Stefan Neuner-Jehle

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.

Purpose: Antibiotic-sparing treatment (ASPT) strategies, such as delayed prescribing and symptomatic treatment, are promising to reduce antimicrobial consumption (AMC) in patients with uncomplicated urinary tract infections (uUTI). The aim of this scoping review was to identify literature reporting on factors that may act as barriers and facilitators to the use of ASPT in order to improve implementation. Methods: MEDLINE (Ovid), Embase, the Cochrane Database, Google Scholar, Proquest Dissertations and Theses, the Clinical Trials Gov Registry and the ICTRP WHO Registry were searched for evidence of health care professionals and/or patients exposed to ASPT in the context of uUTI. We included evidence published between 2000 and 2024, from high-income countries and in any language. Identified factors were grouped into themes and categorized as facilitators or barriers. Results: A total of 6543 unique records were screened for eligibility and 108 records were included in the review. Most evidence was from original research ( n = 50, 46.3%) or reviews ( n = 46, 42.6%). We identified AMC, clinical outcomes, healthcare utilisation, and patient- or prescriber-related factors as main themes. The main facilitator was the expectation of reduced AMC, while prolonged symptom duration and increased risk of disease progression were identified as main barriers. Conclusion: The clinical management of uUTIs is shaped by factors that can facilitate or hinder ASPT use. This scoping review identified key factors and provided a basis for future research in the area of patient-provider decision making for ASPT, with the ultimate goal to inform targeted interventions and promote wider implementation of ASPT.

Background: The nonmedical use of anabolic androgenic steroids (AASs) has become a considerable substance use concern worldwide, and it is a growing public health risk, particularly among male individuals in recreational sports. Individuals who use these substances for recreational purposes may experience various medical problems. However, there is a lack of high-quality guidance and consensus among medical experts regarding the adequate provision of medical care for this population. Objective: This study aims to develop best practice guidance for health care professionals providing medical care to individuals engaging in the nonmedical use of AASs by achieving consensus on relevant and feasible measures for the Swiss primary care context. Methods: The Delphi consensus method will be applied in this study to develop best practice guidance, following the criteria for conducting and reporting Delphi studies (DELPHISTAR). The development of evidence-based, relevant, and feasible measures for primary care practice follows a mixed methods approach to identify the problem area by conducting 4 substudies: a scoping literature review, incorporation of medical experience, peer involvement, and the selection of a heterogeneous research steering group of medical experts based on individual and group discussions. This Delphi consensus study consists of 3 rounds of anonymous web-based surveys with medical experts in primary care (N=25 Delphi panelists). Recruitment will occur through a network of primary care experts at the University of Zurich. Participants will rate each measure for relevance and feasibility using a 5-point Likert scale and provide comments and recommendations for additional measures. Each measure will require more than 75% agreement in both relevance and feasibility to achieve consensus. Descriptive statistics will be used. Aggregated ratings will be statistically analyzed for response rates, level of agreement, medians, and IQRs. Qualitative responses will be analyzed thematically and evaluated by the steering group for inclusion in subsequent rounds. The final draft of the resulting best practice guidance will be reviewed by an external board of medical associations, and approval will be sought before publication and dissemination. Results: The resulting best current clinical guidance is expected to be published in the summer of 2026. Ethics approval was received from the local ethics committee for this study. Conclusions: With the development of high-quality best practice guidance for health care professionals in primary care, this Delphi study will help close the existing treatment gap among people using AASs. As a strength, primary care offers low-threshold access to health care, chronic care management, and coordination within the health care sector for patients experiencing multiple AAS-related health complications. The Delphi technique is an appropriate study design to develop consensus among a group of medical experts, with the strength of maintaining anonymity throughout the survey process. International Registered Report Identifier (IRRID): PRR1-10.2196/65233

Objectives: To (i) investigate the current state of depression management in Swiss primary care post-COVID-19, focusing on the utilization of guidelines or associated tools, (ii) explore potential associations with depression management, and (iii) evaluate availability of and communication with psychiatrists and psychotherapists. Methods: A previously developed self-report questionnaire, covering screening, diagnosis, management, and interprofessional collaboration, was distributed online, with a supplementary paper version, to 168 Swiss primary care physicians (PCPs) participating in the Swiss Sentinel Surveillance System. Multivariable logistic regressions explored associations. Results: Of the 168 primary care physicians invited to participate, 116 completed the survey (response rate: 69%). Among these, 61% utilized guidelines for depression management, with statistically significant associations towards increased guideline utilization for PCPs with some psychiatric training as residents (odds ratio [OR] 4.13; 95% confidence interval (95% CI) 1.27, 16.02) and decreased utilization for the age group 60–81 (OR 0.29; 95% CI 0.09, 0.93). Guideline utilization was associated with perceived competency in prescribing antidepressants (OR 3.51; 95% CI 1.21, 11.08). The majority reported difficulties in organizing therapy with mental health specialists and rarely received feedback after patient referrals. Conclusion: While the utilization of guidelines among participants was inconsistent, over 60% indicated using either guidelines, tools, or both. The study highlights systemic issues in interprofessional collaboration between PCPs and mental health specialists that require attention.

Objective: This scoping review will explore the evidence on factors influencing the decision to use antibiotic-sparing treatments in women with uncomplicated urinary tract infections. Introduction: Overuse and misuse of antibiotics are the main drivers of antimicrobial resistance. Antibiotic-sparing treatments, such as symptomatic treatment with analgesics and delayed prescriptions, have considerable potential to reduce antibiotic consumption, but the majority of patients still receive antibiotics without delay. The reasons for the poor implementation of these alternative approaches are unknown. A better understanding of the factors influencing treatment decisions is needed. Inclusion criteria: This review will consider the experiences and attitudes of health care professionals and women in outpatient settings in high-income countries, regarding the use of antibiotic-sparing treatments for the diagnosis or suspected diagnosis of uncomplicated urinary tract infections (ie, healthy women aged 18–64 years who are not pregnant, immunosuppressed, and have no functional or structural urinary tract abnormalities). Methods: This review will follow the JBI methodology for scoping reviews. MEDLINE (Ovid), Embase, and the Cochrane Library will be searched to identify peer-reviewed articles: original research (quantitative or qualitative studies, experimental, or observational), reviews, case reports, and case series. Gray literature will also be searched for. Sources in any language from 2000 to 2024 will be included. Three reviewers will screen the sources and extract data using a tool developed by the reviewers. The analysis will use counts and descriptive qualitative content analysis. The results will be presented in visual, tabular, and narrative formats. Review registration: Open Science Framework osf.io/t8y5e/

Objectives Proton pump inhibitors (PPIs) are widely prescribed medications and commonly used for the treatment of gastric acid-related disorders. Nevertheless, PPIs are often overused leading to potential adverse effects and unnecessary healthcare costs. Deprescribing strategies have emerged to safely reduce or substitute inappropriate PPIs and optimise patient care in an evidence-based manner. This protocol describes a study to evaluate the effectiveness of a PPI deprescribing intervention in comparison to usual care in the Swiss primary care setting. Design An open-label, cluster randomised controlled trial. Setting Swiss primary care settings. Participants Included participants will be adults with inappropriate PPI treatment and will be recruited by general practitioners (GPs). Participants treated by the same GP constitute a cluster. Clusters are randomised 1:1 to either the intervention group or the control group. Interventions The intervention components consist of deprescribing tools including educational material, decision aids for both participants and GPs, and additional trainings for GPs only. Patients in the control group will receive usual care. Data will be collected at baseline, 3-, 6-, 9- and 12-month follow-up time through online surveys or a phone call for both GPs and participants. Primary and secondary outcome measures The first co-primary endpoint is the effectiveness of the deprescribing intervention measured by the change of prescribed PPI dose. The second co-primary endpoint is safety, which is measured with the Reflux Disease Questionnaire assessing change in gastrointestinal symptoms. There are several secondary endpoints, such as the total number of prescribed medications, occurrences of changes in prescription patterns, PPI discontinuation and cost-effectiveness. Conclusions The findings from this study will provide evidence on the effectiveness and safety of a PPI deprescribing intervention for patients and GPs. Successful implementation of our PPI deprescribing strategy has the potential to improve patient outcomes and lower costs. Trial registration number NCT06129474.

BACKGROUND The nonmedical use of anabolic androgenic steroids (AASs) has become a considerable substance use concern worldwide, and it is a growing public health risk, particularly among male individuals in recreational sports. Individuals who use these substances for recreational purposes may experience various medical problems. However, there is a lack of high-quality guidance and consensus among medical experts regarding the adequate provision of medical care for this population. OBJECTIVE This study aims to develop best practice guidance for health care professionals providing medical care to individuals engaging in the nonmedical use of AASs by achieving consensus on relevant and feasible measures for the Swiss primary care context. METHODS The Delphi consensus method will be applied in this study to develop best practice guidance, following the criteria for conducting and reporting Delphi studies (DELPHISTAR). The development of evidence-based, relevant, and feasible measures for primary care practice follows a mixed methods approach to identify the problem area by conducting 4 substudies: a scoping literature review, incorporation of medical experience, peer involvement, and the selection of a heterogeneous research steering group of medical experts based on individual and group discussions. This Delphi consensus study consists of 3 rounds of anonymous web-based surveys with medical experts in primary care (N=25 Delphi panelists). Recruitment will occur through a network of primary care experts at the University of Zurich. Participants will rate each measure for relevance and feasibility using a 5-point Likert scale and provide comments and recommendations for additional measures. Each measure will require more than 75% agreement in both relevance and feasibility to achieve consensus. Descriptive statistics will be used. Aggregated ratings will be statistically analyzed for response rates, level of agreement, medians, and IQRs. Qualitative responses will be analyzed thematically and evaluated by the steering group for inclusion in subsequent rounds. The final draft of the resulting best practice guidance will be reviewed by an external board of medical associations, and approval will be sought before publication and dissemination. RESULTS The resulting best current clinical guidance is expected to be published in the summer of 2026. Ethics approval was received from the local ethics committee for this study. CONCLUSIONS With the development of high-quality best practice guidance for health care professionals in primary care, this Delphi study will help close the existing treatment gap among people using AASs. As a strength, primary care offers low-threshold access to health care, chronic care management, and coordination within the health care sector for patients experiencing multiple AAS-related health complications. The Delphi technique is an appropriate study design to develop consensus among a group of medical experts, with the strength of maintaining anonymity throughout the survey process. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/65233

Prescribing of potentially inappropriate medications (PIMs) exposes older adults to increased risk of unfavorable outcomes. PIMs have been associated with hip fractures,¹ fall-related injuries,² hospitalizations,^1,3-8 increased public health services utilization,⁹ and increased health care expenditure.¹⁰ A recent meta-analysis found a significant association between the prescription of PIM and cardiovascular events as well as overall mortality.¹¹

Background: Coronavirus pandemic (COVID-19) particularly affected older adults, with the highest risks for nursing home residents. Stringent governmental protective measures for nursing homes unintendedly led to social isolation of residents. Nursing home directors (NDs) found themselves in a dilemma between implementing protective measures and preventing the social isolation of nursing home residents.Objectives: The objectives of this study were to describe protective measures implemented, to investigate NDs’ perception of social isolation and its burden for nursing home residents due to these measures, and to explore experiences of NDs in the context of the dilemma.Methods: Cross-sectional embedded mixed-method study carried out by an online survey between April 27 and June 09, 2022, among NDs in the German-speaking part of Switzerland. The survey consisted of 84 closed-ended and nine open-ended questions. Quantitative findings were analyzed with descriptive statistics and qualitative data were evaluated using content analysis.Results: The survey was completed by 398 NDs (62.8% female, mean age 55 [48–58] years) out of 1′044 NDs invited.NDs were highly aware of the dilemma. The measures perceived as the most troublesome were restrictions to leave rooms, wards or the home, restrictions for visitors, and reduced group activities. NDs and their teams developed a variety of strategies to cope with the dilemma, but were burdened themselves by the dilemma.Conclusion: As NDs were burdened themselves by the responsibility of how to deal best with the dilemma between protective measures and social isolation, supportive strategies for NDs are needed.