Fleming D M, Schellevis F G, Paget W J
Birmingham Research Unit, The Royal College of General Practitioners, Birmingham, UK.
Eur J Public Health. 2003 Sep;13(3 Suppl):80-4. doi: 10.1093/eurpub/13.suppl_1.80.
The health monitoring programme of the European Commission has proposed a set of health indicators whereby the health status of member states can be measured. As part of that programme we considered how primary care might contribute relevant data.
Using a questionnaire distributed to personal contacts and health authorities, we investigated the activities of sentinel practice networks and sought opinions on the place of primary care as a provider of information on health indicators. Studies on the prevalence of diabetes mellitus and on the incidence of chickenpox were undertaken within selected networks.
33 networks were found who provided relevant information on a timely and continuing basis. Contributions varied; some were limited to monitoring influenza but others recorded morbidity data from every consultation. Recording methods ranged from the paper based to fully automated systems in which all morbidity was coded electronically at data entry. The study of diabetes mellitus showed less variation between national networks than currently suggested on the WHO database. For chickenpox we estimated the incidence of cases not presenting to general practitioners ranged between 3 and 27%.
Information on health indicators needs to come from the place where relevant care is delivered; for many conditions that is from primary care. It can be delivered from appropriately resourced practices where the population is defined, the practice populations are nationally representative and data collection is automated.
欧盟委员会的健康监测计划提出了一套健康指标，据此可衡量成员国的健康状况。作为该计划的一部分，我们思考了初级保健如何提供相关数据。
通过向个人联系人及卫生当局发放问卷，我们调查了哨点诊所网络的活动，并就初级保健作为健康指标信息提供者的地位征求意见。在选定的网络内开展了糖尿病患病率及水痘发病率研究。
发现33个网络能及时持续提供相关信息。贡献各不相同；一些仅限于监测流感，而其他的则记录每次会诊的发病数据。记录方法从纸质记录到全自动化系统不等，在全自动化系统中，所有发病情况在数据录入时都进行电子编码。糖尿病研究显示，各国网络之间的差异比世界卫生组织数据库目前显示的要小。对于水痘，我们估计未就诊于全科医生的病例发病率在3%至27%之间。
健康指标信息需来自提供相关护理的场所；对于许多病症而言，该场所就是初级保健机构。可从资源充足、确定了人群、诊所人群具有全国代表性且数据收集自动化的诊所获取信息。
