Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison.

OBJECTIVES: To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. METHODS: We used hospital administrative data from >10 million children aged 6-15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex. RESULTS: Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts. CONCLUSIONS: The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

Ethical evaluation of compulsory measles immunisation as a benchmark for good health management in the European Union.

The results of the study Benchmarking Regional Health Management II suggest that compulsory measles immunisation is a good practice in public health management. Yet, the potential achievement of the desired health outcome alone is not a sufficient reason to make the immunisation obligatory. Rather, compulsory measles immunisation is a morally challenging measure. In this article, compulsory measles immunisation is critically evaluated from a public health ethics point of view. For this evaluation, a set of ethical criteria is proposed: respect for autonomy, health maximisation, efficiency, proportionality and social justice. The authors suggest it should not be taken for granted that compulsory measles immunisation should be championed, rather, health policy makers in the European Union should try to raise immunisation rates with non-compulsory means.

Reference frameworks for the health management of measles, breast cancer and diabetes (type II).

This paper presents reference frameworks which order effective and feasible policies and interventions for the health management of measles, breast cancer and diabetes (type II). These reference frameworks can be used to rapidly appraise regional health policy documents and existing health management systems. Furthermore, the reference frameworks can serve health policy makers for the planning of health management measures.

Self-medication with antimicrobial drugs in Europe.

We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug self-medication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000-3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe. The most common reasons for self-medication were throat symptoms (e.g., dry, inflamed, red, or sore throat, inflamed tonsils, tonsil pain). The main medication sources were pharmacies and medication leftover from previous prescriptions. Younger age, higher education, and presence of a chronic disease were associated with higher rates of self-medication. Attempts to reduce inappropriate self-medication should target prescribers, pharmacists, and the general public.