Sen­ti­nel Prac­ti­ce Networks


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” [1]. 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 [2]. 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 [3]. 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.


  1. Schwartz FW, Schlaud M (eds). Beob­ach­tungs­pra­xen – Daten­qua­li­tät, Nen­ner­kon­zep­te, räum­li­che und zeit­li­che Häu­fig­keits­mus­ter. Gesund­heits­we­sen 1993; 55 (Sup­pl 1): 1–52.
  2. StLe­ger S, Schlaud M, Schwartz FW (eds). Sen­ti­nel prac­ti­ce net­works for mor­bi­di­ty sur­veil­lan­ce. J Epi­de­mi­ol Com­mu­ni­ty Health 1995; 49 (Sup­pl 1): 1–36.
  3. StLe­ger S, Schlaud M, Schwartz FW (eds). Sen­ti­nel prac­ti­ce net­works – oppor­tu­ni­ties and limi­ta­ti­ons. J Epi­de­mi­ol Com­mu­ni­ty Health 1998; 52 (Sup­pl 1): 1–60.
  4. 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.
  5. Schlaud M. Netz­wer­ke von Beob­ach­tungs­pra­xen als epi­de­mio­lo­gi­sche Metho­de. Habi­li­ta­ti­ons­schrift. Medi­zi­ni­sche Hoch­schu­le Han­no­ver, 2001.

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