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PubMed1999

Barriers for dissemination of a national health care data network. A list of recommendations for better dissemination.

Establishment of a Danish Nation-wide Health Care Data Network for exchange of health care related information using standardised EDIFACT messages is agreed between the Danish Government, the Hospital Owners and the GPs organisations. The aim is, within year 2000 in the MedCom project, to reach a level of 66% of all messages between the secondary and primary health sector must be send electronically using EDIFACT. There are many barriers for reaching this goal, and to reveal this barriers an investigation was done, and a list of recommendations are set up. The investigation was based upon literature, interviews and most important a questionnaire among 200 GPs and specialists all over the country. After 6 months where the recommendations have been handled there is seen an increase in communicated messages on 40%, and from January 1999 more than 1.1 mill messages are exchanged each month.

Communication Barriers↗
PubMed1984

[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 2. Facilitating decision making in public health for optimal dissemination of an innovation].

Only a specific public health policy can resolve the technical, ethical, and financial problems posed by the diffusion of prenatal diagnosis by amniocentesis for the prevention of Down's syndrome. The purpose of this article is to facilitate decision making in this field by evaluating the costs and benefits associated with the different prevention strategies. Beginning with projections of the number of Down's syndrome births to be expected among women of 35 and older to the year 2000 (assuming that no prenatal diagnosis are made), various objectives combining the age of the target population and usage rates are presented and discussed. An evaluation of the overall costs of prenatal diagnosis and caring for Down's syndrome patients shows that a policy reaching a 50% usage rate for women 38 and older would save up to 66 millions French francs (using the 1981 franc value). On the other hand, it is shown that lowering the incidence of Down's syndrome in a target population of women over 35 to the level of the younger population would imply a usage rate of at least 80%. This goal is unrealistic unless amniocentesis were to become a compulsory examination. In such case, women would be deprived of an essential freedom, in view of the related ethical issues. The authors lastly discuss the different means of increasing usage rates without inhibiting women's freedom of choice.

Adult↗
PubMed1984

[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 1. Epidemiologic, medical and socioeconomic bases. The dissemination of a diagnostic innovation].

The article offers a detailed analysis of the characteristics of the supply and demand of prenatal diagnosis by amniocentesis in order to identify the major problems that must be faced in formulating a policy designed to diffuse the use of this technique. The data collected for the whole of France made it possible to evaluate exhaustively the increase in the number of prenatal diagnoses during the years 1972-1981; to determine the number and geographic distribution of the diagnostic centers; to identify the medical criteria justifying the examinations. A comprehensive survey covering all examinations performed in the Ile de France (Paris region) in 1979--which constituted 46.5% of all the prenatal diagnoses performed in France that year--made it possible to determine the predominant socioeconomic characteristics of the women who took this examination, revealing, particularly, the significant inequalities of access, with an underrepresentation of the least privileged socioprofessional categories. The confirmation of the influence of socioeconomic status on access to this medical innovation is further reinforced by the fact that usage rates vary widely according to place of residence; furthermore, it adds to the financial barriers implicit in any policy of having reimbursement of the examinations dependent upon Social Security conventions. A public health policy regulating the diffusion of this innovation must take into account the discriminatory aspects of the first phase of diffusion, as analyzed here.

Adult↗