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Vincze F, Földvári A, Pálinkás A, Sipos V, Janka EA, Ádány R, Sándor J. Prevalence of Chronic Diseases and Activity-Limiting Disability among Roma and Non-Roma People: A Cross-Sectional, Census-Based Investigation. Int J Environ Res Public Health 2019; 16:ijerph16193620. [PMID: 31561641 PMCID: PMC6801756 DOI: 10.3390/ijerph16193620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022]
Abstract
The lack of recommended design for Roma health-monitoring hinders the interventions to improve the health status of this ethnic minority. We aim to describe the riskiness of Roma ethnicity using census-derived data and to demonstrate the value of census for monitoring the Roma to non-Roma gap. This study investigated the self-declared occurrence of at least one chronic disease and the existence of activity limitations among subjects with chronic disease by the database of the 2011 Hungarian Census. Risks were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) from logistic regression analyses controlled for sociodemographic factors. Roma ethnicity is a risk factor for chronic diseases (OR = 1.17; 95% CI: 1.16–1.18) and for activity limitation in everyday life activities (OR = 1.20; 95% CI: 1.17–1.23), learning-working (OR = 1.24; 95% CI: 1.21–1.27), family life (OR = 1.22; 95% CI: 1.16–1.28), and transport (OR = 1.03; 95% CI: 1.01–1.06). The population-level impact of Roma ethnicity was 0.39% (95% CI: 0.37–0.41) for chronic diseases and varied between 0 and 1.19% for activity limitations. Our investigations demonstrated that (1) the Roma ethnicity is a distinct risk factor with significant population level impact for chronic disease occurrence accompanied with prognosis worsening influence, and that (2) the census can improve the Roma health-monitoring system, primarily by assessing the population level impact.
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Affiliation(s)
- Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Anett Földvári
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Eszter Anna Janka
- Department of Dermatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Róza Ádány
- WHO Collaborating Centre on Vulnerability and Health, Public Health Research Institute, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Public Health Research Institute, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- MTA-DE-Public Health Research Group, Public Health Research Institute, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
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Kovács N, Varga O, Nagy A, Pálinkás A, Sipos V, Kőrösi L, Ádány R, Sándor J. The impact of general practitioners' gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study. BMJ Open 2019; 9:e027296. [PMID: 31494598 PMCID: PMC6731795 DOI: 10.1136/bmjopen-2018-027296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact. STUDY DESIGN A nation-wide cross-sectional study was performed in 2016. SETTING AND PARTICIPANTS The study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners. MAIN OUTCOME MEASURES Multilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated. RESULTS 48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations. CONCLUSION Female GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.
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Affiliation(s)
- Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Orsolya Varga
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kőrösi
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Centre on Vulnerability and Health, Debrecen, Hungary
- MTA-DE Public Health Research Group, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Pálinkás A, Kovács N, Sipos V, Vincze F, Papp M, Czifra Á, Ádány R, Sándor J. Az indikátoralapú teljesítményértékelésre épülő forráselosztás hatékonysága Magyarországon a felnőtteket ellátó háziorvosi praxisokban. Orv Hetil 2019; 160:1542-1553. [DOI: 10.1556/650.2019.31464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Introduction: The indicator-based performance monitoring and pay-for-performance system for Hungarian primary care was established in 2009, covering the whole country. It is based on a stable legal system and well operating information technology. Although, the health insurance system is able to facilitate the performance improvement only by the financing for general medical practices, the many times modified present system does not take into consideration (apart from the geographical location of practices) factors which determine the performance but cannot be influenced by general practitioners. Aim: The study aimed at renewing the indicator set and evaluation methodology in order to enable the monitoring to evaluate the performance of general medical practices independent of their structural characteristics. Method: Each adult care specific primary care performance indicator from June 2016 covering the whole country has been investigated. Indicators adjusted for structural practice characteristics (age and gender of patients; relative education of people provided; settlement type and county of the practice) have been computed. The difference between adjusted indicators and national reference values has been evaluated by statistical testing. Appropriateness of the present monitoring and financing system has been investigated by comparing the practice level presently applied and adjusted indicators to outline the opportunities to develop the present system. Results: The present monitoring allocates 34.46% of pay-for-performance resources for improving the performance of practices. The majority of resources supports the conservation of performance. Furthermore, the present system is not able to identify each practice with better than reference performance, withholding amount corresponding to 8.83% of pay-for-performance resources. If this financing were restricted to practices with significantly better than reference performance, the maximum of the financing a month in a practice would increase from 176 042 HUF (551 EURO) to 406 604 HUF (1274 EURO). Conclusion: Completing the performance monitoring system operated at present by the National Health Insurance Fund of Hungary with indicators adjusted for structural characteristics of the general medical practices, the resource allocation effectiveness could be improved. Orv Hetil. 2019; 160(39): 1542–1553.
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Affiliation(s)
- Anita Pálinkás
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
| | - Nóra Kovács
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
| | - Valéria Sipos
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
| | - Ferenc Vincze
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
| | - Magor Papp
- Nemzeti Népegészségügyi Központ Budapest
| | - Árpád Czifra
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
| | - Róza Ádány
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
| | - János Sándor
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen, Pf. 400, 4002
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Nagy A, Kovács N, Pálinkás A, Sipos V, Vincze F, Szőllősi G, Ádány R, Czifra Á, Sándor J. Improvement in Quality of Care for Patients with Type 2 Diabetes in Hungary Between 2008 and 2016: Results from Two Population-Based Representative Surveys. Diabetes Ther 2019; 10:757-763. [PMID: 30771162 PMCID: PMC6437308 DOI: 10.1007/s13300-019-0582-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Due to the increasing trends of recent decades, diabetes prevalence has reached a frequency of 1/11 adults worldwide. However, this disadvantageous trend has not been accompanied by worsened outcome indicators; better short-term (e.g., HbA1c levels) and long-term [e.g., all-cause mortality among type 2 diabetes mellitus (T2DM) patients] outcomes can be observed globally. We aimed to describe changes in the effectiveness of type 2 diabetes mellitus care between 2008 and 2016 based on outcome indicators. METHODS The study is a secondary analysis of data from two previously performed surveys. Both surveys were conducted in the framework of the General Practitioners' Morbidity Sentinel Stations Program (GPMSSP), which maintains a nationally representative registry of T2DM patients. RESULTS The largest improvement was observed in achieving fasting blood glucose and HbA1c target values [OR = 0.67, 95% confidence interval (CI), 0.56-0.80 and OR = 0.58; 95% CI, 0.48-0.70, respectively]. Moderate improvement was detected by reaching body mass index (BMI), diastolic blood pressure and total cholesterol target values (OR = 0.78, 95% CI, 0.65-0.93; OR = 0.78, 95% CI, 0.65-0.94 and OR = 0.76, 95% CI, 0.63-0.92, respectively). CONCLUSION Our study demonstrated that if standardized indicators are investigated in population-based samples, the effectiveness of T2DM care can be monitored by ad hoc surveys. The systematic application of this approach completed with the detailed documentation of the applied therapies could demonstrate the public health impact of certain modifications in T2DM care. An overall improvement in metabolic control (glycaemic control, lipid status and obesity) was observed, which was not accompanied by improved therapeutic target achievement for systolic blood pressure.
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Affiliation(s)
- Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gergő Szőllősi
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Árpád Czifra
- General Practitioners' Cluster Haláp, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
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Sándor J, Nagy A, Jenei T, Földvári A, Szabó E, Csenteri O, Vincze F, Sipos V, Kovács N, Pálinkás A, Papp M, Fürjes G, Ádány R. Influence of patient characteristics on preventive service delivery and general practitioners' preventive performance indicators: A study in patients with hypertension or diabetes mellitus from Hungary. Eur J Gen Pract 2018; 24:183-191. [PMID: 30070151 PMCID: PMC6084504 DOI: 10.1080/13814788.2018.1491545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Regular primary healthcare (PHC) performance monitoring to produce a set of performance indicators for provider effectiveness is a fundamental method for improving guideline adherence but there are potential negative impacts of the inadequate application of this approach. Since performance indicators can reflect patient characteristics and working environments, as well as PHC team contributions, inadequate monitoring practices can reduce their effectiveness in the prevention of cardiometabolic disorders. OBJECTIVES To describe the influence of patients' characteristics on performance indicators of PHC preventive practices in patients with hypertension or diabetes mellitus. METHODS This cross-sectional analysis was based on a network of 165 collaborating GPs. A random sample of 4320 adults was selected from GP's patient lists. The response rate was 97.3% in this survey. Sociodemographic status, lifestyle, health attitudes and the use of recommended preventive PHC services were surveyed by questionnaire. The relationship between the use of preventive services and patient characteristics were analysed using hierarchical regression models in a subsample of 1659 survey participants with a known diagnosis of hypertension or diabetes mellitus. RESULTS Rates of PHC service utilization varied from 18.0% to 97.9%, and less than half (median: 44.4%; IQR: 30.8-62.5) of necessary services were used by patients. Patient attitude was as strong of an influencing factor as demographic properties but was remarkably weaker than patient socioeconomic status. CONCLUSION These findings emphasize that PHC performance indicators have to be evaluated concerning patient characteristics.
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Affiliation(s)
- János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tibor Jenei
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anett Földvári
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Edit Szabó
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Orsolya Csenteri
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Magor Papp
- National Institute on Health Development, Department of Primary Health Care, Budapest, Hungary
| | - Gergely Fürjes
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- MTA-DE-Public Health Research Group, University of Debrecen, Debrecen, Hungary
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Sándor J, Pálinkás A, Vincze F, Kovács N, Sipos V, Kőrösi L, Falusi Z, Pál L, Fürjes G, Papp M, Ádány R. Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study. Int J Environ Res Public Health 2018; 15:ijerph15091835. [PMID: 30149586 PMCID: PMC6163424 DOI: 10.3390/ijerph15091835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
Abstract
Roma is the largest ethnic minority of Europe with deprived health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health indicators for adults living in segregated Roma settlements (SRS), representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54,682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and all-cause premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR = 1.152, 95% CI: 1.136–1.167). The proportion of subjects hospitalized (RR = 1.286, 95% CI: 1.177–1.405) and the reimbursement for inpatient care (RR = 1.060, 95% CI: 1.057–1.064) were elevated for SRS. All-cause premature mortality was significantly higher in SRSs (RR = 1.711, 1.085–2.696). Our study demonstrated that it is possible to compute the SRS-specific version of routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue into a non-sensitive small-area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of all-cause premature death.
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Affiliation(s)
- János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - Zsófia Falusi
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - László Pál
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - Gergely Fürjes
- National Institute for Health Development, Diószegi St 64, Budapest H-1113, Hungary.
| | - Magor Papp
- National Institute for Health Development, Diószegi St 64, Budapest H-1113, Hungary.
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
- MTA-DE-Public Health Research Group, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
- WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
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Nagy A, Kovács N, Pálinkás A, Sipos V, Vincze F, Szőllősi G, Csenteri O, Ádány R, Sándor J. Exploring quality of care and social inequalities related to type 2 diabetes in Hungary: Nationwide representative survey. Prim Care Diabetes 2018; 12:199-211. [PMID: 29326023 DOI: 10.1016/j.pcd.2017.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/05/2017] [Accepted: 12/17/2017] [Indexed: 01/23/2023]
Abstract
AIMS The study aimed to launch a T2DM adult cohort that is representative of Hungary through a cross-sectional study, to produce the most important quality indicators for T2DM care, to describe social inequalities, and to estimate the absolute number of T2DM adult patients with uncontrolled HbA1c levels in Hungary. METHODS A representative sample of the Hungarian T2DM adults (N=1280) was selected in 2016. GPs collected data on socio-demographic status by questionnaire, and on history and laboratory parameters from medical records. The process and outcome indicators used in the international monitoring practice were calculated. The socio-economic status influence was determined by multivariate logistic regression models. RESULTS Target achievement was 61.66%, 53.48%, and 54.00% for HbA1c, LDL-C, and blood pressure, respectively, in the studied sample (N=1176). In Hungary, 294,534 patients have above target HbA1c value out of 495,801 T2DM adults. The education-dependent positive association with majority of process indicators was not reflected in HbA1c, LDL-C, and blood pressure target achievements. The risk of microvascular complications and requirement of insulin treatment were higher among less educated. CONCLUSIONS According to our observations, the education-independent target achievement for HbA1c and LDL-C is similar as, for blood pressure is less effective in Hungary than in Europe.
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Affiliation(s)
- Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gergő Szőllősi
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Orsolya Csenteri
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary; MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
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Sipos V, Pálinkás A, Kovács N, Csenteri KO, Vincze F, Szőllősi JG, Jenei T, Papp M, Ádány R, Sándor J. Smoking cessation support for regular smokers in Hungarian primary care: a nationwide representative cross-sectional study. BMJ Open 2018; 8:e018932. [PMID: 29431134 PMCID: PMC5829607 DOI: 10.1136/bmjopen-2017-018932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our study aimed to evaluate the effectiveness of general practitioners' (GPs') smoking cessation support (SCS). STUDY DESIGN We carried out a cross-sectional study between February and April 2016. SETTING AND PARTICIPANT A sample of 2904 regular smokers aged 18 years or older was selected randomly from 18 general medical practices involved in a national representative, general medical practice-based morbidity monitoring system. The GPs surveyed the selected adults and identified 708 regular smokers. MAIN OUTCOME MEASURES Multivariate logistic regression models have been applied to evaluate the determinants (age, gender, education, smoking-related comorbidity, smoking intensity, intention to quit smoking and nicotine dependence) of provision of GP-mediated SCS such as brief intervention, pharmacological and non-pharmacological programmatic support. RESULTS According to the survey, 24.4% of the adults were regular smokers, 30% of them showed high nicotine dependence and 38.2% willing to quit smoking. Most of the smokers were not participated in SCS by GPs: brief intervention, programmatic non-pharmacological support and pharmacotherapy were provided for 25%, 7% and 2% of smokers, respectively. Low-nicotine-dependence individuals were less (OR 0.30, 95% CI 0.12 to 0.75), patients with intention to quit were more (OR 1.49, 95% CI 1.00 to 2.22) likely to receive a brief intervention. Vocational (OR 1.71, 95% CI 1.13 to 2.59) and high school education (OR 2.08, 95% CI 1.31 to 3.31), chronic obstructive pulmonary disease and cardiovascular diseases (OR 3.34, 95% CI 1.04 to 10.68; OR 3.91, 95% CI 2.33 to 6.54) increased the probability to receive support by GP. CONCLUSIONS Although there are differences among smokers' subgroups, the SCS in Hungarian primary care is generally insufficient, compared with guidelines. Practically, the pharmacological support is not included in Hungarian GPs' practice. GPs should increase substantially the working time devoted to SCS, and the organisation of primary healthcare should support GPs in improving SCS services.
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Affiliation(s)
- Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Karola Orsolya Csenteri
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - József Gergő Szőllősi
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tibor Jenei
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Magor Papp
- National Institute for Health Development, Budapest, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- MTA-DE-Public Health Research Group, University of Debrecen, Debrecen, Hungary
- Department of Preventive Medicine, Faculty of Public Health, WHO Collaborating Centre on Vulnerability and Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Sándor J, Nagy A, Földvári A, Szabó E, Csenteri O, Vincze F, Sipos V, Kovács N, Pálinkás A, Papp M, Fürjes G, Ádány R. Delivery of cardio-metabolic preventive services to Hungarian Roma of different socio-economic strata. Fam Pract 2017; 34:83-89. [PMID: 27650307 DOI: 10.1093/fampra/cmw102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Because the cardiovascular mortality in Hungary is high, particularly among the socio-economically deprived and the Roma, it is implied that primary health care (PHC) has a limited ability to exploit the opportunities of evidence-based preventions, and it may contribute to social health inequalities. OBJECTIVES Our study investigated the underuse of PHC preventive services. METHODS Random samples of adults aged 21-64 years free of hypertension and diabetes mellitus were surveyed with participation rate of 97.7% in a cross-sectional study. Data from 2199 adults were collected on socio-demographic status, ethnicity, lifestyle and history of cardio-metabolic preventive service use. Delivery rates were calculated for those aged 21-44 years and those aged 45-64 years, and the influence of socio-demographic variables was determined using multivariate logistic regression. RESULTS Delivery rates varied between 12.79% and 99.06%, and the majority was far from 100%. Although most preventive service use was independent of education, younger participants with vocational educations underutilized problematic drinking (P = 0.011) and smoking (P = 0.027) assessments, and primary or less educated underutilized blood glucose (P = 0.001) and serum cholesterol (P = 0.005) checks. Health care measures of each lifestyle assessment (P nutrition = 0.032; P smoking = 0.021; P alcohol = 0.029) and waist circumference measurement (P = 0.047) were much less frequently used among older Roma. The blood glucose check (P = 0.001) and family history assessment (P = 0.043) were less utilized among Roma. CONCLUSIONS The Hungarian PHC underutilizes the cardio-metabolic prevention contributing to the avoidable mortality, not generating considerably health inequalities by level of education, but contributing to the bad health status among the Roma.
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Affiliation(s)
- János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary, .,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anett Földvári
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Edit Szabó
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Orsolya Csenteri
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Magor Papp
- National Institute of Primary Care, Budapest, Hungary and
| | - Gergely Fürjes
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,MTA-DE-Public Health Research Group, University of Debrecen, Debrecen, Hungary
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Sandor J, Nagy A, Földvári A, Szabó E, Csenteri O, Vincze F, Sipos V, Kovács N, Pálinkás A, Jenei T, Papp M, Fürjes G, Ádány R. Cardio-metabolic preventive service underuse among Hungarian Roma: a nationwide survey 2013. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lampen-Imkamp S, Alte C, Sipos V, Kordon A, Hohagen F, Schweiger U, Kahl KG. [Training in iterative hypothesis testing as part of psychiatric education. A randomized study]. Nervenarzt 2011; 83:64-70. [PMID: 21305260 DOI: 10.1007/s00115-011-3252-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The improvement of medical education is at the center of efforts to reform the studies of medicine. Furthermore, an excellent teaching program for students is a quality feature of medical universities. Besides teaching of disease-specific contents, the acquisition of interpersonal and decision-making skills is important. However, the cognitive style of senior physicians leading to a diagnosis cannot easily be taught. Therefore, the following study aimed at examining whether specific training in iterative hypothesis testing (IHT) may improve the correctness of the diagnostic process. MATERIALS AND METHODS Seventy-one medical students in their 9th-11th terms were randomized to medical teaching as usual or to IHT training for 4 weeks. The intervention group received specific training according to the method of IHT. All students were examined by a multiple choice (MC) exam and additionally by simulated patients (SP). The SPs were instructed to represent either a patient with depression and comorbid anxiety and substance use disorder (SP1) or to represent a patient with depression, obsessive-compulsive disorder and acute suicidal tendencies (SP2). RESULTS All students identified the diagnosis of major depression in the SPs, but IHT-trained students recognized more diagnostic criteria. Furthermore, IHT-trained students recognized acute suicide tendencies in SP2 more often and identified more comorbid psychiatric disorders. The results of the MC exam were comparable in both groups. An analysis of the satisfaction with the different training programs revealed that the IHT training received a better appraisal. CONCLUSIONS Our results point to the role of IHT in teaching diagnostic skills. However, the results of the MC exam were not influenced by IHT training. Furthermore, our results show that students are in need of training in practical clinical skills.
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Affiliation(s)
- S Lampen-Imkamp
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover
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Abstract
OBJECTIVE Iterative hypothesis testing (IHT) or related strategies of diagnostic decision making have been taught in many curricula for medical students but not in psychiatry. We therefore asked whether the addition of training in IHT may add to the quality of the psychiatry course. METHOD Seventy-two medical students were randomized to four weeks problem-based learning or to IHT. Knowledge and skills of the students were tested using a multiple choice exam and simulated patients. RESULTS Iterative hypothesis testing-trained students recognized more diagnostic items and more often identified comorbid psychiatric disorders and acute suicidal tendencies. Acquisition of general psychiatric knowledge and global satisfaction with the course were similar in both groups. CONCLUSION We conclude that teaching IHT to medical students may enhance their clinical ability to recognize complex disease patterns. Further studies are required concerning the enhancement of clinical skills in the psychiatric specialty.
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Affiliation(s)
- Kai G Kahl
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
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Abstract
Patients with chronic depression constitute a problem group because of therapy resistance, symptom severity, and impaired psychosocial functioning. Compared with healthy groups, they show increased comorbidity with psychological and medical disorders, report more adverse conditions in childhood, show problematic interpersonal behaviors, and differ in structural characteristics of their thought processes. For these reasons, several specific treatment manuals have been developed for this target population. First results suggest that specific psychotherapy may be effective in chronic depression.
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Affiliation(s)
- U Schweiger
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck.
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Schweiger U, Sipos V, Hohagen F. [Identification and treatment of personality disorders in the physician's office]. MMW Fortschr Med 2006; 148:29-31. [PMID: 16566100 DOI: 10.1007/bf03364571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- U Schweiger
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikums Lübeck.
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Sipos V, Schweiger U, Renneberg B. [Anxious (avoidant) personality disorder]. MMW Fortschr Med 2006; 148:32, 34-5. [PMID: 16566101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The anxious (avoidant or fearful) type of personality disorder has a lifetime prevalence of 5%, which makes it the most common form of personality disorder. Although it is one of the leading risk factors for severe depressive illnesses, anxiety disorders, substance dependence, eating disorders and chronic pain, its importance is frequently underestimated. Ambulatory treatment comprises psychoeducation, self-management and training in social competence.
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Affiliation(s)
- V Sipos
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Lübeck.
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Sipos V, Schweiger U. [Borderline personality disorder]. MMW Fortschr Med 2006; 148:44, 46-7. [PMID: 16566104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Characteristics of a borderline personality disorder include emotional instability and a self-threatening lack of impulsive control. As a result, interpersonal relationships are rendered difficult. The central elements of treatment are psychoeducation, self-management, improved stress tolerance and awareness, emotion managment and training in social competence.
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Affiliation(s)
- V Sipos
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Lübeck.
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Schweiger U, Sipos V, Hohagen F. [Critical observation on the term "complex post-traumatic stress disorder"]. Nervenarzt 2005; 76:344-6; author reply 346-7. [PMID: 15892192 DOI: 10.1007/s00115-004-1748-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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