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Presentations contributed by Franz Pirbauer at the EUPHA conference 2005 in Graz


Periodic health examination by Austrian general practitioners

Walter Devillé

Devillé W 1, Piribauer F 2, Groenewegen PP 1
1. NIVEL – Netherlands Institute for Health Services Research, Utrecht, Netherlands; 2. PiCo, Vienna, Austria
Contact details: w.deville@nivel.nl
Issue:
In European countries professional opinions differ about the usefulness of Periodic Health Examination (PHE). Austria and Germany are the only one with a standardised PHE in the basic social insurance package. New insights in the role of GPs in monitoring population health and the role of PHE in enhancing population health have been developed since the introduction in 1970.

Description:
The umbrella organisation of Austrian Social Insurance Carriers commissioned a project to modernise the system of PHE and to bring it in line with the principles of evidence-based medicine. The project focussed on adapting the original forms of the PHE for a number of priority domains. The aim was to define a small number of self-administered questions that could be used to define risk profiles of patient groups. Risk profiles should be connected to health education tools, which can be applied, in general practice. Feasibility in a general practice context is therefore important, apart from being in line with international evidence and experience.

Lessons:
Annually, approximately 800,000 people (out of six million eligible) use PHE, accumulating to large numbers over time. The PHE is an income component of GPs (€70 per PHE) and therefore of interest to them. The turnout shows a demand for PHE of the insured population. There is lack of evidence both on the utility of PHE in general and on the design of the specific documentation. Computerisation is necessary to produce individual risk profiles from patient information forms and to produce public health information on the basis of PHE.

Conclusions:
Currently, the observed public health value is low because of self-selection of examined patients and because the information from PHE is not aggregated nor linked to research in the primary health care – public health interface. Although PHE could be a link between health promotion and health care, this opportunity is presently not fully exploited.


Implementing traumatic brain injury (TBI) guidelines in trauma centers of Bosnia, Croatia and Macedonia

Martin Rusnak

Rusnak M 1, Mauritz W 1, Janciak I 1, Dizdarevic K 2, Girotto D 3, Soljakova M 4, Splavski B 5, Vukic M 6, Wilbacher I 1, Brazinova A 1, Rosso A 1, Piribauer F 7
1. Internationale Gesellschaft zur Erforschung von Hirntraumata, Vienna, Austria; 2. Department of Neurosurgery, Clinical Center, University of Sarajevo, Sarajevo, Bosnia-Herzegovina; 3. Department of Neurosurgery, University Hospital Rijeka, Rijeka, Croatia; 4. Clinic of Anesthesiology and Intensive Care, KARIL, Skopje, Macedonia – FYROM; 5. Department of Neurosurgery, University Hospital Osijek, Osijek, Croatia; 6. Department of Neurosurgery, University Clinical Center Zagreb, Medical School, Zagreb, Croatia; 7. PiCo, Vienna, Austria
Contact details: rusnakm@igeh.org

Background:
The EU 5th Framework Program funded project researches factors determining health outcomes of TBI victims in three Balkan countries prior and after implementation of Scientific Evidence Based guidelines for the management of TBI patients. Those three countries face “silent” epidemics of TBI due to the infrastructure, tourism, and some behavioral factors. The overall goal is to base a policy advice on broad dissemination of evidence based clinical practice to local authorities on results from this research.

Methods:
Each participating center implemented the TBI guidelines under supervision of the project contact person. Retrospective data collection using ITCP database covered years 2002 and 2003. Prospective collection of new cases admitted elapsed over two years: 2004 and 2005. Every center autonomously decided the method used to obtain data on the long term outcome of registered cases. Variation of care was measured using indicators of TBI guidelines compliance developed for the purpose.

Results:
Over two and a half year of the project over 600 patients' records were collected. An interim analysis revealed, that most of the centers sees similar composition of TBI patients as reported in world literature. Analysis of clinical procedures revealed that certain level of variability in treatment modalities remain despite the project efforts. Relation of individual procedures to outcomes is still being studied.

Conclusions:
The project will end this year, that is why the emphasis is put to develop policy advice and to prepare conditions for sustaining the activity and disseminating to other trauma centers in individual countries. The project also provides an evidence, that it is feasible to implement the most up to date guidelines into clinical environments with seriously limited resources for the benefit of a patient. Implementation of guidelines in spite of limits will significantly influence the quality of care provided and improve outcomes.


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