RESUMEN
In recent years international policies have aimed to stimulate the use of information and communication technologies (ICT) in the field of health care. Belgium has also been affected by these developments and, for example, health electronic regional networks ("HNs") are established. Thanks to a qualitative case study we have explored the implementation of such innovations (HN) to better understand how health professionals collaborate through the HN and how the HN affect their relationships. Within the HNs studied a common good unites the actors: the continuity of care for a better quality of care. However behind this objective of continuity of care other individual motivations emerge. Some controversies need also to be resolved in order to achieve cooperative relationships. HNs have notably to take national developments into account. These developments raise the question of the control of medical knowledge and medical practice. Professional issues, and not only practical changes, are involved in these innovations.
Asunto(s)
Redes de Comunicación de Computadores/organización & administración , Sistemas de Información/organización & administración , Relaciones Interprofesionales , Médicos de Familia , Personal de Salud , Calidad de la Atención de SaludRESUMEN
Several OECD countries have capped the number of physicians to be licensed to practice. However, a relevant cap must take into account changes in physician activities. We set out to study the transitions leading physicians to leave health care or to stop any activity in health system. These transitions were assessed using a register of medical practice. We studied changes in activity between 1994 and 2002 for about 19,840 physicians who in 1994 were already working for 5 years and were in 2002 less than 65 years old. After 8 years of career, one physician out of 20 were inactive in health system. Some medical specialties such as surgery and radiotherapy had a greater risk of leaving health care while GP's had a lower risk. Gender differences in leaving health system were mostly non-existant in younger age groups but then increased with age. Among physicians aged 55 and over, women were more likely to leave health system. We conclude that the percentage of physicians leaving health care after 5 years of practice is significant and deserve being taken into account for manpower planning and that planning should be aware of that some groups of physicians are more at risk than others to leave health care. Qualitative studies would help understand better this drop out.
Asunto(s)
Movilidad Laboral , Médicos/estadística & datos numéricos , Bélgica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Medicina/estadística & datos numéricos , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Factores Sexuales , EspecializaciónRESUMEN
Utilization of health care is a major concern in the debates about public expenditures and the regulation of human health resources. Concerns regarding inappropriate services are regularly mentioned in Belgium. Our study aims at assessing the utilization of health care, with a particular focus on the impact of morbidity, and a possible sub-consumption behaviour. The probability of having had a medical encounter with a general practitioner or with a specialist during the latest year and the probability of a frequency of encounters higher than national average is assessed thanks to logistic regressions. The functional limitations and the chronic conditions (mainly the poly-pathology) are major factors related to patient encounters with medical doctors. In the future, the number of individuals suffering from functional limitations and/or chronic illness will increase due to the ageing of the population. The pressure on health expenditures will increase also if: the frequency of encounters is adequate, as recommended by the "guidelines" for some illnesses and, the frequency of encounters increases due to the evolution of other factors that have been put forward by our logistic regressions. However, any sub-consumptions cannot be simply labeled as additional real needs, because these are also linked to some characteristics of the patients. Consequently, problems of subconsumption cannot be easily solved just by increasing medical supply.
Asunto(s)
Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Médicos de Familia/estadística & datos numéricos , Adulto , Anciano , Bélgica , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Medicina , Persona de Mediana Edad , EspecializaciónRESUMEN
As widely discussed in the literature, there are many potential scientific usages of data extracted from the primary care Electronic Health Records (EHR), such as quality of care, epidemiological or socio-economical studies. Yet, can we use the current available data in the EHR for such purposes? In this paper, our objective is to report on the preliminary findings of the Belgian ResoPrim project (2003-2005) to answer the question. We set up a semi-anonymous network involving 26 current practices (28 volunteer GPs), 3 different EHR software systems and two Trusted Third Parties. Based on a literature overview we identified 27 research questions to be answered using 50 indicators. The study design includes retrospective (2002-2004) and prospective (6 weeks) data collection processes around the theme of "Hypertension and cardiovascular risk factors". For some data sets, the data extraction was a full automatic procedure, for some others, the data extraction was related to an input from the GPs allowing some comparisons between both procedures. At this stage, we performed an extended descriptive analysis of our data. Retrospectively we collected data related to 42,217 patients and 203,128 contacts. Prospectively we collected data for 9,236 patients and 15,234 contacts. Our main findings are briefly presented and discussed in this paper. The most promising fields seem to be the Health Research Information Systems assessment and the quality of care studies. It is quite too soon to reach the expected theoretical benefits for epidemiologic and socio-economic studies, yet some progresses could be made in relation with the denominator issue. Based on our preliminary findings and hypotheses, further analyses are foreseen during the second phase of the project (2006-2007).