Health Telematics (AIM) Final Report


	Updated: Feb 1, 97
PRIMACARA

Concerted Action on Telematics used in Primary Health Care

Project Code: A2105

Project value: 150 KECU

EC contribution: 150 KECU

No of partners: 30

No of countries: 15

Duration: 24 months

Contact:
Prof. Jan De Maesseneer
Université de Gand
Primary Health Care
De Pintelaan 185
B-9000 Gent, Belgium
Tel.: +32-9-240.35.42
Fax: +32-9-240.49.67

Overview

The general aim of this concerted action was to identify how the applications of telematics to general practice, in the framework of primary health care, can be further developed to improve the quality of health care in Europe. In this context, PRIMACARA described quality in general practice as the relationship between actual care and the expectations of the various involved parties.

Objectives

In all member states of the EC, increasing pressure on the limited resources for health care has led to greater emphasis on cost effectiveness and to a shift from hospital care to primary health care. In some countries the number of hospital beds are decreasing and even whole hospitals are being closed. At the Maastricht conference, in 1992, it was proposed that "The Community shall contribute to ensure a high level of human health protection by encouraging co-operation between the Member States". Adequate data-gathering and data-flow is an essential condition in order to realise the implementation of this goal. Telematics (information and communication technology) provides us with the tools for accessing valuable information held in the medical records of general practitioners (GPs). Moreover, increasing mobility of inhabitants requires a European effort towards standardisation. Much work has already been done in this field, mainly in relation to secondary care (hospitals). It is clear that this is also required for primary health care.

Within Europe, governments strive to provide equitable access to primary health care for all citizens, including socially vulnerable groups such as refugees, homeless people, unemployed persons, etc. It is hoped that the implementation of new technologies can contribute to improve access to primary health care for these specific target groups, but this issue needs to be investigated.

The organisation of the health care system in the different EC countries varies considerably and the role of the GP as gatekeeper to secondary care is not uniform. Nevertheless. there is a consensus that the general practitioner/family physician has a key role to play. This concerted action therefore focuses on the general practitioner, emphasising the importance of the communication and data flow to and from GPs.

Objectives of the Concerted Action were:

to identify the actual objectives of Primary Health Care in Europe
to survey the current activity in information and communication technology for primary health care
to co-ordinate current activity
to analyse trends in information and communication technology in primary health care
to assess the impact of information and communication technology within primary health care at the social and ethical level, at the organisation level and at the individual level (professionals and consumer)
to assess what the technological management of primary health care data offer epidemiology, medical decision making, teaching and learning, policy development...
to identify enabling and limiting factors related to the implementation of information and communication technology within primary health care
to define the needs of primary health care in terms of information and communication technology in order to meet defined objectives, with special emphasis on equity and accessibility
to formulate recommendations to EC in the domain of primary health care for the next AIM-phase and for implementation on the field
to encourage more Primary Care based projects in the AIM-programme.

The concerted action has studied the various aspects of this communication i.e. the "horizontal communication" (between the different practitioners, agencies and patients in primary care) and the "vertical communication" (with hospitals and other secondary care facilities).

Results

A theoretical- frame of reference has been developed, an extensive questionnaire was developed and three working-groups have been working.

The questionnaire has provided with up-to-data description of the different primary health care systems in the European Community, the actual use of informatics and telematics in general practice and the major problems for the further developments.

A first working group, co-ordinated by H.B. Jensen (Denmark) has looked at communication and data-flow in Primary Health Care. A case-study approach has confronted some representative projects in different European countries.

A second working group, co-ordinated by N. Jones (UK), has focused on the hundreds of different GP-systems for Medical Records that are in use in daily practice The common European requirements for software-programmes has been described. A thorough analysis has identified the limiting and enabling factors for the implementation of telematics in general practice. Finally, an attempt has been made to develop a network of national GP-telematic-user-groups in Europe.

A third working group, co-ordinated by L.Boydell (Northern Ireland), has examined the following issues :

the acceptability of telematics to the consumer ;

the social, organisational and ethical impact of telematics in primary health care including aspects of equity, accessibility and inter professional relationships ;

the contribution that technological management of primary health care data can offer at different levels: epidemiology, medical decision making, health care policy development. This work will take into account aspects of validity and quality assurance of data.

List of Deliverables

Synthesis-report 02/93
2 interim reports 09/93
Discussion paper 09/93
Gent Conference (B) : Feb. 1994-Report
Estoril Conference (Pt): June 1994 - Report
Funen Conference (DK): September 1994 - Report
Final report by December 1994

List of Participants

Dr. João Luis Mocho Gonzalez Universidade de Vila Real Largo do Pioledo P-5000 Vila Real, Portugal Tel.: +351-59-32.22.08 Fax: +351-59-737.69	Dr. José Maria de La Higuera Junta de Andalucia-Consejeria de Salud Av. de la Constituciòn 18 E-41071 Sevilla, Spain Tel.: +34-95-421.16.02 Fax: +34-95-438.95.06
Mr. Henrik Bjerregaard Jensen Fyns Amt Orbaekvej 100 DK-5220 Odense, Denmark Tel.: +45-66-15.94.00 Fax: +45-65-935.72	Dr. Pierre Fedi Organisation des Médecins Généralistes Bld Latour Maubourg 60 F-75007 Paris, France Tel.: +33-1-47.05.59.72 Fax: +33-1-45.51.97.58
Dr. Andrea Francesconi BocconiUniversity Via Bocconi 8 I-20136 Milano, Italy Tel.: +39-2-58.36.62.09 Fax: +39-2-58.36.68.32	Prof. Salvatore Criscione Università dell'Aquila-Fac. di Medicina Colle Maggio I-67100 l'Aquila, Italy Tel.: +39-6-88.64.06.22 Fax: +39-6-42.27.44
Dr. José Luis Monteagudo Pena Instituto de Salud Carlos III Subdir. general de Investigacion Calle Sinesio Delgado 6 E-28029 Madrid, Spain Tel.: +34-1-323.03.57 Fax: +34-1-323.19.43	Dr. Claudio Cricelli Società Italiana di Medicina generale Vila Milton 3 I-50129 Firenze, Italy Tel.: +39-55-47.55.53 Fax: +39-55-28.40.38
Mr. Knut Bernstein Danish Institute Hospital Landemaerket 10 DK-1119 Copenhagen, Denmark Tel.: +45-33-11.57.77 Fax: +45-33-93.10.19	Dr. J. Strobbe Université de Gand Primary Health Care De Pintelaan 185 B-9000 Gent, Belgium Tel.: +32-91-40.49.67 Fax: +32-91-40.35.42 / 404.96
Dr. Neil Jones Marsden Road Health Center Marsden Road NE34 6 Tyne & Wear Sunderland, UK Tel.: +44-191-454.04.57 Fax: +44-191-427.17.93	Dr. Filoutitis Salaminios University of Athens Medicin Fac. Snoufa Street 32 GR-10673 Athens, Greece Tel.: +30-1-64.50.87.10 Fax: +30-1-360.48.94
Dr. Leslie Boydell Purdysburn Hospital Public Health Saintfield Road Belfast, U.K. Tel.: +44-232-40.22.02 Fax: +44-232-40.21.21



	Copyright 1997 © EHTO All rights reserved This server is the only official EHTO WWW knowledge repository. Mail suggestions to: webmaster@ehto.org