Secondary Care Sectors Research Articles

Specialisation in oral surgery.

The 1994 report by the chief dental officer on specialist dental training in the UK focuses on the need for a more structured approach to post-graduate education and practice. As the report is designed to produce a broad choice of specialist dental services that will be based in the primary rather than the secondary care sector, specialist services will become more accessible to both the dental profession and patients.

Teleconsulting: A Practical Account of Pitfalls, Problems and Promise. Experience from the TEAM Project Group

In Wales the Tele Education and Medicine (TEAM) project has given clinicians, in both the primary- and secondary-care sectors, practical experience in teleconsulting. From this project we have been able to identify the potential pitfalls and problems in developing and using this new technology. These problems include: using teleconsulting simply because it is fashionable; the failure to base it on the needs of the patients and the primary-care physicians; the failure to validate accuracy, acceptability and cost; the failure to adapt to new technical improvements; and the failure to scale up from a pilot project to a wider teleconsulting service. In our experience technical support is essential and is best facilitated by multisite cooperation, rather than small free-standing projects.

Teleconsulting: a practical account of pitfalls, problems and promise. Experience from the TEAM project group.

In Wales the Tele Education and Medicine (TEAM) project has given clinicians, in both the primary- and secondary-care sectors, practical experience in teleconsulting. From this project we have been able to identify the potential pitfalls and problems in developing and using this new technology. These problems include: using teleconsulting simply because it is fashionable; the failure to base it on the needs of the patients and the primary-care physicians; the failure to validate accuracy, acceptability and cost; the failure to adapt to new technical improvements; and the failure to scale up from a pilot project to a wider teleconsulting service. In our experience technical support is essential and is best facilitated by multisite cooperation, rather than small free-standing projects.

Inter-organizational networks on the Dutch home health care market.

The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age-related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors. In order to promote coordinated care, Dutch health care providers are building inter-organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter-organizational networks contribute to the balance between quality and cost.

Medicine in Europe: The changing scene in general practice in Europe

Europe is currently in a state of flux, not just in political and economic terms, but also with regard to medicine. Changes in the provision of medical care have been common throughout both western and eastern Europe.1 The changes have two main determinants: the need to match limited resources to increasing health care demands, and - especially in central and eastern Europe - the search for new health care philosophies allied to new methods of financing and delivery. Within this process of change, primary medical care is of increasing importance. In many countries hospital based care has traditionally been overvalued and emphasised to the neglect of the appropriate funding and development of primary care. This has led to the inefficient use of both primary and secondary care sectors, often with a lack of proper cooperation and integration. Growing value is placed on the role of the well educated and trained generalist at the primary level. This is clear from developments in the United Kingdom, Holland, Denmark, Sweden, Finland, Spain, and Portugal. From the countries of central and eastern Europe, in which Soviet-style health systems have increasingly failed to meet patients' needs, come numerous requests for information, literature, and expertise on topics such as the principles of primary health care, the role of the family physician, education and training of general practitioners, and the development of the discipline of general practice in both academic and medicopolitical terms. General practice throughout Europe is diverse in its development, organisation, and funding. Some aspects of this diversity can be seen clearly from table I, which shows the numbers of doctors in European countries and the percentage of general practitioners. Table II indicates the considerable variety in consulting patterns by general practitioners throughout the European Union. In spite of this considerable diversity, which has …