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Skill mix in Swiss primary care group practices - a nationwide online survey

机译：瑞士初级保健小组实践中的技能组合-全国在线调查

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Increasing chronic conditions and multimorbidity is placing growing service pressures on health care, especially primary care services. This comes at a time when GP workforce shortages are starting to be felt across Switzerland, placing a threat on the sustainability of good access to primary care. By establishing multiprofessional teams in primary care, service capacity is increased and the pressures on the GP workforce can be alleviated. The roles of non-medical health professions in primary care are not established so far in Switzerland and the personnel composition of primary care group practices is not known. Therefore this study aims to provide insights into the current composition, educational background and autonomy of the these new professional roles in primary care. For this descriptive exploratory study a web-based online survey methodology was used. Group practices were defined as being a medical practice with any specialisation where at least three physicians work together in a team. Based on this restriction 240 eligible group practices were identified in Switzerland. The following four tertiary-level health professions were included in the study: nurses, physiotherapists, occupational therapists and dietitians. Additionally medical practice assistants with couselling competencies were included. A total of 102 practices answered the questionnaire which is equivalent to an answer rate of 43%. The sample included data from 17 cantons. 46.1% of the practices employed non-physician health professionals. Among the tertiary-level health professions, physiotherapists were the most frequent profession with a total of 78 physiotherapists over all group practices, followed by nurses (43), dietitians (34) and occupational therapists (3). In practices which employ those professionals their average number per practice was 3.4. 25.5% of the practices had health professionals employed with advanced roles and competencies. The results from this study demonstrate that while nearly 50% of groups practices have established non-physician professionals, only 25% of practices integrate these professionals with advanced roles. Compared with other countries, there would appear to be significant scope to extent and broaden the uptake of non-physician professionals in primary care in Switzerland. Clear policy direction along with supporting regulation and financing arrangements are required.
机译：越来越多的慢性病和多发病，给医疗保健，尤其是初级保健服务带来越来越大的服务压力。这是在整个瑞士开始感觉到全科医生劳动力短缺之际，这对良好获得初级保健服务的可持续性构成了威胁。通过在基层医疗中建立多专业团队，可以提高服务能力，并减轻GP员工的压力。到目前为止，瑞士尚未确定非医疗保健专业在初级保健中的作用，并且初级保健团体实践的人员组成尚不清楚。因此，本研究旨在提供对这些新的专业角色在初级保健中的当前组成，教育背景和自主权的见解。对于此描述性探索性研究，使用了基于Web的在线调查方法。团队实践被定义为具有任何专业知识的医学实践，其中至少三位医生组成一个团队。基于这一限制，在瑞士确定了240个合格的团体做法。该研究包括以下四个三级卫生专业：护士，物理治疗师，职业治疗师和营养师。此外，还包括具有咨询能力的医学执业助理。共有102种实践回答了问卷，相当于43％的回答率。样本包括来自17个州的数据。 46.1％的做法雇用了非内科保健专业人员。在三级卫生专业中，物理治疗师是最常见的专业，在所有团体治疗中共有78名物理治疗师，其次是护士（43），营养师（34）和职业治疗师（3）。在雇用这些专业人员的实践中，每个实践的平均人数为3.4。 25.5％的实践聘用了具有高级角色和能力的卫生专业人员。这项研究的结果表明，尽管近50％的团队实践已经建立了非医师专业人士，但是只有25％的实践将这些专业人士整合为高级角色。与其他国家相比，瑞士的初级保健领域似乎有很大的范围并扩大了非医师专业的吸收。需要明确的政策方向以及配套的监管和融资安排。

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