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Background: The WHO have set health standards in the form of 21 targets Health 21 - and the EU are developing a set of health indicators whereby national health status can be measured. Data from Slovenia and from England and Wales assessing information systems in primary care and their capacity to deliver the requirements of these initiatives have been examined. In both countries, primary care is provided through a state-led service. Methods: Consultation data from the annual report of the Department of Health Slovenia (1999) are compared in respect of relevant targets with data from the Fourth National Morbidity Survey (1992) in England and Wales. Consultation rates were standardized to the European Union 15 country population (1998). Results: Consultation rates in females were similar in the two countries whereas in males rates were higher in Slovenia. The proportionate distributions of consultations by chapter of the International Classification of Diseases (ICD) were similar in both countries, respiratory (17%) and musculoskeletal (9%) disorders ranked first and second. For eye diseases, injury and poisoning, factors influencing health status (e.g. medical examination), proportions were higher in Slovenia: for mental disorders higher in England and Wales. The relativity of male to female consultation rates was broadly similar with higher rates in females in most ICD chapters. These differences are considered in detail against the background of WHO targets. Conclusions: Data gathered systematically from the surveillance of consultations in primary care are important to the measurement of WHO 'Health 21' targets. [ABSTRACT FROM AUTHOR]

Background: In recent years there has been an increasing emphasis on the delivery of preventive care in general practice. At the same time, available evidence suggests people from lower social classes receive less preventive care compared with people from higher social class. The objective of this study was to assess the uptake of screening by blood pressure measurement, cervical cytology and manual breast examination in risk populations by patients attending their general practitioners and relate the findings to levels of educational attainment and type of health insurance. Methods: The study was based on data gathered in the Dutch National Survey of General Practice in which 161 GPs recorded sociodemographic data, reasons for encounter, diagnoses and interventions during a 3 month period. Persons receiving the above procedures as screening measures were counted and expressed as rates per 1,000 persons registered and per 1,000 persons consulting. These rates were examined at three levels of educational attainment and according to the health insurance of the patient using logistic regression methods. Results: When analysed by educational attainment, high levels of blood pressure measurement were found in persons of lower educational attainment in both males and females (30-59 years) while for cervical cytology (35-54 years) higher levels were found amongst the better educated and for breast examination (40-69 years) the rates were similar regardless of educational attainment. When analysed by insurance status parallel trends were observed, with higher rates for blood pressure measurement among the publicly insured and higher rates for cervical cytology among the privately insured. Conclusions: The results, whether based on persons registered or persons consulting, suggest no important social bias in the extent to which persons are screened by blood pressure measurement or breast examination. There were strong social gradients for cervical cytology favouring the better educated and privately insured. More effective targeting of women with low educational attainment and publicly insured is called for. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes has been proposed as a European Community Health Indicator. The prevalence of diabetes known to general practitioners (GPs) in different European countries has been investigated and the usefulness of sentinel practice networks in delivering prevalence data on diabetes has been evaluated., Methods: Patients presenting with diabetes in a 12 month period (1999/2000) to GPs in established European sentinel practice surveillance networks in eight European countries were registered. Estimates of prevalence were standardized to the 1998 European population., Results: All-age prevalence reported in the network populations was lowest in Slovenia (male 16, female 16 per 1000) and highest in Belgium (male 31, female 34). The range of estimates obtained in this study was narrower than that published by the WHO in the Health For All database. The range was further reduced by age standardization. In males aged 45 years and over, age standardized prevalence ranged from 39 (Slovenia) to 76 (Belgium) and in females from 37 (Slovenia) to 75 (Belgium). There were no consistent gender differences in national prevalence rates., Conclusions: The study demonstrates the capacity of sentinel practice networks to deliver data on the prevalence of known diabetes in persons over 45 years. National differences in prevalence are less than hitherto reported. Prevalence in Belgium measured in all ages and in 45 years and over males and females was higher than in the seven other countries.

Background: 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., Methods: 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., Results: 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%., Conclusions: 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.