چکیده (انگلیسی):

Background:According to the Organization for Economic Cooperation and Development, the Swiss
healthcare system is one of the most effective in the world. Yet, as other occidental countries, it has to face
the increase of chronic diseases frequency and its resulting cost, particularly for primary care (PC). However
very few consistent data are available to describe PCfeatures and its evolution over time. The aim of this
study is to describe the evolution of the Swiss PC physicians’ (PCPs) profile and activities between 1993
and 2012.
Methods:The date come from two independent European surveys carried out in Switzerland respectively in
1993 and 2012. Both surveys were cross-sectional onesand based on representative samples of 200 PCPs,
interviewed by questionnaire.
Results:In 20 years, PCPs became older (median age 46 vs56,p< 0.001) and more feminized (7 %vs22 %,p<0.001).
Nowadays, they more often work in group practices (28 %vs52 % in 2012,p< 0.001) and are more involved in other
paid activities (28 %vs66 % in 2012,p< 0.001). All the PCPs have a computer in 2012 (78 % in 1993,p< 0.001) and it is
mostly used for keeping records of consultations (47 %). The number of daily face-to-face contacts with patients
decreased from 31 to 24 but the average length rose from 15 to 20 min (p< 0.001). PCPs provide fewer pediatric and
gynecological services but their activity remains globally unchanged in other domains. The frequency of meetings with
other disciplines decreased significantly (e.g. once/month face-to-face meets with ambulatory specialists: 78 %vs23 %
in 2012, p< 0.001). The involvement of PCPs in follow-up and treatment of chronic disease globally little
differed. In 2012, 8.5 % of the PCPs never performed any chirurgical acts (vs0 % in 1993,p< 0.001).
Conclusion:This study showed a substantial evolution of Swiss PC over the last twenty years in terms of
socio-demographic, organizational and service provided. The main changes include: feminization and ageing,
lower diversity in services provided, fewer but longer consultations. These changes may have important
implications for patients’ management and will need to be considered for health planning purposes