MD and PhD Theses

Ongoing

  • The role of primary care physicians in discussing advance directive with their patients and their interest in interprofessional collaboration

    Advance care planning is central to patient-centred care and to reducing low-value interventions, particularly in the final years of life. In Switzerland, advance directive completion rates among older adults remain low. Given their longitudinal role, general practitioners are ideally placed to initiate and support advance care planning, but the extent to which patients and general practitioners engage with advance directive completion in primary care is insufficiently understood. This study explored the perspectives of Swiss older adults and general practitioners on advance directive completion and examined barriers and facilitators. We also assessed whether involving non-medical professionals such as social workers, chaplains and community professionals could provide a strategy to promote advance directive completion.

    Anna Stoffel

  • A systematic review and meta-analysis on the occupational risk factors in farmers and other outdoor workers for basal cell carcinoma, cutaneous squamous cell carcinoma, and malignant melanoma

    The prevalence of skin cancer is rising, particularly in outdoor workers like farmers, who are frequently exposed to ultraviolet radiation (UVR). Non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), has the highest incidence among all cancers, with SCC being more dangerous. Melanoma, although rarer, has a higher mortality rate. Farmers and other outdoor workers face increased skin cancer risks due to UVR exposure, machinery injuries, chemicals, and other hazards. 

    The objective of the study is to assess how occupational factors in farmers and outdoor workers affect their risk of developing various skin cancers. To answer these questions, a systematic review of the literature and, if possible, a meta-analysis will be conducted.

    Michael Aeby

  • A pilot study in the Swiss Alps: Impact of alpine dairy products on blood lipid levels

    Lifestyle changes such as diet are important strategies in the prevention of cardiovascular diseases. Dyslipidemia, among others, has been shown to be a major cardiovascular risk factor. Clinical observations by a few general practitioners in the Swiss Alps have shown that consumption of dairy products from cows grazing at high altitudes may have a beneficial effect on blood lipid parameters. However, the clinical data available is limited. The aim of this randomized controlled trial was to investigate the impact of alpine dairy products intake on blood lipid levels among hypercholesterolemic patients.

    Sunita Abplanalp

  • Impact of Health Insurers’ Cost Monitoring and Economic Audits on Quality of Care and Equity in Swiss Primary Care

    In Switzerland, primary care physicians (PCPs) are routinely subject to insurer cost monitoring based on statistical comparisons, with some identified as outliers and exposed to formal economic audits with potential financial consequences. While intended to promote cost-effective care, concerns suggest unintended effects on clinical practice, equity, and workforce sustainability. We conducted a national study to examine their scope and impact on PCPs’ practice, well-being, and work satisfaction.

    Pauline Cottet

  • Primary Care Led Interventions of Advance Care Planning among Community Dwelling Adults

    Advance care planning (ACP) is a process by which adults at any age or stage of health can understand and express their personal values, life goals, and preferences for future medical care. This process has been shown to improve value-concordant care, support principles of self-determination, quality of life, and respect individual dignity. As these end-of-life decisions strongly shape the process of dying, it is imperative to research how ACP interventions are implemented and institutionalized.

    Primary care is a favorable setting for ACP due to trust-based relationships between patients and their general practitioner. However, most existing evidence focuses on hospital, nursing home, or disease-specific contexts, leaving the role of primary care-led ACP interventions underexplored.

    This PhD thesis opens with a systematic review of ACP interventions in primary care for community-dwelling adults, with a focus on implementation science outcomes.

    Jade Bonanno

  • Quality of care in Swiss primary care

    Swiss legislation seeks to guarantee accessible, high-quality healthcare. However, the approaches used to define, achieve, and monitor quality remain insufficiently specified and vary across stakeholders and care settings. In this context, quality indicators are widely regarded as key tools for assessing healthcare performance. To date, most quality improvement efforts have focused on inpatient care, whereas the outpatient setting presents distinct challenges—from data collection to the selection and validation of relevant indicators—for which no clear consensus exists.
    The objective of this thesis is to develop a pragmatic and implementable framework of quality-of-care indicators tailored to primary care. This framework aims to support routine use and meaningful evaluation in real-world settings, while enhancing the consistency, transparency, and applicability of quality assessment in Switzerland.

    Romane Challet

Completed

2026

  • Challenges in Research on Herbal Medicine: Insights from a Clinical Trial on Acute Bronchitis

    Acute bronchitis is a respiratory infection most often of viral origin, for which no conventional treatment has demonstrated clear efficacy in reducing the duration or severity of symptoms. In the absence of effective therapeutic alternatives and under patient pressure, general practitioners (GPs) still frequently prescribe antibiotics, thereby contributing to the progression of antimicrobial resistance. In this context, herbal medicine appears to be a promising option.

    Against this background, the overall aim of this thesis was to identify a herbal medicine that could provide GPs with an effective option for managing acute bronchitis, focusing specifically on Andrographis paniculata and Pelargonium sidoides. More precisely, it first assesses the quality of products containing these plants and, once adequate quality has been established, evaluates their effectiveness in reducing the duration of symptoms of acute bronchitis as well as inappropriate antibiotic use as part of a clinical trial.

    Angélique Bourqui