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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ includes, as an evidence-based intervention, education of physicians and the political commu- nity regarding the risks and benefits of mammography screening. The analysis of responses shows that invitation strategies for mammography screening have been developed in 13 of the 17 regions that responded. Of the remaining 4 regions, 2 have no invitation strategy and 2 have no screening programme. The mammography screen- ing participation rate in 1 of the 2 regions without an invitation strategy is low and no infor- mation on participation rate was received from the other region. Identification and invitation of eligible women for mammography screening (every two/three years) is included in the ref- erence framework for breast cancer. Invitation registers for mammography screening have been established in 12 of the 17 regions whose responses were analysed. Such a register exists in parts of 1 region and not at all in 4 regions, but 2 of the latter do not have a mammography screening programme. The same remarks as in the previous paragraph regarding participation rate, again apply to the 2 regions that do not have an invitation register. In addition to the identification and invitation of eligible women, the reference framework for breast cancer also includes as good practice norm, the existence of an invitation system for mammography screening. The analysis of responses shows that the age at which women are invited to mammography screening varies considerably. The target age group for 7 out of 16 regions is 50-69 years of age and this coincides with the evidence-based intervention included in the reference framework for breast cancer. The target age group for the other 9 regions varies with 5 of them starting at between 35 and 50 years of age, rising to 69 or 70 years. The remaining 4 regions start at between 40 and 50 years of age rising to 64 or 65 years of age. This means that 12 of the 16 regions meet the good practice norm for the age at which women are invited to mammography screening. As regards the interval between mammography screenings, the analysis shows that for 12 of the 15 regions with screening programmes, the interval is two years. The reference framework indicates a good practice norm of two/three years. In another 2 regions the interval is either one or two years depending on risk or age. The interval is 3 years in 1 region. All 15 regions therefore meet the good practice norm. The responses show that responsibility for the planning of mammography screening programmes varies very widely with regions citing National Government, Ministries at National or Regional levels, National Public Health Centre or Department, National Associations of Statutory Health Insurance or Statutory Sickness Funds, and one dedicated National Breast Screening Board. This lack of harmonisation is not entirely surprising given the differences in - 274 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ health systems of the regions and other factors. The organigraphs were drawn up to provide an overview of the organisation of the regional health management systems and the relation- ships of the different decision-making bodies to each other as well as the flow of actions within the health management process. These may provide further insights into the govern- ance process in regions. The responses regarding financing of the mammography screening programmes also produced a wide variety of approaches by the regions. This is as one would expect, given the different health systems, socio-political or socio-economic circumstances. These differences are not all that significant from a Ben RHM II perspective as financing arrangements are not included in the reference framework. One region has a dedicated ring-fenced budget for mammography screening. What would be interesting in the context of financing is whether the budget for mammography screening has to compete with other services as part of a general budget for mainstream ser- vices or whether it is a dedicated ring-fenced budget for all services related to a mammogra- phy screening programme. We had not asked for information on this or on the views of re- gions regarding the benefits or otherwise of ring-fenced budgets. The analysis of responses shows that recall systems for mammography screening have been installed in 11 of the 17 regions that responded. There is no such system in 4 regions and 2 regions do not have screening programmes. This compares to recall systems for clinical examination installed in 3 regions. It is clear that recall systems are associated with invitation systems and, as such, are equivalent to a good practice norm as in the reference framework. The responses show that guidelines aimed at raising quality levels are used for clinical examination and for mammography screening. They are used by 8 regions for clinical exami- nation and by all regions that have mammography screening programmes. A number of Euro- pean best practice guidelines have been published and the reference framework makes spe- cific reference to the use of EUREF guidelines for breast cancer screening. The responses also show that differences exist between the degree to which guidelines are used by some regions; also the EUREF guidelines are supplemented by national or locally developed guidelines in a number of regions. The wide range of such differences makes it difficult to judge the degree to which good practice is being implemented through the use of guidelines. Regarding surveillance of breast cancer, the responses show that there are some differ- ences of approach amongst regions concerning breast cancer being a notifiable disease. In 14 - 275 -

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