Thomas Grischott

Background: Orthodontic treatment is increasingly common across Europe, but little is known about long-term population trends and social disparities in Switzerland, where orthodontic care is mainly privately financed. Objective: To examine temporal and sociodemographic patterns of orthodontic treatment in Switzerland between 2002 and 2022 and to identify associated inequalities. Methods: Data came from three waves of the Swiss Health Survey (2002, 2012, 2022), a nationally representative cross-sectional study. The analytic sample comprised 53,019 individuals aged ≥ 15 years. The outcome was self-reported lifetime experience of wearing braces. Covariates included survey year, sex, age, education, language region, and urbanicity. Statistical evaluation included survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CI). Interaction terms were used to test temporal changes. Results: The prevalence of orthodontic treatment rose from 23.0% in 2002 to 34.8% in 2022. Women were more likely than men to report treatment (aOR 1.59, 95% CI 1.51–1.68). Among adults (≥ 20 years), a strong educational gradient persisted: those with upper-secondary (aOR 2.82; 95% CI 2.43–3.28) or tertiary education (aOR 4.58; 95% CI 3.92–5.34) had significantly higher odds of treatment compared to those with compulsory education. Living in rural or intermediate regions was associated with lower odds compared to urban areas (aOR 0.93; 95% CI 0.88–0.99). Furthermore, residents of French-speaking (aOR 0.84; 95% CI 0.78–0.91) and Italian-speaking regions (aOR 0.79; 95% CI 0.71–0.89) showed lower treatment uptake than those in German-speaking Switzerland. Significant interactions of age and urbanicity with survey year reflect that prevalence increases over the past 20 years occurred particularly among younger individuals and those outside urban areas. Conclusion: Orthodontic treatment in Switzerland has increased significantly, becoming a new norm for younger generations. However, this growth is not equitable; access remains heavily patterned by education, region, and urbanicity. In a predominantly privately financed system, these persistent disparities suggest that orthodontic care remains socially stratified.

Background: Electronic medical records are a vast and valuable source of information, useful for tasks such as estimating disease prevalence. However, in routine primary care, much of this information is in free-text format rather than in a structured form and, therefore, not readily amenable to analysis. Manual coding of this textual data is both time-consuming and resource-intensive, making it impractical for large datasets. Although powerful open-source language models offer new opportunities for automated coding, their use on short heterogeneous primary care notes, particularly in German-language settings, remains insufficiently studied. Objective: By providing hands-on guidance for applied health researchers, this study aims to demonstrate the effective and accurate automatic classification of free-text notes using a language model fine-tuned for automated International Statistical Classification of Diseases, Tenth Revision ( ICD-10 ) coding. Methods: Building on the extensive Family Medicine Research Using Electronic Medical Records (FIRE) routine database from the Institute of Primary Care at the University Hospital Zurich and the University of Zurich, we trained a large language model–based multilabel classifier on a dataset of 38,728 free-text notes, which had been manually categorized into 47 classes using specific ICD-10 codes and code ranges or nondiagnostic/ad hoc labels (eg, “unclear diagnosis,” “status post”). We stratified the labeled data into training (70%), validation (15%), and posttraining test (15%) sets, ensuring similar label distributions across these sets. Using the Transformers Python library, we trained the model over 10 epochs and evaluated it on the posttraining test dataset. Results: Across 48 classes, the FIRE classifier achieved strong performance on the held-out posttraining set, with F ₁ -scores of 0.85 (micro, overall across all predictions), 0.86 (macro, mean of per-class scores treating classes equally), and 0.84 (weighted, per-class scores weighted by class frequency). Conclusions: This study demonstrates steps for training open-source large language models and highlights the potential to streamline and scale the extraction of diagnostic information for practical applications. Our model can be robustly deployed, for example, for prescreening and labeling of free-text information, thus potentially reducing the burden of repetitive and error-prone manual handling.

Purpose: This study evaluated the effectiveness, feasibility, and acceptance of a caregiver-need-driven intervention to reduce caregiver burden among informal caregivers of people with dementia, delivered by non-physician medical staff of general practices in Switzerland. Methods: In this prospective, single-group, pre-post superiority trial, non-physician medical practice staff were trained to deliver a supportive intervention for informal dementia caregivers involving three home visits and optional home-based and/or telephone counseling. Comparator was the "usual care" arm of the randomized DE-REACH trial in a similar setting. Primary outcome was increase in caregiver burden at six months, measured by the Zarit Burden Interview (ZBI) and analyzed by one-sample superiority t -test. Secondary outcomes included changes in quality of life. Hierarchical regression served to identify associations between outcomes and participant characteristics. Results: Among 32 non-physician medical practice staff (96.9% female, mean 14.6 years of professional experience) and 55 informal caregivers (69.1% female, mean age 70.0 years), the intervention proved superior to usual care by significantly attenuating the increase in caregiver burden (mean ZBI score increase 2.65 [95% confidence interval: -∞ to 4.10] vs. 7, p = 0.017). There was no significant change in quality of life during the intervention, which was well feasible and accepted by caregivers and health professionals. Conclusion: This study demonstrated that a scalable, caregiver-need-driven intervention by trained non-physician medical staff in general practices mitigated the rise in caregiver burden over six months. The intervention holds potential to enhance the efficacy of general practice teams in supporting the frequently overlooked dementia patient-caregiver dyad, thereby improving their well-being and the quality of care provided. Trial Registration: ISRCTN55348828 , registered 12/10/2021.

Background: Proton pump inhibitors (PPI) are frequently prescribed in primary care, yet overprescribing is common. Documentation of the indication for treatment initiation is important to assess prescribing appropriateness and support medication review. Objectives: The study aimed to describe PPI indications in patients with first-time PPI prescriptions and to identify factors that play a role in the presence of a documented indication. Design: Retrospective cross-sectional database study using electronic medical record data from Swiss primary care practices contributing to the FIRE (Family Medicine Research using Electronic Medical Records) database. Methods: The study period was March 1, 2022, to February 28, 2025. We included patients aged 18 years or older with a first recorded PPI prescription during the study period. The main outcome was the presence of a documented indication for PPI initiation in the diagnosis/problem list. Associations with patient age, sex, prior consultation frequency, practice location, physician age, sex, and consultation rate were estimated using mixed-effects logistic regression with physician as random effect. Results: Among 53,800 patients with first-time PPI prescriptions, 5,058 (9.4%) had a documented indication in the diagnosis/problem list. Among the 48,742 patients without a documented indication, 25,134 (51.6%) had potentially explanatory co-medication, most commonly nonsteroidal anti-inflammatory drugs. Of the 24,912 patients with presumed PPI use for ulcer prophylaxis, 14,011 (56.2%) were 60 years old or younger. Female patients had lower odds of documented indication than male patients (odds ratio 0.86; 95% CI 0.81–0.91). Prior consultation frequency was positively associated with documentation, whereas physicians aged 50-69 years less frequently documented PPI indications than their colleagues aged under 40 years. Between-physician variation remained substantial. Conclusion: Only a minority of patients initiating PPI therapy had a corresponding indication documented in the diagnosis/problem list. Our findings warrant improved indication documentation and regular review of prescribing in primary care.

BACKGROUND: Electronic medical records (EMRs) in general practice provide various methods for identifying patients with specific diagnoses. While several studies have focused on case identification via structured EMR components, diagnoses in general practice are frequently documented as unstructured free-text entries, making their use for research challenging. Furthermore, diagnoses may remain undocumented even when evidence of the underlying disease exists within structured EMR data. OBJECTIVE: This study aimed to quantify the extent to which free-text diagnoses contribute to identifying additional cases of diabetes mellitus, obesity and dyslipidaemia (target diseases) and assess the cases missed when relying exclusively on free-text entries. METHODS: This cross-sectional study utilised EMR data from all consultations up to 2019 for 6,000 patients across 10 general practices in Switzerland. Diagnoses documented in a free-text entry field for diagnoses were manually coded for target diseases. Cases were defined as patients with a corresponding coded free-text diagnosis or meeting predefined criteria in structured EMR components (medication data or clinical and laboratory parameters). For each target disease, prevalence was calculated along with the proportion of cases identified exclusively via free-text diagnoses and the proportion missed when using free-text diagnoses alone. RESULTS: The prevalence estimates for diabetes mellitus, obesity and dyslipidaemia were 8.8%, 16.2% and 38.9%, respectively. Few cases relied exclusively on free-text diagnoses for identification, but a substantial proportion of cases were missed when relying solely on free-text diagnoses, particularly for obesity (19.5% exclusively identified; 50.7% missed) and dyslipidaemia (8.7% exclusively identified; 53.3% missed). CONCLUSION: Free-text diagnoses were of limited utility for case identification of diabetes mellitus, obesity or dyslipidaemia, suggesting that manual coding of free-text diagnoses may not always be justified. Relying solely on free-text diagnoses for case identification is not recommended, as substantial proportions of cases may remain undetected, leading to biased prevalence estimates.

Background: Chronic conditions are a significant public health concern due to their rising prevalence, association with high mortality, and substantial healthcare costs. General practitioners play a crucial role in managing these conditions, and quality indicators are essential tools for assessing the quality of care. Electronic feedback reports incorporating quality indicator performance have shown promise in improving care quality. However, most studies have focused on single conditions or link feedback to financial incentives, which may not sustain long-term practice changes. This study aims to evaluate the effectiveness of a multi-condition electronic feedback reports on quality indicator performance in Swiss general practice without financial incentives. Methods: This randomized controlled trial involves general practitioners enrolled in the FIRE project, a database of electronic medical records from Swiss primary care. Participants are randomized to receive either a plain feedback report or a comprehensive quality indicator -specific feedback report bi-monthly for 12 months. The plain feedback report contains descriptive summaries of practice activities, while the quality indicator-specific feedback report includes performance data on 14 quality indicators across cardiovascular, endocrine, pulmonary, and renal domains. The quality indicators were selected in multi-step process involving review of the literature and clinical guidelines, domain expert consultations, and a panel discussion with general practitioners. The primary study objective is to compare the effectiveness of the quality indicator-specific feedback report and of the plain feedback report with respect to the performance of the selected quality indicators. Conclusion: The study addresses a critical gap by evaluating a multi-condition feedback report without financial incentives. Its findings can inform future health policies and strategies, in line with national and international initiatives that promote or even require the implementation of quality measurement activities in general practice. Trial registration: Trial registry: ISRCTN. Registration number: ISRCTN10637092, https://www.isrctn.com/ISRCTN10637092. Registered January 9, 2024.

AIMS OF THE STUDY: Arterial hypertension is a major global health risk. Global surveys indicate that only half of patients with arterial hypertension receive pharmacotherapy, and only a quarter achieve the primary blood pressure target recommended by guidelines. This study aimed to evaluate the achievement of the primary blood pressure target in Swiss general practice, provide insights into arterial hypertension treatment, and identify factors associated with achieving this goal. METHODS: This cross-sectional study utilised data from a large Swiss primary care database. Patients with arterial hypertension, aged ≥18 years, who underwent blood pressure monitoring in 2021 were included. The primary observation was blood pressure control, defined as the achievement of the primary blood pressure target of systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Demographic data from physicians and patients, blood pressure measurements, comorbidities, cardiovascular risk factors, and pharmacotherapy were collected, and arterial hypertension stages were calculated. Unadjusted and multivariable-adjusted mixed logistic regression models were used to identify factors associated with blood pressure control. RESULTS: A total of 49,290 patients were included, of whom 23,933 (48.6%) were female. The median patient age was 71 years (interquartile range 61–80). Blood pressure control was observed in 23,022 patients (46.7%), and 36,692 patients (74.4%) had an antihypertensive pharmacotherapy prescription. In multivariable analysis, blood pressure control was positively associated with arterial hypertension stage, antihypertensive pharmacotherapy, the intensity of blood pressure monitoring, and the number of blood pressure-increasing drugs, but negatively associated with a long-standing arterial hypertension, female sex, and old age. CONCLUSIONS: While general practitioners appear to consider arterial hypertension stages in their treatment strategies, there is still room for improvement in arterial hypertension care by prescribing pharmacotherapy, especially in patients with long-standing arterial hypertension, female sex and old age.