Læknablaðið - 15.09.1982, Page 31

LÆKNABLADID
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bacteriology, immunology, virology and histo-
pathology.
3.2 Radiation medicine, comprising radiodiag-
nostic, radiotherapeutic and nuclear medicine
services.
3.3 Services involving manually operated, me-
chanized and fully automated bioinstrumenta-
tion which are being used in specialized
hospital units, such as intensive care and
physiotherapy, general hospital wards, outpa-
tient clinics, health centres and even the home.
In Europe there are 65,000 clinical laborato-
ries, 21,000 radiodiagnostic, radiotherapeutic
and nuclear medicine departments and over
150,000 units using mechanized or electronic
equipment. This involves approximately
1,000,000 physicians, scientists and technicians.
It is to be noted that these figures do not
include the health industry.
4. Life cycle of a technology
The constant development of medical techno-
logies is based on two other parallel develop-
ments: the general scientific advancement
which includes Physics, Chemistry, Biology,
Basic and Clinical Medical Sciences, and the
general technological evolution in Physical
Engineering, Electronics, Optics and Imaging,
Instrumentation and Computation as well as
the introduction of new materials. Both devel-
opments have led to elaborations and unfold-
ings in medical practice which in turn provide
the necessary feedback for a further evolution
in both the scientific, and technological fields.
The reason for the great increase in requests
for more support services are given below:
Reasons for requesting more tests and support
services
— Technological advances: reliability — varíety —
data records.
— Emphasis on more prevention and earíy diagno-
sis: better prognosis
— Physician education: inappropriate use. Advan-
tages VS limitations. Insufficient information.
— Possible malpractice litigation: Test = safe-
guard.
— Broad third party coverage: health and social
security schemes
— Financial incentives for physicians and hospitals:
justification
— Professional prestige
— Marketing pressures
The life cycle of any medical technology
begins with basic and applied research in
which a great variety of disciplines collabora-
te. This is followed by a stage of practical
development, pilot studies and clinical trials.
Once the technology has proven its safety,
efficacy and its clinical relevance and innovati-
ve character, it may be adopted and ready for
diffusion. It is only here that it will become
apparent whether this diffusion will lead to a
widespread use, a more limited use or its
passage into stagnation or even obsolescence.
The responsibilities at the consecutive sta-
ges in the development of a medical technolo-
gy must also be defined. While the basic and
applied research activities are in the hands of
academic institutions, national research bodies
and industry, the research aspects from the
adoption and diffusion stages onwards are the
responsibility of the health services. Similarly,
assessment, whether technical, clinical or eco-
nomic should be carried out by specialized
institutions and university hospitals while utili-
zation studies should be done at all levels of
health care. Regulation, certification and li-
censing when provided for, should start al-
ready in the developmental stages and conti-
nue all through the adoption and diffusion
stages. Finally a programme for the develop-
ment of the cost consciousness concept should
be developed.
How to develop the cost-consciousness concept
— Bills sent to -*■ Physicians
—+ Patients
— In-house discussions hospitals and institutes
— Involvement of professional societies
— Diffusion of scientific reports and publications
— Organizations of seminars for decision-makers
— Include technology costs in under and post
graduate education for all health care personnel
—■ Utilization of mass media
— Education of community through
• Motivation
• A ttitudes
• Behaviour
5. The »Shift«
During the last five years a remarkable
change in most of the European health care
systems has been taking place. We propose to
name this change: »shift«. While in the past
more emphasis has been given to the thera-