Temi

Social isolation and loneliness amongst older adults are one of the most pressing public health issues in our ageing society. A big obstacle to effectively addressing this issue is how to identify individuals who are experiencing or most at risk of social isolation and loneliness. This policy brief outlines current strategies used to facilitate the outreach to people most in need: i) enlist personnel in the community in the identification process, ii) build strong databases and use existing data to create heat maps, and iii) launch awareness campaigns to raise awareness and reduce stigma.

In March 2020, the Swiss Learning Health System invited its partners to think and work on ways current research efforts in Switzerland and outside of the country can be supported and strengthened to address the international COVID-19 emergency. Thereupon, three Rapid Response Reviews on the following topics have been written:

Policymakers have to consider various factors and information types when making decisions about policies, health service management and delivery. Apart from research and data, stakeholder interests, public opinion, ideology, values, and emotions may essentially influence how policymakers think and decide. To increase the relevance of research in policymaking within Swiss health authorities, this policy brief discusses recommendations for effective interventions to build capacity for evidence-use and the implementation thereof.

In order to reduce overuse and underuse in the healthcare system, it is necessary to define appropriate care according to current knowledge and to measure it. However, measurement is hampered by inadequate political and structural frameworks, limited availability of electronic data and poor data quality. To improve the measurement of over- and underuse in Swiss family medicine, this policy brief recommends i) the development of a comprehensive digital strategy, ii) the strengthening of a data-based quality culture and iii) the support of bottom-up initiatives.

Improving care and the experiences of care by providing high-quality care responding to people’s needs (i.e. patient-centered care), are important as it translates into more positive experiences of care, which in turn can translate into treatments working better and better health. Patient-centered care is especially important in cancer care, as cancer has a particular emotional, social and financial burden on patients and their families, in addition to the health burden. While information about the effectiveness of cancer care is available in Switzerland, reports from patients about cancer care are missing. To increase the patient-centeredness in cancer care, this policy brief recommends i) developing a position statement on the importance and value of patients’ experiences of cancer care and ii) collecting patients’ experiences of cancer care at the national level, by implementing a national survey or by integrating data collection in cantonal cancer registries.

The Code of Law of the Roman Catholic Church contains an impediment to the marriage of impotence. It says that someone can only get married if the person can engage in sexual intercourse. To forbid marriage due to this reason poses discrimination for the people concerned because entering marriage is a fundamental and human right that cannot be exercised. This learning cycle meets the challenge to examine and eliminate the discrimination of people with a disability posed by the law of the Roman Catholic Church, by presenting information on i) the signing of the convention on the Rights of Persons with Disabilities by the Holy See with the consequence of a legislative adjustment, ii) the revision and discussion of the natural justice of the impediment to the marriage of impotence and iii) the discussion of the implementation/third-party effect of the fundamental rights.

For reasons such as non-standardized final competencies for Advanced Practice Nurses (APN) or the lack of role definitions, APNs are not sufficiently employed in general practitioners' (GP) practices in Switzerland. APNs are already taking over GPs' activities on their own responsibility, however these are performed in a "grey area" and are associated with many uncertainties. The aim is to leave this "grey area" and to promote the implementation of new care models with APNs in Swiss GP practices. To this end, this policy brief recommends (1.) clarifying and expanding the roles of APNs in primary care, as well as (2.) clarifying the training and legal framework for the employment of APNs (available only in german)

Social isolation and loneliness in the elderly have a number of negative health consequences and are particularly harsh for the socially disadvantaged. Strengthening social participation of socially disadvantaged older people can contribute to reducing social isolation and loneliness and the associated health inequalities in this group. This learning cycle approaches the challenge of increasing social participation among the socially disadvantaged elderly by providing evidence-based insights on i) improved methods of outreach, ii) the inclusion of target groups in the planning and implementation of programs, and iii) improved program evaluation considering socially disadvantaged groups.

Greater awareness for the right for data protection leads to conflicts in the collaboration between hospitals and hospital pastors. This Policy Brief examines how the involvement of pastoral care in hospitals in the canton of Zurich can be better regulated in terms of legal requirements for patient data protection. In order to change the current situation, it is recommended (1.) to take the Palliative Care Concept as a model, (2.) to change the cantonal and federal legislation and (3.) to use the digital patient file to improve the holistic approach to treatment. 

International clinical guidelines for the conservative management of knee osteoarthritis (OA) recommend exercise, education, and weight control as first-line treatment for all people with knee OA. However, findings from various health care settings have identified an underuse of exercise and education. A recent survey among medical specialists in Switzerland identified an evidence-performance gap, implying that the strong evidence in favour of exercise is not being transferred into clinical practice. This policy brief describes the challenges facing the improvement of conservative disease management by presenting recommendations regarding i) tanslation of guideline recommendations into a specific exercise and education programme ii) facilitation of the systematic application of exercise through standardised treatment pathways and iii) promotion of the benefits of exercise in the long-term management of chronic diseases.

The Swiss Health System is a complex system with different groups of actors for which data is collected and analyzed using various methods, leading to a large heterogeneity and dispersion of available data. The specificities of a Swiss Health System favor a hybrid infrastructure to manage the heterogeneity and dispersion of Swiss health-related data. This policy brief shows the importance of a metadata management infrastructure to identify and describe health data resources and highlights several essential key elements for the design of a metadata repository and also raises important practical questions.