Differences in the diagnose panorama in primary health care in Dalby, Sweden and Spili, Crete.

We have compared the use of primary health care and the diagnoses at visits to doctors in the Spili Health Centre (SHC) in Crete and the Dalby Health Centre (DHC) in Sweden. In DHC more patients per 1000 population visited the doctors than in SHC. This was so regardless of age-group and sex, in fact more or less regardless of diagnosis. Other differences between the populations were: The diagnosis acute otitis media was more frequent in the Dalby children than in the Spili ones. The opposite was true of "head injuries" which were more frequent in the Spili boys. Visits to doctors for bronchitis was more frequent in the Spili men, maybe because of the extensive smoking habits of Cretan men. Visits for diseases of the musculoskeletal system were more frequent in DHC than in SHC. A hypothesis worth testing is that this was influenced by differences in the health insurance and sick benefit systems. Angina pectoris was fairly frequent in both areas but cardiosclerosis (including healed myocardial infarction) was more common in DHC than in SHC. Use of primary health care may be influenced by the need for health care in the population, the accessibility of the health care facilities, the costs for the patients, the quality of care as perceived by the patients and by other sociocultural factors. Comparative studies, even though fairly uncommon today, may be of use in generating hypotheses about the impact of different factors on the use of health care.

Patient-number-based computerized medical records in Crete. A tool for planning and assessment of primary health care.

Primary Health Care (PHC) in Crete is in a state of rapid development. The strategy for introducing PHC involves an orientation towards the population and the creation of possibilities for evaluation. A case records system, "Egino", was installed in the University of Heraklion and at the Health Centre in Spili in 1988, and was further developed according to local needs during 1989, when also a Greek version of the statistical system, "DoIt", was installed. The main reasons for establishing a computerized medical information system were (i) to assess the health needs in Crete, (ii) to monitor activities of the primary health care organizations, and (iii) to introduce epidemiological research into primary health care in Greece. The information system was based on specially assigned patient numbers containing several pieces of information about the individual; the system was developed at the Dalby Health Sciences Centre in Sweden. Each month, data were extracted in Spili Health Centre, and these data were regularly used to present incidence and prevalence indices. Some of the data extracted were reported to the health authorities in Greece. "EginO" and "DoIt" gave possibilities to evaluate health services by following the morbidity, while also making it possible to describe and analyse health needs in the population of Spili and other primary health care catchment areas in Greece.

PIP: The Lund University Health Sciences Centre in Dalby, Sweden and the Department of Family and Social Medicine at the Crete University in Heraklion entered a collaborative agreement in December 1987 which involved the development of a computerized patient information system for primary health care (PHC) in Crete. In 1988, computer programmers installed the case record system "Egin0" on a personal computer at the University of Heraklion and at the health center in Spili, Crete. Based on local needs, this system was improved upon in 1989 which included installation of the Greek statistical System "DoIt". Purposes of the system included assessment of the health needs of the island, monitoring activities of PHC organizations, and introduction of epidemiologic research into PHC in Greece. The Crete and Swedish team successfully established a computer based information system in Spili in only 1 year and was able to analyze data on health care use and cardiovascular risk. The Greek version was more inclusive than the Swedish version because it included dental and preventive. The installed patient information system should allow comparison of date to evaluate new PHC settings in Greece in the future. Further, it should permit analyses of the effect of sociocultural factors on the use of PHC and attitudes and behavior of patients. Health center workers in Spili have continuously assessed the system. Immediate feedback has resulted in identifying needs for training and modifications of procedures. The "Egin0" and "DoIt" systems have also allowed researchers to analyze aggregate data. The success of these systems have resulted in their implementation in other health centers in Crete and other parts of Greece.

Use of primary health care in Spili, Crete, and in Dalby, Sweden.

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC). In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%) but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%). There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.

PIP: In 1989, researchers from Crete University in Crete and Lund University in Dalby, Sweden examined similarities and differences in the health care use pattern at the Spili Health Center (SHC) in Crete and at the Dalby Health Center (DHC) in Sweden. They also needed to establish a computerized medical record system in Greek primary health care. Essentially the same proportion of the population visited the 2 health centers (56% for SHC and 57% for DHC), but DHC patients made more frequent visits than did SHC patients (3.33 vs. 2.3). Yet there were more physicians per person in Spili than in Dalby (10.1 vs. 5.2/10,000 population). The mountainous terrain in an near Spili may have made it more difficult for people to go to the health center. Another possible explanation for the differences in number of visits for each patient in 1989 was that Swedes are perhaps more willing to go the health center for medical advice than the Cretes. 36% of visits to DHC were appointments compared with only 12.6% at SHC. In Crete, males were just as likely to visit the health center as females (55% vs. 57%), but females were more likely to visit the health center than males in Sweden (64% vs. 50%). People 65 years of age or older were more common in Spili than in Dalby (28% vs. 11%). Acute upper respiratory infections were the most common diagnoses in the 0-14 and 15-44 age groups. Head injuries were more common among 0-14 year old patients at SHC than their DHC counterparts (5% vs. 1.3%). Ear inflammation was the 2nd most common diagnosis at DHC but it was not 1 of the 10 most common diagnoses at SHC. This may have been due to better diagnostic abilities and modern equipment at DHC. Hypertension and diabetes mellitus predominated among 45 year old people.