access_time veröffentlicht 28.10.2021
Unisanté, the new university center for primary care and public health in Lausanne
Prof. Jacques Cornuz
Unisanté, the new university center for primary care and public health in Lausanne
Since January 1st, 2019, a new player has emerged in the Swiss university medical field: Unisanté, University Center for General Medicine and Public Health (www.unisante.ch). This center has been created by merging five institutions based in Lausanne: 1) the University Institute for ambulatory community care (Policlinique médicale universitaire, PMU); 2) the University Institute of Social and Preventive Medicine (Institut universitaire de médecine sociale et preventive, IUMSP); 3) the University Institute of Occupational Health (Institut romand de médecine du travail, IST); 4) the Center for Health Promotion (Promotion santé Vaud, ProSV); 5) the Foundation for Cancer Screening (Fondation vaudoise pour le dépistage du cancer, FVDC).
The creation of this center addresses several challenges of health care systems in high income countries (1,2,3). The health care systems’ center of gravity is indeed shifting from the hospital to the front line (general practitioners, pharmacists, nurses, medical assistants). This shift is influenced by the hospital saturation and the growing importance of chronic diseases. Further, general practitioners have become one of the pillars of the health care system: two thirds of the population consulted a general practitioner over the past year. Among those who consulted a specialist, more and more do so after seeing a general practitioner (4).
The development of primary care is aligned with the health policy objectives of most western countries including Switzerland. It was therefore timely and important to innovate on the organizational level and create a primary care university center with an asserted responsibility for teaching, training and research. As aforementioned, this new focus on university primary care was also warranted by the growing role of general practitioners as actors in community medicine. This initiative also builds on the importance of academic public health in identifying and monitoring public policies in health promotion and prevention, as well as organizing and financing healthcare systems.
Health is not primarily determined by health care services. It is determined by structural, socio-economic, psychosocial, political, occupational, behavioural and environmental factors. In all countries, including Switzerland, health and illness typically follow a social gradient: the lower the socio-economic position, the worse the health (5).
In this context, it is imperative to put more weight on prevention and health promotion so that rising life expectancy coexists with good health and well-being for as long as possible. Public health policies must therefore combine interventions on structural and behavioral determinants of health, while integrating environmental issues. Multi-sectoral interventions are therefore necessary to develop environments conducive to healthy aging, particularly by promoting home care (6).
the PMU’s Board, launched the “Alliance santé” project in 2017. The objective of this project was to create a new university medical center bringing together the expertise from ambulatory care, community medicine and public health. This center, named Unisanté, is an institution under public law, with its own legal personality and governance. This university center is therefore neither a government department nor a foundation. Its budget is in the order of 140 million. About a third is subsidized by the University of Lausanne and the Department of Health and Social Action of the Canton of Vaud.
Unisanté currently has about 900 employees, including 230 doctors, 160 nurses and care workers, 55 pharmacists or assistant pharmacists, 100 researchers/scientists, 60 people working in health promotion, about 30 doctoral students and 200 people involved in logistical and administrative support. Although this organizational innovation is unique in Switzerland, it is based on successful examples from other universities, particularly in the Netherlands (Maastricht) and the UK (London, Cardiff).
Unisanté mission includes the following activities:
- The activities of the first line of care, in particular general and family medicine, nursing and pharmaceutical advice, as well as access to care and orientation within the health system.
- Activities related to vulnerable patients including those with disabilities.
- Health promotion, primary prevention and screening interventions.
- Expertise and research in public health, in particular on the organization and financing of health systems, as well as population-based surveillance, especially to better match the health needs of the population.
- Expertise and services related to occupational medicine.
- Academic research and teaching activities in general and with a focus on community medicine, public health and occupational health.
Finally, the remits and purpose of this center are directly aligned with the recent pattern of ambulatory medicine. The majority of general practitioners carry out one or more activities outside their practice, in community structures, such as nursing care facilities, home care, school health services, medical advice, expert reports and teaching in the primary care practice. This involvement of general practitioners in community medicine confirms their role as actors in community medicine and public health (7), which strengthens their position in the health care system.
Unisanté supports the development of a population-based vision (Figure 1) in ambulatory care (8,9,10). This perspective should make it possible to be proactive in implementing targeted interventions, particularly in the areas of prevention and equitable care. This should also promote better coordination of care for patients with multiple chronic diseases, for example by better identifying those who need specific support (case management, social support, etc.).
Unisanté also aims to help policy makers better take into account socio-economic determinants of health and lower health literacy issues. One objective may be to use new technologies to address specific needs and challenges. Adapting healthcare delivery and related communication also makes it possible to tackle other challenges, such as those related to migration. In addition, with its expertise in health economics, Unisanté will also be able to serve as a laboratory for testing new financing options.
Moreover, the evolution of occupational health suggests that the interfaces with general medicine and public health should be encouraged. Finally, synergies between the fields of environmental health and occupational health makes it necessary to bring together the expertise of these two fields, in particular to understand the impact of pollutants present in the environment of work.
This development also echoes the new Swiss federal catalog of pre-graduate medical education (www.profilesmed.ch) in which community medicine is clearly identified as one of the priorities in the training of future doctors. Ultimately, should we not prepare for change, consistent with the conclusion of a "Perspective paper" published few years ago by The New England Journal of Medicine, "In many respects, our medical systems are best suited to diseases of the past, nor those of the present or future." (1).
Marie-Anne Durand for her help in the preliminary version of the manuscript.
- Frieden Th. The future of Public Health N Engl J Med 2015; 373:1748-52
- Orkin A et al. Clinical Population Medicine: integrating clinical medicine and population health in practice. Ann Fam Med. 2017;15(5):405-409
- Cornuz J, Senn N, Bodenmann P, Staeger P, Bochud M. Unisanté, le nouveau centre universitaire de médecine générale et santé publique. Primary and Hospital Care 2020;20:145-148
- Senn N., Ebert ST, Cohidon, C. Family medicine in Switzerland. Analysis and perspectives on the basis of SPAM indicators. Obsan Dossier 55. Neuchâtel: Swiss Health Observatory. 2016
- Bulletin of the Federal Office of Public Health, Spectra 119; January 2018
- Bonk M. Policies on Ageing and Health. A selection of innovative models. Multisectoral action for a life course approach to healthy aging. Bern, December 2016, available at www.bag.admin.ch/ageing
- Jakob J et al. Participation in medical activities beyond standard consultations by Swiss general practitioners. BMC Family Practice 2018;19:52
- Levesque J et al. The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives. Public Health Reviews 2013;35:21-27
- Cohidon C, Cornuz J, Senn N. Primary care in Switzerland: evolution of physicians' profile and activities in twenty years (1993-2012). BMC Family Practice 2015;16:107 doi:10.1186/s12875-015-0321-y
- Cornuz J, Bodenmann P. Senn N. Staeger Ph. General practice and community health: common interests. Rev Med Suisse 2018;625: 1923-4