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Original article

Vol. 145 No. 2122 (2015)

Impact evaluation of Swiss Medical Board reports on routine care in Switzerland: a case study of PSA screening and treatment for rupture of anterior cruciate ligament

  • Klaus Eichler
  • Sascha Hess
  • Marco Riguzzi
  • Uenal Can
  • Urs Brügger
Cite this as:
Swiss Med Wkly. 2015;145:w14140


QUESTIONS UNDER STUDY: Evidence-based recommendations play an important role in medical decision-making, but barriers to adherence are common. In Switzerland, the Swiss Medical Board (SMB) publishes evidence reports that conclude with recommendations. We assessed the impact of two SMB reports on service provision (2009: Recommendation of conservative treatment as first option for rupture of the anterior cruciate ligament of the knee; 2011: Recommendation against PSA screening for prostate cancer).

METHODS: We performed an observational study and assessed quantitative data over time via interrupted times series analyses. The primary outcome was the quarterly number of performed prostate-specific antigen (PSA) tests and the annual rates of surgical ACL repair in patients with ACL rupture. Data were adjusted for time trends and relevant confounders.

RESULTS: We analysed PSA tests in 662,874 outpatients from 2005–2013 and treatment data in 101,737 patients with knee injury from 1990–2011.

For the number of PSA tests, the secular trend before the intervention showed a continuous but diminishing increase over time. A statistically significant reduction in tests was estimated immediately after the intervention, but a later return to the trend before the intervention cannot be ruled out.

The rate of surgical ACL repair had already declined after the late 1990s to about 55% in 2009. No relevant additional change emerged in this secular trend after the intervention.

CONCLUSIONS: Despite some evidence of a possible change, we did not find a sustained and significant impact of SMB recommendations in our case study. Further monitoring is needed to confirm or refute these findings.


  1. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65.
  2. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24.
  3. Eichler K, Zoller M, Tschudi P, Steurer J. Barriers to apply cardiovascular prediction rules in primary care: a postal survey. BMC Fam Pract. 2007;8:1.
  4. Gurses AP, Marsteller JA, Ozok AA, Xiao Y, Owens S, Pronovost PJ. Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines. Crit Care Med. 2010;38(8 Suppl):S282–91.
  5. Thornhill MH, Dayer MJ, Forde JM, Corey GR, Chu VH, Couper DJ, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ. 2011;342:d2392.
  6. Roberts VI, Esler CN, Harper WM. What impact have NICE guidelines had on the trends of hip arthroplasty since their publication? The results from the Trent Regional Arthroplasty Study between 1990 and 2005. J Bone Joint Surg Br. 2007;89(7):864–7.
  7. Rosen M, Werko S. Does health technology assessment affect policy-making and clinical practice in sweden? Int J Technol Assess Health Care. 2014;30(3):265–72.
  8. Gesundheitsdirektion des Kantons Zürich. Ruptur des vorderen Kreuzbandes: operative oder konservative Behandlung? Fachbericht. Zürich: Medical Board, 2009.
  9. Swiss Medical Board. Stellenwert des PSA-Wertes bei der Früherkennung des Prostatakarzinoms. Fachbericht. Zürich: Swiss Medical Board, 2011.
  10. Eichler K, Hess S, Tecklenburg L, Ledergerber A, Riguzzi M, Brügger U. Swiss Medical Board: Impact Evaluation. Schlussbericht: Winterthurer Institut für Gesundheitsökonomie, Zürcher Hochschule für Angewandte Wissenschaften, 2014.
  11. Overmeer T, Linton SJ, Holmquist L, Eriksson M, Engfeldt P. Do evidence-based guidelines have an impact in primary care? A cross-sectional study of Swedish physicians and physiotherapists. Spine. (Phila Pa 1976) 2005;30(1):146–51.
  12. Sondergaard J, Andersen M, Stovring H, Kragstrup J. Mailed prescriber feedback in addition to a clinical guideline has no impact: a randomised, controlled trial. Scand J Prim Health Care. 2003;21(1):47–51.
  13. Howard DH, Adams EK. Mammography rates after the 2009 US Preventive Services Task Force breast cancer screening recommendation. Prev Med. 2012;55(5):485–7.
  14. Pace LE, He Y, Keating NL. Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer. 2013;119(14):2518–23.
  15. Minshall I, Berry D, Smith D. The impact of an educational intervention, the New GP Contract and NICE guidelines on anti-epilepsy therapeutic drug monitoring. Seizure. 2011;20(2):126–30.
  16. Howard DH. Declines in prostate cancer incidence after changes in screening recommendations. Arch Intern Med. 2012;172(16):1267–8.
  17. Sammon JD, Pucheril D, Diaz M, Kibel AS, Kantoff PW, Menon M, et al. Contemporary Nationwide Patterns of Self-reported Prostate-Specific Antigen Screening. JAMA internal medicine 2014;174(11):1839–41.
  18. Recker F, Sulser T. Swiss Medical Board oder: “das Kind mit dem Bade ausschütten”. Schweiz Ärzteztg. 2011;92(51/52):2002–04.
  19. Swiss Medical Board. Stellungnahme des Swiss Medical Board zur Kritik an seiner Empfehlung zum PSA-Test Swiss Medical Board oder: «von der Angemessenheit des PSA-Tests». Schweiz Ärzteztg. 2012(93: 3):83–85.
  20. Dubler DmO. Briefe an die SÄZ; Keine Statistiken, sondern Menschen. Schweiz Ärzteztg. 2012(93: 8):281–83.
  21. Hurley R. Can doctors reduce harmful medical overuse worldwide? BMJ. 2014;349:g4289.
  22. Choosing Wisely. Unnecessary Tests and Procedures In the Health Care System. 2014.
  23. Selby K, Cornuz J, Neuner-Jehle S, Meier C, Rodondi N, Gaspoz J. “Smarter Medicine”: 5 Interventionen, die in der ambulanten allgemeinen inneren Medizin vermieden werden sollten. Schweiz Ärzteztg. 2014;95(20):769.
  24. Arie S. Switzerland debates dismantling its breast cancer screening programme. BMJ. 2014;348:1625.
  25. Biller-Andorno N, Juni P. Abolishing mammography screening programs? A view from the Swiss Medical Board. N Engl J Med. 2014;370(21):1965–7.
  26. Matowe L, Ramsay CR, Grimshaw JM, Gilbert FJ, Macleod MJ, Needham G. Effects of Mailed Dissemination of the Royal College of Radiologists’ Guidelines on General Practitioner Referrals for Radiography: A Time Series Analysis. Clinical Radiology. 2002(57):575–78.

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