Background: Digitalization and patient empowerment result in new requirements and challenges. In response, the module “Clinical Telemedicine/e-Health” was implemented by the Faculty of Medicine of Zurich in 2008. The module was systematically evaluated to determine if the students would benefit from this course. In 2011, 2015, and 2016 further evaluations were performed. Method: In 2008 and 2009, students evaluated 16 statements. We calculated the combined mean value and medians for both evaluations. In 2011, the same evaluation was conducted, and the results were compared through U-test. In 2015, students were asked about the application and benefits of telemedicine; the answers were analyzed qualitatively and quantitatively. In 2016, the University of Zurich created an online survey which integrated three of the statements from the original evaluations. Results: Every mean value of the combined evaluations of 2008/2009, 2011, and 2016 achieved a score of over 4 on a 6-point scale. In 2011, and also again in 2016, the overall satisfaction and understanding of telemedicine as a supplement in traditional medical consultations increased as follows: 4.71 ± 0.74 versus 4.86 ± 0.93 versus 5.1 ± 1.5 and, respectively, 5.02 ± 0.96 versus 5.25 ± 0.81 versus 5.7 ± 0.6. In the 2015 evaluation, 93% of students indicated that they would use telemedicine for chronically ill and elderly patients. Conclusion: The positive assessment of the module indicates the successful introduction of the topics of telemedicine and e-health to medical students at the University of Zurich. Throughout the course, the students gained confidence and basic skills.

Sex differences in cardiovascular prevention have been reported, yet the role of sex with regard to different modifiable risk factors such as low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (BP), and glycated hemoglobin (HbA1c) in primary care settings is unclear. Therefore, we studied sex differences in assessment and measured values of LDL-C, BP, and HbA1c in primary and secondary cardiovascular prevention delivered by general practitioners. This cross-sectional study was based on electronic medical records of 59,092 primary care patients (51.9% women) aged 40-79 years in Switzerland. Multilevel regression was used to model associations of sex with assessment and measured values of LDL-C, BP, and HbA1c in 2018. In both primary and secondary prevention, women had lower LDL-C assessment rates (age-adjusted odds ratio (aOR) 0.71 [95% confidence interval (CI) 0.67 to 0.75] and 0.70 [CI 0.51 to 0.95]), and higher measured LDL-C values than men (age-adjusted difference 0.30 mmol/L [CI 0.25 to 0.35] and 0.28 mmol/L [CI 0.07 to 0.48]). Compared with men, women in primary prevention displayed lower BP and HbA1c assessment frequencies (aOR 0.77 [CI 0.73 to 0.81] and 0.76 [CI 0.71 to 0.80]) and measured values (age-adjusted difference -2.49 mmHg [CI -2.99 to -1.79] and -0.19% [CI -0.24 to -0.14]), while there was no sex difference in secondary prevention. Age-dependent increases in measured values of LDL-C, BP, and HbA1c were greater in women than men. Control of LDL-C in women in primary care should be improved to reduce sex-based inequalities in prevention of cardiovascular disease.

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: Medication safety in patients with polypharmacy at transitions of care is a focus of the current Third WHO Global Patient Safety Challenge. Medication review and communication between health care professionals are key targets to reduce medication-related harm. Objective: To study whether a hospital discharge intervention combining medication review with enhanced information transfer between hospital and primary care physicians can delay hospital readmission and impact health care utilization or other health-related outcomes of older inpatients with polypharmacy. Design: Cluster-randomized controlled trial in 21 Swiss hospitals between January 2019 and September 2020, with 6 months follow-up. Participants: Sixty-eight senior physicians and their blinded junior physicians included 609 patients ≥ 60 years taking ≥ 5 drugs. Interventions: Participating hospitals were randomized to either integrate a checklist-guided medication review and communication stimulus into their discharge processes, or follow usual discharge routines. Main Measures: Primary outcome was time-to-first-readmission to any hospital within 6 months, analyzed using a shared frailty model. Secondary outcomes covered readmission rates, emergency department visits, other medical consultations, mortality, drug numbers, proportions of patients with potentially inappropriate medication, and the patients’ quality of life. Key Results: At admission, 609 patients (mean age 77.5 (SD 8.6) years, 49.4% female) took a mean of 9.6 (4.2) drugs per patient. Time-to-first-readmission did not differ significantly between study arms (adjusted hazard ratio 1.14 (intervention vs. control arm), 95% CI [0.75–1.71], p = 0.54), nor did the 30-day hospital readmission rates (6.7% [3.3–10.1%] vs. 7.0% [3.6–10.3%]). Overall, there were no clinically relevant differences between study arms at 1, 3, and 6 months after discharge. Conclusions: The combination of a structured medication review with enhanced information transfer neither delayed hospital readmission nor improved other health-related outcomes of older inpatients with polypharmacy. Our results may help researchers in balancing practicality versus stringency of similar hospital discharge interventions. Study Registration: ISRCTN18427377, https://doi.org/10.1186/ISRCTN18427377