a Department of Ambulatory Care and Community Medicine , University of Lausanne , Lausanne , Switzerland.
b Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA.
Eur J Gen Pract. 2018 Dec;24(1):32-38. doi: 10.1080/13814788.2017.1395018. Epub 2017 Nov 23.
In 2014, the 'Smarter Medicine' campaign released a top five list of unnecessary tests and treatments in Swiss primary care, such as imaging for acute low-back pain and long-term prescribing of proton pump inhibitors.
Measure general practitioners' (GPs) agreement with the recommendations and self-reported adherence.
Cross-sectional, online survey of GPs in the 'Swiss primary care active monitoring' (SPAM) network, which assessed awareness of 'Smarter Medicine' and views on each recommendation. Questions included whether the clinical situation is common, whether the recommendation is followed, whether GPs agree with the recommendation and reasons why the recommendation would not be followed.
One-hundred-and-sixty-seven of 277 GPs from the SPAM network participated (60%), of which 104 (62%) knew of 'Smarter Medicine', including 79% in German areas, 49% in French areas and 38% in Italian areas (P < 0.001). Agreement with the five recommendations was high, with scores around nine out of 10. The proportion saying they typically follow each recommendation was 68 to 74%, except not continuing long-term PPI prescriptions without attempting dose reduction, with only 34%. Common reasons for not following the recommendations were patient or other provider requests and situations that might suggest the need for more aggressive care.
Two years after the launch of the campaign, awareness and acceptance of 'Smarter Medicine' appear to be high among Swiss GPs. By self-report, the recommendations are adhered to by most of the respondents but there may be room for improvement, especially for long-term PPI prescriptions.
2014 年，“更明智的医疗”运动发布了瑞士初级保健中不必要的五项测试和治疗清单，例如急性腰痛的影像学检查和质子泵抑制剂的长期处方。
衡量全科医生（GP）对这些建议的认同度和自我报告的依从性。
采用横断面、在线调查瑞士初级保健主动监测（SPAM）网络中的全科医生，评估他们对“更明智的医疗”的认识以及对每项建议的看法。问题包括临床情况是否常见、建议是否遵循、GP 是否认同建议以及不遵循建议的原因。
来自 SPAM 网络的 277 名全科医生中有 167 名（60%）参与了调查，其中 104 名（62%）知道“更明智的医疗”，包括德语区的 79%、法语区的 49%和意大利语区的 38%（P<0.001）。对这五条建议的认同度很高，评分接近十分之九。表示通常遵循每条建议的比例为 68%至 74%，但不减少剂量就继续长期使用质子泵抑制剂的比例仅为 34%。不遵循建议的常见原因是患者或其他提供者的要求以及可能需要更积极治疗的情况。
在运动发起两年后，瑞士全科医生对“更明智的医疗”的认识和接受度似乎很高。根据自我报告，大多数受访者都遵守了这些建议，但可能仍有改进的空间，尤其是对于长期使用质子泵抑制剂的情况。
