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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ 5.2.15 Discussion 47 The following discussion draws on the introductory systematic remarks made in the analo- gous discussion of the measles organigraphs (5.1.16). Organigraphs and Programme Descriptions for Breast Cancer Organigraphs for breast cancer were received from 17 of the 19 regions. Programme descriptions were received from 15 regions. No organigraphs or programme descriptions for diabetes were received from Saxony-Anhalt (DE) or Madeira (PT). Gyor-Moson-Sopron County (HU) and Veneto (IT) submitted organigraphs only. Whilst the organigraphs can give an overview of the health management system, the programme descriptions can give a number of more detailed insights into the system. The programme descriptions received with the organigraphs refer principally to breast screening programmes and to a lesser extent to treatment and care. Two types of screening programme are included – professional breast examination allied to self-examination, and mammography screening. The first type of screening programme, professional breast examination, is shown or described by 5 regions, Upper Austria (AT), Varna Oblast (BG), Moravia-Silesia (CZ), North Rhine-Westphalia (DE), and Chuvash Republic (RU). Western Greece (EL) has no programme as such but a number of individual initiatives. All of the programmes are national screening programmes implemented nationwide, but with the addition of self-examination campaigns by two regions, North Rhine-Westphalia (DE) and Chuvash Republic (RU). Because they are national programmes they are part of a chain from national through regional to local level. Such programmes and self-examination campaigns are in line with the good practice interventions included in the reference framework for breast cancer. The second type of screening programme, mammography screening, is shown or referred to by 11 of 17 regions, Flemish Community (BE), Moravia-Silesia (CZ), North Rhine- Westphalia (DE), Gyor-Moson-Sopron County (HU), Szabolcs-Szatmar (HU), Dublin/Mid- Leinster and Dublin/North-East (IE), Emilia-Romagna (IT), Sicily (IT), Veneto (IT), Vastra- Gotaland (SE), England (UK). 47 Kieran Hickey, Health Service Executive, Dublin. - 178 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ Part of Western Greece (EL) is covered by a mammography screening programme. Varna Oblast (BG) has periodic mammography campaigns and Upper Austria (AT) will par- ticipate in a planned national mammography screening programme. The 11 mammography screening programmes are organised differently in a number of respects, 6 (CZ, DE, HU (2), IE, UK) are organised at national level and 5 (BE, IT (3), SE) at regional level, taking account of the goals of national prevention plans and national guide- lines. The chain of control can therefore run from national to local level or from regional to local level. But there are other differences, shown in the business model for the implementation of the programmes. In BE, CZ and HU (2) a number of recognized or accredited screening cen- tres are contracted to provide the mammography screening service. In IT (3) and SE the mammography screening is provided directly by the regional/local health service. In ER (IT) there is a dedicated regional office for screening that co-ordinates the mammography screening programme. In SE there is a separate regional organisation shown screening foe breast cancer and co-ordination of mangement. In IE the mammography screening service is organised and managed by a dedicated, nationally funded, stand-alone statutory board that employs its own staff and resources and contracts with host hospitals for follow-up services. In the UK mammography screening is provided under the NHS breast screening programme. Mammography screening units are part of local cancer networks or webs and accountable to a Quality Assurance Reference Centre (QARC) at regional level that has a director and support team including co-ordinators from each of the professions. Most of the regions with mammography screening programmes indicate or refer to invitation systems and quality assurance arrangements in operation. The programmes operate under national or regional guidelines drawn up with the advice of one or more expert bodies. Some operate under EUREF guidelines or undergo EUREF evaluation, BE, DE and IE. So, apart from noting that the initiation and promotion of manual breast selfexamination, professional non-mammography breast examinations and quality assured mammography screening programmes are integral parts of the reference framework for breast cancer, what other conclusions can be drawn from the above? If one refers to the health performance indicators data available for breast cancer (cf. annex 5) the data for percentage participation rate for eligible women in mammography screening and the breast cancer detection rate, particularly the former, appears to suggest that contracted screening services do not perform as well as directly provided services. The best participation rates for 2005 or nearest year were achieved in directly provided services where there is also a dedicated management or - 179 -

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