, Tal K, Etter JF, Selby K, Schoeni A, Poirson P, Auer R. Counseling in Vape Shops: A Survey of Vape Shop Managers in Switzerland. Int J Environ Res Public Health 2021; 18:ijerph182010861. [PMID: 34682603 PMCID: PMC8535370 DOI: 10.3390/ijerph182010861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Vaporizers (e-cigarettes) are the most common smoking cessation aids in Switzerland, but we do not know what information customers receive in vape shops. We surveyed vape-shop managers to find out what recommendations they make to their customers. An interdisciplinary group developed the questionnaire. Respondents self-reported their smoking history, demographics, and the recommendations they thought they would give to hypothetical customers in clinical vignettes. We also queried if they collaborated with health care professionals. Of those contacted, 53.8% (70/130) of vape-shop managers responded, and 52.3% (68/130) were included in the final analysis. Managers were mostly male and ex-smokers who switched to vaporizers; 60.3% would encourage a hypothetical smoker with high nicotine dependence to start with the highest possible nicotine concentration when switching to vaporizers. For this smoker, 36.9% would recommend high (≥15 mg/mL), 32.3% medium (6–14 mg/mL), and 3.1% low (1–5 mg/mL) nicotine concentrations. The rest adapted their recommendations to fit the customer or device; 76.5% reported that physicians referred customers to them, and 78.8% would attend a course given by experts in the field of vaporizers and smoking cessation. Vape-shop managers varied widely in the recommendations they gave customers. Most reported ongoing collaboration with health care professionals and were interested in improving their counselling skills through training.
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Affiliation(s)
- Sandra Joss
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland; (S.J.); (A.M.); (J.J.); (K.T.); (A.S.)
| | - Anna Moser
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland; (S.J.); (A.M.); (J.J.); (K.T.); (A.S.)
| | - Julian Jakob
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland; (S.J.); (A.M.); (J.J.); (K.T.); (A.S.)
- Department of Pediatrics, University Hospital Bern, Inselspital, 3010 Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland; (S.J.); (A.M.); (J.J.); (K.T.); (A.S.)
| | - Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), 1011 Lausanne, Switzerland;
| | - Anna Schoeni
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland; (S.J.); (A.M.); (J.J.); (K.T.); (A.S.)
| | | | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland; (S.J.); (A.M.); (J.J.); (K.T.); (A.S.)
- Center for Primary Care and Public Health (Unisanté), 1011 Lausanne, Switzerland;
- Correspondence:
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Beattie E, Dowling J, Chardon JW, Kothary R, Lintern S, Amin R, Buffone T, Brais B, Campbell C, Gagnon C, Gonorazky H, Karamchandani J, Korngut L, McMillan H, Oskoui M, Osman H, Selby K, Wojtal D, Worsfold N, Lochmüller H. REGISTRIES AND CARE OF NMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hodgkinson-Brechenmacher V, McCormick A, Sheriko J, Lounsberry J, Osman H, Worsfold N, Campbell C, Mah J, McAdam L, Selby K, Korngut L, N. CNDR Investigator Network. DMD/BMD – OUTCOME MEASURES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Selby K, Bornet MA, Sancosme Y, von Elm E, d'Acremont V, de Valliere S, Cornuz J, Genton B. Expert guidance for COVID-19 vaccine deployment in Switzerland: a Delphi process. Swiss Med Wkly 2021; 151:w30076. [PMID: 34581549 DOI: 10.4414/smw.2021.w30076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Vaccines providing protection against COVID-19 are a core tool for ending the pandemic. Though international organisations created guidance in 2020 for vaccine deployment, this had to be adapted for each country's situation and values. We aimed to assist public health decision makers by identifying areas of consensus among Swiss experts for the deployment of one or more novel COVID-19 vaccines. METHODS An electronic, modified Delphi process between September and November 2020. We recruited a convenience sample of experts working in Switzerland from a variety of specialities, who completed two anonymous questionnaires. They voted on clarification questions and guidance statements from 0 (complete disagreement) to 10 (complete agreement). Responses for guidance statements with a median ≥8 and a lower inter-quartile range bound ≥7 were considered as reaching consensus. RESULTS Sixty-five experts accepted (66% response rate), with 47 completing the first questionnaire (72%), and 48 the second (74%). Statements reaching consensus included: in the first phase we should vaccinate front-line healthcare professionals and people ≥65 years with risk factors; widespread vaccination of children and adolescents should not be an early priority; and vaccines should be provided free of charge in the setting of national or cantonal vaccination campaigns. Statements not reaching consensus included: early vaccination of people living with someone with risk factors who are not themselves at risk; vaccination of people with previous confirmed or suspected COVID-19; and whether vaccination should be mandatory for individuals with certain activities, such as front-line healthcare professionals. CONCLUSIONS Experts reached consensus on several statements that were available for decision-makers when making key decisions for COVID-19 vaccine deployment in Switzerland. Statements without consensus highlighted areas requiring expert and public dialogue. The modified Delphi process allowed us to rapidly synthesise views from a broad panel of experts on sensitive topics, and could be considered for a broad range of issues during public health crises.
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Affiliation(s)
- Kevin Selby
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Marc-Antoine Bornet
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Yann Sancosme
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Erik von Elm
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Valérie d'Acremont
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Serge de Valliere
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Jacques Cornuz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Blaise Genton
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
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Kherad O, Selby K, Martel M, da Costa H, Vettard Y, Schaller P, Raetzo MA. Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study. J Gen Intern Med 2021; 36:2672-2677. [PMID: 33555552 PMCID: PMC8390713 DOI: 10.1007/s11606-021-06624-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The impact of the Choosing Wisely (CW) campaign is debated as recommendations alone may not modify physician behavior. OBJECTIVE The aim of this study was to assess whether behavioral interventions with physician assessment and feedback during quality circles (QCs) could reduce low-value services. DESIGN AND PARTICIPANTS Pre-post quality improvement intervention with a parallel comparison group involving outpatients followed in a Swiss-managed care network, including 700 general physicians (GPs) and 150,000 adult patients. INTERVENTIONS Interventions included performance feedback about low-value activities and comparison with peers during QCs. We assessed individual physician behavior and healthcare use from laboratory and insurance claims files between August 1, 2016, and October 31, 2018. MAIN MEASURES Main outcomes were the change in prescription of three low-value services 6 months before and 6 months after each intervention: measurement of prostate-specific antigen (PSA) and prescription rates of proton pump inhibitors (PPIs) and statins. KEY RESULTS Among primary care practices, a QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4, p value<0.01; coefficient of variation (Cov) 93.0% vs 91.0%, p=0.49), PSA measurement (6.5 ± 8.7 vs 5.3 ± 6.9 tests per GP, p<0.01; Cov 133.5% vs 130.7%, p=0.84), as well as statins (6.1 ± 6.8 vs 5.6 ± 5.4 prescriptions per GP, p<0.01; Cov 111.5% vs 96.4%, p=0.21). Changes in prescription of low-value services among GPs who did not attend QCs were not statistically significant over this time period. CONCLUSION Our results demonstrate a modest but statistically significant effect of QCs with educative feedback in reducing low-value services in outpatients with low impact on coefficient of variation. Limiting overuse in medicine is very challenging and dedicated discussion and real-time review of actionable data may help.
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Affiliation(s)
- Omar Kherad
- Internal Medicine Department, Hôpital de la Tour and University of Geneva, 1217, Geneva, Switzerland.
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Myriam Martel
- Division of Epidemiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
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Hollanda De Sa Neto H, Habfast-Robertson I, Hempel-Bruder C, Durand MA, Jacot-Sadowski I, Khazaal Y, Berlin I, Selby K. Formative provider testing of a New Encounter Decision Aid for Smoking Cessation (Preprint). JMIR Form Res 2021; 6:e32960. [PMID: 35442200 PMCID: PMC9069282 DOI: 10.2196/32960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Smoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments. Objective We aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care. Methods We developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians. Results In all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments. Conclusions The overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.
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Affiliation(s)
| | | | | | - Marie-Anne Durand
- Lausanne University Hospital, Lausanne, Switzerland
- Centre d'Epidémiologie et de Recherche en Santé des Populations, University of Toulouse, Institut National de la Santé et de la Recherche Médicale, Toulouse, France
- Dartmouth Institute for Health Policy and Clinical Practice, University of Dartmouth, Lebanon, NH, United States
| | | | - Yasser Khazaal
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Ivan Berlin
- Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
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Selby K, Cardinaux R, Metry B, de Rougemont S, Chabloz J, Meier-Herrmann V, Stoller J, Durand MA, Auer R. Citizen advisory groups for the creation and improvement of decision aids: experience from two Swiss centers for primary care. Res Involv Engagem 2021; 7:37. [PMID: 34090511 PMCID: PMC8179076 DOI: 10.1186/s40900-021-00283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Guidelines for patient decision aids (DA) recommend target population involvement throughout the development process, but developers may struggle because of limited resources. We sought to develop a feasible means of getting repeated feedback from users. METHODS Between 2017 and 2020, two Swiss centers for primary care (Lausanne and Bern) created citizen advisory groups to contribute to multiple improvement cycles for colorectal, prostate and lung cancer screening DAs. Following Community Based Participatory Research principles, we collaborated with local organizations to recruit citizens aged 50 to 75 without previous cancer diagnoses. We remunerated incidental costs and participant time. One center supplemented in-person meetings by mailed paper questionnaires, while the other supplemented meetings using small-group workshops and analyses of meeting transcripts. RESULTS In Lausanne, we received input from 49 participants for three DAs between 2017 and 2020. For each topic, participants gave feedback on the initial draft and 2 subsequent versions during in-person meetings with ~ 8 participants and one round of mailed questionnaires. In Bern, 10 participants were recruited among standardized patients from the university, all of whom attended in-person meetings every three months between 2017 and 2020. At both sites, numerous changes were made to the content, appearance, language, and tone of DAs and outreach materials. Participants reported high levels of satisfaction with the participative process. CONCLUSIONS Citizen advisory groups are a feasible means of repeatedly incorporating end-user feedback during the creation of multiple DAs. Methodological differences between the two centers underline the need for a flexible model adapted to local needs.
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Affiliation(s)
- Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland.
| | - Regula Cardinaux
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Beatrice Metry
- Institute of primary health care (BIHAM), University of Bern, Bern, Switzerland
| | | | | | | | | | - Marie-Anne Durand
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
- University of Toulouse, Toulouse, France
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Reto Auer
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
- Institute of primary health care (BIHAM), University of Bern, Bern, Switzerland
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43
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Sancosme Y, Selby K, D'acremont V, Kokkinakis I, Gouveia A, Favrat B, Cornuz J. [Mass testing for Covid-19 : what can we learn from real-world implementation ?]. Rev Med Suisse 2021; 17:877-880. [PMID: 33950589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While several modelling studies suggest mass testing for SARS-CoV-2 could be effective, real-world attempts at implementation have not been sufficient to evaluate its contribution to controlling the pandemic. To slow the spread of the virus, a mass-testing campaign would need frequent testing over a prolonged period with high rates of participation, all while maintaining public health measures. Screening seems more useful for targeted populations or high-risk events (businesses, teaching facilities, public or private institutions, sporting or cultural events). With their low cost and rapid results, rapid tests should be favored for these interventions.
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Affiliation(s)
- Yann Sancosme
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
| | - Kevin Selby
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
| | - Valérie D'acremont
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
| | - Ioannis Kokkinakis
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
| | - Alexandre Gouveia
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
| | - Bernard Favrat
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
| | - Jacques Cornuz
- Centre universitaire de médecine générale et santé publique, Unisanté, 1015 Lausanne
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44
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Doubeni CA, Selby K, Levin TR. Disparities in Preventable Mortality from Colorectal Cancer: Are They the Result of Structural Racism? Gastroenterology 2021; 160:1022-1025. [PMID: 33417932 DOI: 10.1053/j.gastro.2020.12.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Chyke A Doubeni
- Center for Health Equity and Community Engagement Research and, Department of Family Medicine and, Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Family Medicine, Mayo Clinic, Phoenix, Arizona.
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Theodore R Levin
- Kaiser Permanente Medical Center, Walnut Creek, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
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45
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Selby K, Senore C, Wong M, May FP, Gupta S, Liang PS. Interventions to ensure follow-up of positive fecal immunochemical tests: An international survey of screening programs. J Med Screen 2021; 28:51-53. [PMID: 32054392 PMCID: PMC10610030 DOI: 10.1177/0969141320904977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Colorectal cancer screening programs frequently report problems ensuring adequate follow-up of positive fecal immunochemical tests (FITs). We investigated strategies implemented by ongoing screening programs to improve follow-up for FIT-positive participants, and explored associations between interventions and reported rates of follow-up. METHODS We submitted an electronic survey to 58 colorectal cancer screening programs or affiliated researchers. Primary outcomes were the proportion of program participants with a positive FIT completing diagnostic colonoscopy, and patient, provider, and system-level interventions used to improve follow-up. We compare mean colonoscopy completion at six months in programs with and without interventions. RESULTS Thirty-five programs completed the survey (60% response). The mean proportion of participants with a positive FIT who completed colonoscopy was 79% (standard deviation 16%). Programs used a mean of five interventions to improve follow-up. Programs using patient navigators had an 11% higher rate of colonoscopy completion at six months (p = 0.05). Programs sending reminders to primary care providers when no colonoscopy has been completed had a 12% higher rate of colonoscopy completion (p = 0.03). Other interventions were not associated with significant differences. CONCLUSIONS Almost all programs employ multiple interventions to ensure timely follow-up of positive FIT. The use of patient navigators and provider reminders is associated with higher rates of colonoscopy completion.
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Affiliation(s)
- Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Carlo Senore
- Epidemiology and screening unit – CPO, University Hospital Citta’ della Salute e della Scienza, Turin, Italy
| | - Martin Wong
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, Jonsson Comprehensive Cancer Center, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Samir Gupta
- VA San Diego Healthcare System, San Diego, CA and Division of Gastroenterology and the Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Peter S Liang
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, NY, USA
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46
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Hodgkinson V, Lounsberry J, M'Dahoma S, Russell A, Jewett G, Benstead T, Brais B, Campbell C, Johnston W, Lochmüller H, McCormick A, Nguyen CT, O'Ferrall E, Oskoui M, Abrahao A, Briemberg H, Bourque PR, Botez S, Cashman N, Chapman K, Chrestian N, Crone M, Dobrowolski P, Dojeiji S, Dowling JJ, Dupré N, Genge A, Gonorazky H, Grant I, Hasal S, Izenberg A, Kalra S, Katzberg H, Krieger C, Leung E, Linassi G, Mackenzie A, Mah JK, Marrero A, Massie R, Matte G, McAdam L, McMillan H, Melanson M, Mezei MM, O'Connell C, Pfeffer G, Phan C, Plamondon S, Poulin C, Rodrigue X, Schellenberg K, Selby K, Sheriko J, Shoesmith C, Smith RG, Taillon M, Taylor S, Venance S, Warman-Chardon J, Worley S, Zinman L, Korngut L. The Canadian Neuromuscular Disease Registry 2010-2019: A Decade of Facilitating Clinical Research Througha Nationwide, Pan-NeuromuscularDisease Registry. J Neuromuscul Dis 2021; 8:53-61. [PMID: 32925088 PMCID: PMC7902956 DOI: 10.3233/jnd-200538] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the recruitment activities and outcomes of a multi-disease neuromuscular patient registry in Canada. The Canadian Neuromuscular Disease Registry (CNDR) registers individuals across Canada with a confirmed diagnosis of a neuromuscular disease. Diagnosis and contact information are collected across all diseases and detailed prospective data is collected for 5 specific diseases: Amyotrophic Lateral Sclerosis (ALS), Duchenne Muscular Dystrophy (DMD), Myotonic Dystrophy (DM), Limb Girdle Muscular Dystrophy (LGMD), and Spinal Muscular Atrophy (SMA). Since 2010, the CNDR has registered 4306 patients (1154 pediatric and 3148 adult) with 91 different neuromuscular diagnoses and has facilitated 125 projects (73 academic, 3 not-for-profit, 3 government, and 46 commercial) using registry data. In conclusion, the CNDR is an effective and productive pan-neuromuscular registry that has successfully facilitated a substantial number of studies over the past 10 years.
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Affiliation(s)
- V Hodgkinson
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - J Lounsberry
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - S M'Dahoma
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A Russell
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - G Jewett
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - T Benstead
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - B Brais
- Montreal Neurological Institute and Hospital, Montreal, Canada
| | - C Campbell
- Department of Pediatrics, Children's Health Research Institute, London Health Sciences Centre, Western University, London, Canada
| | - W Johnston
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - H Lochmüller
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.,Department of Medicine, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - A McCormick
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - C T Nguyen
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - E O'Ferrall
- Montreal Neurological Institute and Hospital, Montreal, Canada.,Department of Neurosciences, McGill University, Montréal, Canada
| | - M Oskoui
- Department of Neurosciences, McGill University, Montréal, Canada.,Departments of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Canada
| | - A Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - H Briemberg
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - P R Bourque
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - S Botez
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada
| | - N Cashman
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - K Chapman
- Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - N Chrestian
- Department of Medicine, Université Laval, Quebec City, Canada, Neuroscience axis, CHU de Québec-Université Laval
| | - M Crone
- Division of Pediatric Neurology, Department of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - P Dobrowolski
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - S Dojeiji
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - J J Dowling
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - N Dupré
- Department of Medicine, Laval University, Québec City, Canada
| | - A Genge
- Department of Neurosciences, McGill University, Montréal, Canada
| | - H Gonorazky
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - I Grant
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - S Hasal
- Division of Pediatric Neurology, Department of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - A Izenberg
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - S Kalra
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - H Katzberg
- University Health Network, University of Toronto, Toronto, Canada
| | - C Krieger
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - E Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - G Linassi
- Department of Physical Medicine and Rehabilitation University of Saskatchewan, Saskatoon, Canada
| | - A Mackenzie
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - J K Mah
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - A Marrero
- CHU Dr. Georges-L-Dumont, Université de Sherbrooke, Moncton, Canada
| | - R Massie
- Montreal Neurological Institute and Hospital, Montreal, Canada.,Department of Neurosciences, McGill University, Montréal, Canada
| | - G Matte
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada
| | - L McAdam
- Department of Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, Canada
| | - H McMillan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - M Melanson
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Canada
| | - M M Mezei
- Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - C O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - G Pfeffer
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Medical Genetics, and Alberta Child Health Research Institute, University of Calgary, Calgary, Canada
| | - C Phan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - S Plamondon
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - C Poulin
- Departments of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Canada
| | - X Rodrigue
- Department of Medicine, Laval University, Québec City, Canada
| | - K Schellenberg
- Department of Physical Medicine and Rehabilitation University of Saskatchewan, Saskatoon, Canada
| | - K Selby
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, University of Vancouver, Vancouver, Canada
| | - J Sheriko
- Division of Neurology, Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - C Shoesmith
- Division of Neurology, Clinical Neurological Sciences, Western University, London, Canada
| | - R G Smith
- Department of Pediatrics, KidsInclusive Centre for Child & Youth Development, Hotel Dieu Hospital, Queen's University, Kingston, Canada
| | - M Taillon
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - S Taylor
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - S Venance
- Division of Neurology, Clinical Neurological Sciences, Western University, London, Canada
| | - J Warman-Chardon
- Department of Medicine, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - S Worley
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - L Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - L Korngut
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Selby K, Durand MA, Gouveia A, Bosisio F, Barazzetti G, Hostettler M, D'Acremont V, Kaufmann A, von Plessen C. Citizen Responses to Government Restrictions in Switzerland During the COVID-19 Pandemic: Cross-Sectional Survey. JMIR Form Res 2020; 4:e20871. [PMID: 33156809 PMCID: PMC7717891 DOI: 10.2196/20871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 01/15/2023] Open
Abstract
Background The success of government-recommended mitigation measures during the COVID-19 pandemic depends largely on information uptake and implementation by individual citizens. Objective Our aim was to assess citizens’ knowledge and perceptions about COVID-19 recommendations in the Canton of Vaud, Switzerland. Methods A cross-sectional electronic survey with open and closed questions was disseminated by community-based partners prior to the relaxation of government restrictions. Outcomes included citizen knowledge (9-question measure) and worry about the virus, perception of government measures, and recommendations for improvements. Comparisons used linear regression, controlling for age, sex, education, and health literacy. Free-text answers were analyzed thematically. Results Of 807 people who accessed the survey, 684 (85%) completed all questions and 479 (60%) gave free-text recommendations. Overall, 75% were female, the mean age was 48 years, and 93% had high health literacy. Knowledge scores were high, with a median score of 8 out of 9. Mean levels of worry about the COVID-19 pandemic were higher in women than men (55/100 versus 44/100, P<.001), and in respondents with lower health literacy (57/100 versus 52/100, P=.03). Self-reported adherence to recommendations was high (85%) and increased with age and worry (both P<.001). Respondents rated their own adherence higher than others (85% versus 61%, P<.001). Moreover, 34% of respondents reported having self-quarantined; this rose to 52% for those aged ≥75 years. Those who had self-quarantined reported higher levels of fear. Nearly half (49%) of respondents felt the government response had been adequate, though younger age and higher levels of worry were associated with considering the response to be insufficient (both P<.001). Analysis of open-text answers revealed 4 major themes: access to and use of masks, gloves, and hand sanitizer; government messaging; lockdown and lockdown exit plan communication; and testing for COVID-19. Conclusions Knowledge, adherence, and satisfaction regarding government recommendations and response were high in this sample, but many desired greater access to personal protective equipment. Those with lower health literacy and those who have been in self-isolation reported greater concerns about the pandemic.
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Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Alexandre Gouveia
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Francesca Bosisio
- The ColLaboratory - Participatory, Collaboratory and Action-Research Unit, University of Lausanne, Lausanne, Switzerland
| | - Gaia Barazzetti
- The ColLaboratory - Participatory, Collaboratory and Action-Research Unit, University of Lausanne, Lausanne, Switzerland
| | - Maxime Hostettler
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Alain Kaufmann
- The ColLaboratory - Participatory, Collaboratory and Action-Research Unit, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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48
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Casutt A, Lovis A, Selby K, Noirez L, Peters S, Beigelman-Aubry C, Krueger T, Soccal PM, Von Garnier C. [Lung cancer screening in Switzerland : Who ? How ? When ?]. Rev Med Suisse 2020; 16:2224-2226. [PMID: 33206480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Professional societies encourage the establishment of coordinated national screening programs for lung cancer by « low-dose » chest CT scans. The interdisciplinary Swiss Lung Cancer Screening Implementation Group (CH-LSIG) is exploring the feasibility of such a project. However, several questions still remain unanswered, namely the -financing of such a program, the ideal « number-needed to screen », the definition and follow-up of « positive cases », as well as the role of smoking cessation measures. The key points to discuss in the future with patients requesting screening are based on the « shared -decision-making » approach. Pilot projects guided by the CH-LSIG could help to identify the optimal strategy for establishing a national screening program based on the best available scientific evidence.
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Affiliation(s)
| | | | - Kevin Selby
- Département des policliniques, Unisanté, 1011 Lausanne
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49
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Abstract
Preventable differences in colorectal cancer (CRC) mortality across racial/ethnic, economic, geographic, and other groups can be eliminated by assuring equitable access and quality across the care continuum, but few interventions have been demonstrated to do so. Multicomponent strategies designed with a health equity framework may be effective. A health equity framework takes into account social determinants of health, multilevel influences (policy, community, delivery, and individual levels), screening processes, and community engagement. Effective strategies for increasing screening uptake include patient navigation and other interventions for structural barriers, reminders and clinical decision support, and data to continuously track metrics and guide targets for improvement. Community resource gaps should be addressed to assure high-quality services irrespective of racial/ethnic and socioeconomic status. One model combinespopulation-based proactive outreach screening with screening delivery at in-person or virtual points of contact, as well as community engagement. Patient- and provider-based behavioral interventions may be considered for increasing screening demand and delivery. Providing a choice of screening tests is recommended for CRC screening, and access to colonoscopy is required for completion of the CRC screening process.
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Affiliation(s)
- Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota 55905, USA; .,Department of Family Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne 1011, Switzerland;
| | - Samir Gupta
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.,Department of Medicine, University of California at San Diego, La Jolla, California 92103, USA; .,Moores Cancer Center, University of California at San Diego, La Jolla, California 92103, USA
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50
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Vilas Boas A, Selby K, Cornuz J, Büla C, Nguyen S. [To screen or not to screen after age 75 ?]. Rev Med Suisse 2020; 16:2156-2159. [PMID: 33174696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The older population is heterogenous: at the same age, elderly patients can be robust, frail or dependent. Screening decisions must be individualized, taking into account the remaining life expectancy, the Time to Benefit (TTB: delay until preventive care gives a benefit), and patient preferences. Thus, robust patients, who have a longer life expectancy, can still benefit from some screening tests over age 75 that are inappropriate in vulnerable or dependent patients whose life expectancy is shorter than the TTB. Discussing life expectancy issues remains difficult outside of crises but medical encounters are unique opportunities to inquire about individual preferences and expectations, in order to define care objectives and discuss advanced care planning.
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Affiliation(s)
- Ana Vilas Boas
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Jacques Cornuz
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Christophe Büla
- Service de gériatrie et réadaptation gériatrique, CHUV, 1011 Lausanne
| | - Sylvain Nguyen
- Service de gériatrie et réadaptation gériatrique, CHUV, 1011 Lausanne
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