In many European countries, there is a considerable lack of useable health-related data from the ambulatory care sector. Thus, primary health care research – i. e. contact-based epidemiology of ambulatory care – has been of increasing importance for the last decade. Through ongoing health care research, the frequency and distribution of health problems which either have not yet or never will have contact with the hospital sector can be monitored.
Sentinel practice networks, also referred to as practice research networks, have become an important epidemiological instrument for morbidity surveillance in many countries of the western world. In such networks, office-based physicians coöperate on a (mostly) non-monetary basis in monitoring defined events among their patients (e. g. influenza, mumps, asthma attacks) in a standardized way. Sentinel systems can also be used as an approach to the served population for various types of epidemiological studies. The unique contribution of such networks is the ability to obtain data on pre-clinical health-related events continuously and directly from the ambulatory health care system. After adequate analysis, these data may indicate spatial and temporal trends in the frequency and distribution of defined health events and give information on patient management, or etiologic hypotheses can be generated or tested. Nevertheless, many methodological problems inherent to this approach have to be solved in order to obtain valid information by sentinel systems [4, 5]. Some of these obstacles are intrinsic to the health care system itself, others are specific to contact-based epidemiology by means of sentinel practice networks.
The Hannover Sentinel Workshops
Three international workshops on sentinel research have been organized at Hannover Medical School, Germany, so far. The purpose of these meetings was to bring together scientists from European countries who apply sentinel systems in epidemiological research, to discuss methods, problems, and solutions as well as results of sentinel research, and to present the opportunity for information exchange at a personal level. More than 40 participants from Austria, France, Germany, Great Britain, the Netherlands, Northern Ireland, Portugal, Spain, and Switzerland attended the workshops, and between 15 and 20 oral presentations on methodological issues and results were made during each 2‑day meeting.
Proceedings of the 1st Hannover Sentinel Workshop, which was held in April 1992, have been published in a supplement to the journal „Das Gesundheitswesen” . A compilation of articles based on presentations of the 2nd Hannover Sentinel Workshop, held from 4–5 March 1994, can be found in a supplement to the Journal of Epidemiology and Community Health . This supplement compiles a peer-reviewed selection of all workshop contributions in a revised edition, in order to meet the requirements of scientific articles. Another supplement to that journal with papers from the 3rd Hannover Sentinel Workshop (1−2 March 1996) has also been published . Publication of the latter two supplements was sponsored by the German Federal Ministry of Science and Technology, and the editors wish to express their grateful acknowledgement for the Ministry’s support.
Written proceedings, however, cannot hope to convey the actual spirit of scientific and personal exchange at an international meeting. For those who were unable to attend, the references cited below not only present a good overview on the workshop presentations, but also a cross-section of concepts, activities and developments in the field of practice-based epidemiology, its opportunities and limitations.
- Schwartz FW, Schlaud M (eds). Beobachtungspraxen – Datenqualität, Nennerkonzepte, räumliche und zeitliche Häufigkeitsmuster. Gesundheitswesen 1993; 55 (Suppl 1): 1–52.
- StLeger S, Schlaud M, Schwartz FW (eds). Sentinel practice networks for morbidity surveillance. J Epidemiol Community Health 1995; 49 (Suppl 1): 1–36.
- StLeger S, Schlaud M, Schwartz FW (eds). Sentinel practice networks – opportunities and limitations. J Epidemiol Community Health 1998; 52 (Suppl 1): 1–60.
- Schlaud M, editor. Comparison and harmonisation of denominator data for primary health care research in countries of the European Community – The European Denominator Project. Amsterdam: IOS Press (BHR Series), 1999.
- Schlaud M. Netzwerke von Beobachtungspraxen als epidemiologische Methode. Habilitationsschrift. Medizinische Hochschule Hannover, 2001.