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Factors with regard to computerisation of the Dutch and the Belgian national general practitioner sentinel networks: a comparative analysis.

Schweikardt, C., Casteren, V. van, Verheij, R.A., Coppieters, Y. Factors with regard to computerisation of the Dutch and the Belgian national general practitioner sentinel networks: a comparative analysis. European Journal of Public Health: 2013, 23(Suppl. 1) 223-224. Abstract. 6th European Public Health Conference: Health in Europe: are we there yet? Learning from the past, building the future. 13-16 November 2013, Brussel.
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Background: A general practitioner (GP) sentinel network observes a sample of the population by supplying reports on the incidence and epidemiological characteristics of specific diseases and on
procedures in primary health care. In the 1970s, the Dutch and the Belgian national GP sentinel networks were founded. Since the 1990s, Dutch sentinel surveillance was extended to the work of GPs (contacts, referrals, activities, prescriptions) by developing a second network and collecting data from Electronic Health Records (EHR). Then the first network was integrated into the second. The Belgian GP network kept data collection on diseases and health care topics by paper questionnaires. The objective of the study is to trace the factors which played a role for the computerisation of the Dutch sentinel system, whereas the Belgian national network remained paper-based. Methods: A comparative qualitative approach was chosen. The annual reports of the networks, project reports and methodology chapters of publications based on sentinel data are assessed with regard to factors on different levels (health system, GPs, network structure), to be complemented by expert interviews. Results: Several factors at health system, GP practice, and network level in favour of computerisation and network extension in The Netherlands were lacking in Belgium: For the impetus to do primary health services research in The Netherlands in the early 1990s and the presence of the research institute NIVEL to carry it through there was no equivalent in Belgium on national level. The stronger and more prominent position of Dutch physicians as gatekeepers to secondary care leading to continuing commitment by the Dutch Federal government; a sufficient number of Dutch GPs agreed to have their EHR data extracted; EHR systems in The Netherlands showed less diversity than in Belgium (Dutch/French language, uneven distribution of computerized systems in the Belgian Regions; only on regional level, the computerized GP network Intego was founded in Flanders). Conclusions: The considerable progress of Dutch network computerisation and extended registration of GP practice data took place in a much more supportive context; these achievements are only in part transferable to Belgium in the short run. Key messages: In the 1990s, health services research provided a key stimulus for the extension of Dutch GP network activities without an equivalent in Belgium on national level. Comparing the past development of the Dutch and Belgian GP sentinel networks more distinctly shows favourable factors for Dutch network extension and computerisation hardly present in Belgium.