Health systems: research
The organisation of a country's health system impacts how research can be conducted and what data is available
Our approach:
Feasibility assessments will provide an understanding of each health system; this is vital before undertaking research and they can compliment our experience
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We can provide direct knowledge of the UK and Spanish health care systems
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We can provide expert clinical insights in these countries especially in the area of dermatology
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The importance of appreciating health systems is outlined below:
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For instance, the role of primary care as first point of contact ("gatekeeper") to health care varies
This leads to differences data recording as reported to the International Conference on Pharmacoepidemiology
In the example below we show that population-level estimates of cholesterol will be biased due to the recording habits

Source: Primary care in the Driving Seat. Saltman, Rico, Boerma eds. European Observatory on Health Systems and Policies
In primary care:
We observed differing patterns of cholesterol recording over one year among patients using lipid lowering therapy:
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Most UK patients had a test and the value was available; in France a majority of GPs did not record cholesterol test results... WHY?

Technology and degree of computerisation:
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Tests may be done but values are not routinely computerised, indeed these may only be recorded if they are of concern (hence bias will result)
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National guidelines:
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routine cholesterol testing and recording may have funding implications for the GP or clinic whilst elsewhere routine testing may not be a requirement
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The tests may be carried out in a different setting and thus results are missing from the primary care record