Christine Cohidon

Background: General practitioners (GPs) frequently serve as the first or only point of contact for patients with mental health disorders, playing crucial roles in detection, prevention, and management. Despite this, many GPs feel poorly prepared to address mental health issues, often citing the barriers of limited time, heavy workloads, and insufficient training. Objectives: The present study's main objective was to make an in-depth exploration of the potential difficulties encountered by GPs as they manage and follow up with patients with mental health problems. Methods: Our qualitative approach involved semi-structured individual interviews with 17 GPs from French-speaking Switzerland. Interviews were transcribed and analysed using reflexive thematic analysis within an inductive theoretical framework. Once the most important themes and subthemes had emerged, we externally and internally validated them. Results: Four principal themes emerged. GPs reported that: (i) they enjoyed caring for patients with mental health issues, valuing their unique position in providing comprehensive, long-term support; (ii) they faced significant systemic barriers, including frustration with limitations related to Switzerland's health assurance scheme; (iii) collaboration with psychiatrists was lacking and resources were insufficient; and (iv) they required help and new ideas to improve the quality of their care. Conclusion: GPs' experiences revealed a mixed reality: their dedication to patient care existed alongside their frustration with systemic constraints, highlighting the complexity of mental health management in primary care. Sustainable improvements would require addressing gaps in caregivers' training, greater interprofessional collaboration, and more public health initiatives to mainstream mental health care into society.

Aim: The aim of this study is to describe the rollout of nursing activities during the pilot project’s first 12 months (2019–2021), especially relating to what was initially planned in the nurses’ job description. Background: To provide more comprehensive services and reinforce primary care, a pilot implementation study assessed the integration of nursing activities into eight general practitioners’ (GPs’) practices. The study evaluated how new types of activities were integrated and rolled out over the first year. Methods: A mixed-methods observational study collected quantitative data on nursing activities and duration and qualitative data via five interviews with nurses and patients and one focus group with six GPs. Investigators combined quantitative and qualitative data in discussions about their results. Results: New nursing activities were rolled out progressively, especially follow-up activities with chronically ill patients, with a median time dedicated/month of 21h58 (range: 9h25 to 64h50) at six months and 48h43 (range: 11h01 to 59h51) at 12 months. One-off clinical activities are more easily integrated: the median time dedicated/month was 40h01 (range: 13h44 to 74h53) at six months and 40h30 (range: 9h38 to 76h51) at 12 months. Three elements were crucial in the implementation of nursing activities. The nurse’s previous professional experience influenced the scope of activities developed. GPs’ willingness to refer patients to the nurses enabled the latter to carry out follow-up activities with care plan. Lastly, the implementation of nursing activities was also made possible by patients’ acceptance of being cared for by nurse instead of a GP. Conclusion: Implementation of nursing activities increased progressively, although more slowly for activities with chronically ill patients and within care plans, principally due to the overall change faced by GPs and nurses.

Background: Transforming primary care (PC) through the development of multidisciplinary teams can represent a challenge in terms of occupational wellbeing. Aim: To investigate associations between occupational stress, job satisfaction among GPs, and the professional composition of PC teams. Design & setting: We conducted a secondary analysis of the data from 11 Western countries that participated in the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians ( n = 13 200). Method: PC practice types ( n = 5) were defined in a previous study, based on their composition of healthcare professionals, which were as follows: traditional; multidisciplinary; nurse-centred; psychologist-centred; and physiotherapist-centred models. Using ordered logistic regression analysis, we assessed associations between the five practice models and two GP-reported indicators of wellbeing at work: job satisfaction and occupational stress. Results: Working in multidisciplinary teams, when compared with traditional (GP-centred) practice, was associated with higher occupational wellbeing, both through lower occupational stress (odds ratio [OR] 0.77, 95% confidence interval [CI] = 0.68 to 0.87) and greater job satisfaction (OR 1.43, 95% CI = 1.26 to 1.62). This positive association was also observed in psychologist-centred practices for occupational stress (OR 0.81, 95% CI = 0.71 to 0.93) and for job satisfaction (OR 1.24, 95% CI = 1.09 to 1.42). Working in nurse-centred practices was associated with greater satisfaction but only in the smallest practices (OR 1.59, 95% CI = 1.14 to 2.22) with <1.4 full-time equivalent (FTE) GPs. Conclusion: Positive associations between multidisciplinary PC teams and occupational wellbeing are important results for the future of healthcare systems in Western countries, providing interesting avenues for improvements for healthcare professionals and policymakers.

Background: In many high-income countries, nurses, including registered nurses (RNs), play a key role in primary care (PC), particularly in general practice. Their involvement enhances patients’ experiences, especially in terms of accessibility and comprehensiveness of care provided. To reinforce the provision of care and enhance patients’ experience in family medicine, RNs were integrated into eight private general practices in the canton of Vaud, Switzerland, creating interprofessional teams. This study assessed patients’ experiences with new nursing activities in general practices. Methods: A mixed-methods approach was used to assess patients’ experiences. Quantitative data were collected through a patient experience survey conducted before and after nursing follow-up, with descriptive and bivariate analyses performed. Qualitative data were obtained from interviews with ten patients. Results: A total of 109 patients completed the questionnaire before and after nursing follow-up. Descriptive analyses showed that several dimensions of patients’ experience improved with new nursing follow-up. Bivariate analyses revealed significant improvements in several areas, including unmet healthcare needs, accessibility to nursing care, preventive care, and information provided. Furthermore, patients reported positive changes in their health and lifestyle due to preventive care. Qualitative data supported these results, highlighting the importance of nurses’ accessibility and availability and the holistic nursing care provided. Conclusion: These findings highlight the potential of nurse-led case management to address gaps in PC delivery, particularly in managing chronic diseases. The integration of nurses into general practice settings improved the provision of preventive care, enhanced patient education, and increased accessibility to care.

We aimed to describe the attributes and attitudes of Swiss health professionals who treat persons with occupational burnout (POB) in the outpatient sector and explore associated determinants. The study design was descriptive cross-sectional survey, distributed to the 16,883 general practitioners (GP), psychiatrist-psychotherapists (PP), occupational physicians (OP) and psychologists registered in the Swiss Medical Association, the Swiss Federation of Psychologists, and other specialized associations. Using an online questionnaire, we identified professionals who consult and treat POB, their attributes, volume of POB consultations, diagnostics and treatment modalities and outcomes (OB severity, average proportion of POB who returned to work and who relapsed). Multinomial regression analysis was conducted to identify attributes associated with these outcomes. Among 3216 respondents, 2951 reported to consult POB, and 1130 (713 physicians and 410 psychologists) to treat them. POB consultations constitute 5 to 25% of professionals’ consultations, which varies across professionals’ specialties and specializations and geographic regions. The profile of POB consulted also differs across professionals. Work psychologists reported more often consulting POB at early OB stage, GPs mostly reported having patients with moderate OB, while PPs reported having the largest proportion of patients with severe OB. The treatment practices depend on OB severity but neither latter nor former was associated with the proportion of relapsed POB or POB who return to work. Physicians with waiting time >3 months reported more often having a higher proportion of relapsed patients. Since the study had an exploratory nature using a cross-sectional survey design and aggregated outcomes, these findings should be considered as first descriptive data, motivating further research.

Background: The global burden of non-communicable diseases is increasing and the need for prevention is huge. Policies have yet to produce results and prevention indicators remain low. Primary care (PC) represents an opportunity to optimise the practice of prevention, but GPs are coming up against barriers that are holding back their prevention practices. Aim: To identify the barriers and facilitators for the implementation of routine prevention practices in PC. Design & setting: This study is an international overview of reviews focusing on the integration of prevention in PC settings. Method: The search was conducted in July 2022 using MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Included reviews are systematic reviews or scoping reviews adopting a systematic approach. Results: The 35 reviews included identify multiple barriers and facilitators related to the integration of prevention in PC. These factors are heterogeneous with regard to their source (the patient, the professional, and the health system) and their level of action (individual, organisational, or contextual). The results show the need to organise PC at the professional level (for example, in training), at the local level (for example, the information system), and at the political level (for example, the unclear definition of the role of professionals). Conclusion: The factors influencing the integration of prevention in PC are multiple and act at different levels (individual, organisational, and health-system level). Organisation factors play a major role and seem to be a means of overcoming the difficulties encountered by healthcare professionals in developing preventive practices.

Background: There is a lack of knowledge about how nurses and general practitioners (GPs) collaborated during the COVID-19 pandemicin primary care settings. Our study examined the roles of primary care nurses during the pandemic’s first wave, between March and June 2020, in Switzerland. Methods: The study involved all eight general practices implementing of a nursing role to the practice’s team. Primary care practice staff members (nurses, GPs and medical assistants) have been involved on the development of a new organizational model. A mixed-methods design study collected quantitative data using daily activity monitoring and an electronic survey. Additionally, eight nurses and nine GPs participated in a focus group discussion and individual interviews. Results: GPs recognized the substantial contributions, versatility, and autonomy of the primary care nurses in their practices during the pandemic. Those nurses experienced their involvement positively, mainly thanks to their perceived autonomy. The distribution of activities between primary care practice professionals was heterogenous due to extrinsic and intrinsic factors. Conclusion: Both nurses and GPs agreed that there was added value in having primary care nurses ingeneral practices in time of crisis, and this agreement will bolster plans to integrate this workforce across the canton. The development of nurses’ roles in primary care during the pandemic was reliant on many factors, including practice organization and Switzerland’s healthcare reimbursement and payment system

We aimed to describe the characteristics and current practices of Swiss health professionals who manage patients with occupational burnout (POB), namely the general practitioners (GP), psychiatrist-psychotherapists (PP), occupational physicians (OP) and psychologists. Among 3216 respondents, 2951 reported to consult POB, and 1130 (713 physicians and 410 psychologists) to treat them. The study showed that POB management constitutes 5 to 25% of health care professionals’ consultations, with an inequal distribution of POBs across professionals’ specialties and specializations, but also across geographic regions. The profile of POB consulted also differs across professionals. Work psychologists see more often POB at early burnout stage, GPs have most patients with moderate burnout, while PPs report the largest proportion of patients with severe burnout. The treatment practices depend on burnout severity. Psychiatrists and physicians with double specialty (GP-OPs and GP-PPs) treat patients with more severe burnout than GPs. Psychologists treating patients with severe burnout collaborate with other health professionals and contact the POB’s employer and/or health insurance. Treatment practices and burnout severity are not associated with the proportion of relapsed patients and patients who return to work. Yet, the former is associated with professionals’ age, sex, and specialty. Physicians with waiting time >3 months have a higher proportion of relapsed patients. GPs prescribe most often sick leaves, while PPs are the most frequent prescribers of pharmacological treatment. PPs collaborate significantly more often than GPs with pharmacologists and contact POB’s employer and health insurance. Among psychologists, work psychologists differ from other psychologists by a more frequent POB (psycho)education and coaching, namely on how to negotiate with employer and family, as well as on physical exercise. They also more often contact POB’s employer. Besides profession and specialization, we observed important regional variation in treatment modalities chosen by both physicians and psychologists.

This study aimed to estimate the diagnostic performance of patient symptoms and to describe the clinical course of RT-PCR-positive compared with RT-PCR-negative patients in primary care. Symptomatic COVID-19 suspects were assessed clinically at the initial consultation in primary care between March and May 2020, followed by phone consultations over a span of at least 28 days. Sensitivity and specificity were estimated for each symptom using the initial RT-PCR result as a reference standard. The proportions of symptomatic patients according to the RT-PCR test results were compared over time, and time to recovery was estimated. Out of 883 patients, 13.9% had a positive RT-PCR test, and 17.4% were not tested. Most sensitive symptoms were cough, myalgia, and a history of fever, while most specific symptoms were fever for ≥4 days, hypo/anosmia, and hypo/ageusia. At the final follow up (median time 55 days, range 28–105 days), 44.7% of patients still reported symptoms in the RT-PCR-positive group, compared with 18.3% in the negative group (p < 0.001), mostly with hypo/anosmia (16.3%), dyspnea (12.2%), and fatigue (10.6%). The discriminative value of individual symptoms for diagnosing COVID-19 was limited. Almost half of the SARS-CoV-2-positive patients still reported symptoms at least 28 days after the initial consultation.

This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led by international facilitators. Two research team members took notes during the focus groups. All the material was analyzed using a thematic analysis according to an inductive method. Many challenges were identified, leading to the identification of potential opportunities: integrate the concept of SDH in all phases of the training curriculum for health professionals to foster interprofessional and intersectoral collaboration and sociocultural skills; organize healthcare for better outreach to vulnerable populations; organize local and regional committees to develop management frameworks to produce and use territory-specific data; develop dashboards for primary healthcare providers describing the composition of their territory’s population; work collaboratively, rallying primary healthcare providers, community organization delegates, patient partners, citizens, and municipality representatives around common projects. Discussions prompted new directions for further primary healthcare research, among which are building on best practices in the literature and in the field, and engaging various stakeholders in research, including vulnerable populations, while focusing on patient experience.