Association Between Alcohol Consumption and Cardiovascular Risk Based on Data from the Three Generations for Health Program in Hungary.

BACKGROUND Alcohol consumption has a significant effect on cardiovascular health, and risk factors, such as excessive alcohol use, should be avoided. Although alcohol consumption has decreased over the last decade in Hungary, it is still significantly higher than the average across the European Union. The objective of this study was to describe the patterns of alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), with a special focus on cardiovascular risk status (low, moderate, high, or very high). MATERIAL AND METHODS The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of cardiovascular diseases. An ordinal multiple logistic regression analysis was performed with 10 categorical explanatory variables and the outcome was the categorical cardiovascular risk. RESULTS The database consisted of patients aged 40-65 years with a sample size of 11 348. A significant relationship was found between alcohol consumption and cardiovascular risk status; people with high-risk drinking patterns had higher a value of odds ratio (OR=1.306 [1.003-1.701]) for having a more serious cardiovascular status. According to multiple regression analysis, alcohol dependence was associated with cardiovascular risk. CONCLUSIONS From a public health perspective, the results highlight the importance of reducing alcohol consumption with the help of primary care and preventive services in countries with a high cardiovascular risk profile to reduce the cardiovascular disease-related burden.

Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome.

PURPOSE: This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA. METHODS: This retrospective study included 921 children aged 2-18 years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman's correlation, Receiver Operating Characteristics (ROC) analyses were performed and area under the curve (AUC) was determined. RESULTS: We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the BMI percentile (0.59 AUC [0.54-0.65]) and age (0.58 AUC [0.52-0.63]) predicted severe OSA, according to the sensitivity and specificity values of the ROC curve, the association presents a slight clinical relevance. CONCLUSIONS: OSA severity is determined by the BMI percentile and age in children; however, these factors are unsuitable for predicting severe OSA in clinical practice. Based on our results, obesity is also a significant risk factor for OSA in younger children. Our study highlights that older, overweight, and obese children have a higher risk for severe OSA.

[Investigating cognitive impairment in communities of practice - lessons learned]. / Kognitív funkcióromlás vizsgálata praxisközösségekben ­ tanulságok.

Background and purpose: In the "Three Generations for Health" programme, general practitioners were responsible for screening for dementia in their practices using mini-COG and Mini Mental State Examination. The aim was to present the screening results of those included, their assessment by the doctor and the further fate of the patients. Methods: After mini-COG test, MMSE test was performed in case of suspected dementia. The examiner categorized the result as abnormal or no abnormal, recorded the referral, and recorded the data in an online interface. Our study is a cross-sectional study; the evolution and distribution of the parameters described in the objectives are described with raw case numbers and proportions. Patients aged 55 years and over were recruited consecutively. Only those cases (29 730) where mini-COG and MMSE test results were available, their assessment by the physician, and referral data to specialist care were analyzed. Results: The Mini-COG test revealed that 64% of the subjects were suspected of cognitive decline. Misclassification occurred in 13 015 cases, with 21% of the Mini-Cog test scores matching cognitive decline and 21% of lesions considered abnormal by GPs. The MMSE test raised the suspicion of dementia in 34% of the sample (10 174 people), with 4 262 (42%) of the participating GPs considering the result abnormal. 11% (2095 people) of people with abnormal Mini-Cog test scores and 17% (1709 people) of people with suspected dementia based on MMSE test scores were referred to specialist care. Conclusion: Our study assessed the practice of detecting cognitive decline in primary health care. The tools adopted for screening for dementia were used by practices, but the assessment of results and referral of suspected cases of dementia to specialist care were below the expected level. There is a need to improve primary care providers' knowledge of dementia detection and treatment and to strengthen links with specialist care.

Delivery of cardio-metabolic preventive services to Hungarian Roma of different socio-economic strata.

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.

The role of hyperinsulinemia as a cardiometabolic risk factor independent of obesity in polycystic ovary syndrome.

The aim of this study was to utilize various insulin resistance measuring methods to determine whether insulin resistance and other parameters impact the serum lipid levels of polycystic ovary syndrome (PCOS) patients and how the serum lipid levels in these patients are affected by the body mass index (BMI). Our dataset included patients between the ages of 16 and 42 (N = 228) from the outpatient endocrinology clinic of the Department of Obstetrics and Gynecology, who demonstrated increased hair growth and bleeding disorders and came for a routine oral glucose tolerance test (OGTT). Differences in the serum lipid levels were evaluated by t-test and linear regression analysis after adjusting for BMI. A stepwise regression model was constructed to evaluate the influence of each variable on the lipid levels. In PCOS patients, we found that dyslipidemia is more prevalent among hyperinsulinemic women compared with normoinsulinemic women, even after normalizing for BMI. PCOS patients with insulin resistance, determined by the insulin sensitivity index (ISI) method, showed more significant lipid abnormalities such as low high-density lipoprotein (HDL) and apo-A levels and high total cholesterol, low-density lipoprotein (LDL) and apo-B levels than if insulin resistance (IR) determination was based on insulin level or homeostatic model assessment (HOMA).

Association between the application of ISO 9001:2008 alone or in combination with health-specific standards and quality-related activities in Hungarian hospitals.

OBJECTIVE: To investigate how International Organization for Standardization (ISO) 9001 and the Hungarian Health Care Standards (HHCS) certifications are associated with quality management, patient safety, patient rights and human resource management activities. DESIGN: A cross-sectional study was implemented using the 2009 Hungarian hospital survey's database. SETTING: Hungary. PARTICIPANTS: Fifty-three general hospitals were included in the statistical analysis. INTERVENTION: No intervention was carried out in the study. MAIN OUTCOME MEASURES: The outcomes included the percentage of compliance in the dimensions of quality management, patient safety, patient rights, human resource management and the overall score for each hospital, and they were grouped according to the hospitals' certifications. RESULTS: Sixteen hospitals did not have either ISO 9001 or HHCS certifications, 19 had ISO 9001 certification only and 18 had both. Hospitals with ISO 9001 alone or in combination with the HHCS significantly outperformed hospitals with no certifications in terms of quality management and human resource management activities but not in terms of patient safety or patient rights activities. Combined, the two models provided the highest median levels in all cases. Nevertheless, no significant differences were observed when the hospitals with both certifications were compared with hospitals with ISO 9001 only. CONCLUSIONS: Although the combination of ISO 9001 and the HHCS showed the best results, the benefits were not decisive. Furthermore, although the HHCS include standards addressing patient safety, no direct association was found with regard to compliance. Thus, further investigation is required to understand this enigma.

[Prevention and treatment of the complications of polycystic ovarian syndrome--the significance of evidence-based, interdisciplinary management]. / A polycystás ovarium szindróma szövodményeinek prevenciója, kezelése és a kórkép bizonyítékokon alapuló, interdiszciplináris ellátásának fontossága.

Polycystic ovary syndrome is the most common hormonal and metabolic disorder likely to affect women. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The complex feature of the syndrome requires an interdisciplinary approach to treatment, where cooperation of paediatrician, internist, gynaecologist, endocrinologist, dermatologist, psychologist and oncologist is essential. The prevention and the treatment should be based on the best available evidence. This should include physical examination, laboratory tests for hormones, serum insulin, glucose, lipids, in addition patient's preferences should be considered, too. To maximise health gain of polycystic ovarian syndrome, adequate, effective, efficient and safe treatment is necessary. This article summarises the highest available evidence provided by meta-analyses and systematic reviews of the prevention of metabolic and cardiovascular complications of the syndrome, and discusses the relevant evidence published in the literature.

[Evidence-based therapy of polycystic ovarian syndrome]. / A polycystás ovarium szindróma tüneteinek bizonyítékokon alapuló terápiája.

Polycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder likely to affect women. The heterogeneous endocrinopathy is characterized by clinical and/or biochemical hyperandrogenism, oligo- or amenorrhoea, anovulatory infertility, and polycystic ovarian morphology. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The symptoms and complaint of the patients vary with age. To maximise health gain of the syndrome, adequate, evidence based effective, efficient and safe treatment is necessary. This article summarises the highest available evidence provided by studies, meta-analysis and systematic reviews about the therapeutical possibilities for treating obesity, hyperandrogenism, menstrual abnormalities, infertility and psychological problems related to polycystic ovary syndrome.

[Importance of the interdisciplinary, evidence-based diagnosis of polycystic ovary syndrome]. / A polycystás ovarium szindróma interdiszciplináris, bizonyítékokon alapuló diagnózisának fontossága.

Polycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder of women. This heterogeneous endocrinopathy characterized by clinical and/or biochemical hyperandrogenism, oligo- or amenorrhoea, anovulatory infertility, and polycystic ovarian morphology. The prevalence, clinical feature and the risk of co-morbidity vary depending on the accuracy of the diagnosis and the criteria used. Evidence suggests that those women are at high risk who fulfil the criteria based on National Institute of Health. The complex feature of the syndrome and the considerable practice heterogeneity that is present with regards to diagnostic testing of patients who are suspected to have polycystic ovary syndrome require an interdisciplinary, evidence-based diagnostic approach. Such a method can ensure the patient safety and the effectiveness and efficiency of the diagnosis. This paper summarises the highest available evidence provided by well-designed studies, meta-analysis and systematic reviews of the clinical feature and the clinical implications of the diagnostic criteria of polycystic ovary syndrome.

[Health status and cardiovascular risk of Roma and non-Roma population in underprivileged settlements]. / Egészségi állapot és cardiovascularis kockázat roma és nem roma populációban hátrányos helyzetu településeken.

INTRODUCTION: The "Taking the screening tests in place" program offers cardiovascular screening activities to the inhabitants of underprivileged settlements. OBJECTIVE: Evaluation of the health status and cardiovascular risk of the Roma and non-Roma population in underprivileged settlements. METHOD: Information was collected about the demography, lifestyle, current illnesses, access to healthcare and the quality of patient information. General health check (body weight, height, blood pressure, blood sugar, ankle-brachial index) and cardiovascular examination were performed. Data were analyzed in Roma and non-Roma groups with Pearson's chi-squared test. RESULTS: 3649 people participated in the study (851 [23%] men, 2798 [77%] women), 16% (598) of the investigated population belonged to the Roma population. The mean age of men in the general population was 58 years and of women 55 years, in the Roma population 48 years and 47 years. People in the Roma population smoked more often (men 45%, women 64%) than people in the general population (both sexes 30%). In the Roma population, the consumption of sugary soft drinks at least four times a week (men 55% vs. women 43%) and the BMI (men 30 vs. 29, woman 29 vs. 28) were significantly higher. In the Roma population, 31% of the men and 13% of the women thought that their health status was bad, while in the general population it was 17% of men and 8% of women. Incidence of COPD (18% vs. 9%), coronary disease (18% vs. 13%), peripheral artery disease (13% vs. 9%) was significantly higher in the Roma population among women. CONCLUSION: In the investigated population, the Roma inhabitants were significantly younger, smoked more, they were more obese, the chronic diseases were more common among them, and they considered their health status worse than the general population. Orv Hetil. 2023; 164(20): 792-799.

Differences between SCORE, Framingham Risk Score, and Estimated Pulse Wave Velocity-Based Vascular Age Calculation Methods Based on Data from the Three Generations Health Program in Hungary.

Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved in a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on the SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10-90%, and >90% ePWV values for the participants. In total, 99,231 subjects were involved in the study, and among them, 49,191 patients had hypertension (HT) and 15,921 patients had diabetes (DM). The chronological age of the total population was 54.0 (48.0-60.0) years, while the SCORE and FRS vascular ages were 59.0 (51.0-66.0) and 64.0 (51-80) years, respectively. In the HT patients, the chronological, SCORE, and FRS vascular ages were 57.0 (51.0-62.0), 63.0 (56.0-68.0), and 79.0 (64.0-80.0) years, respectively. In the DM patients, the chronological, SCORE, and FRS vascular ages were 58.0 (52.0-62.0), 63.0 (56.0-68.0), and 80.0 (76.0-80.0) years, respectively. Based on ePWV, the FRS identified patients with an elevated vascular age with high sensitivity (97.3%), while in the case of the SCORE, the sensitivity was much lower (13.3%). In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation in CV preventive strategies requires further studies.

Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2.

OBJECTIVE: Cardiovascular risk estimation is an essential step to reduce the onset of adverse cardiovascular events. For this purpose, the Systematic Coronary Risk Evaluation (SCORE) risk chart method was used in Europe. In 2021, the SCORE2 algorithm was released, bringing changes in the calculation methodology. This study assessed and compared the level of cardiovascular risk in a population aged 40-65 years using the SCORE and SCORE2 methodologies. METHODS: This cross-sectional study included a total of 85 802 patients in Hungary. Cardiovascular risk levels were determined using the SCORE and SCORE2 risk estimation methods. RESULTS: Using SCORE, 97.7% of men aged 40-50 years were classified as low-moderate risk, which decreased to 32.4% using SCORE2. Using SCORE, 100% of women aged 40-50 years were classified as low-moderate risk, compared with 75.6% using SCORE2. Using SCORE, 36.8% of men aged 50-65 years were classified as high risk and 14.8% as very high risk, and 5.4% of women aged 50-65 years were classified as high risk and 0.5% as very high risk. In this age group, using SCORE2, 50% of men were classified as high risk and 25.8% as very high risk, and 38.8% of women were classified as high risk and 11.9% as very high risk. CONCLUSIONS: When the SCORE2 method was used instead of SCORE 43.91% of the whole population were classified with a higher level of risk, which represents a radical increase in the number of patients with high or very high cardiovascular risk.

Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary.

BACKGROUND: The management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors' target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40-65 years and the success of achieving risk factors' target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies. METHODS: We conducted a cross-sectional study involving 37,778 patients aged 40-65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics). RESULTS: For 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%. CONCLUSIONS: The success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.

Assessment of Quality of Life in Children With Pulmonary Hypertension Using Parent and Self-report Questionnaires.

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevation of pulmonary vascular resistance and right ventricular failure. By using advanced therapies to reduce mortality, clinicians focus on improving functional status and quality of life (QOL). The aim of our study was to assess health-related QOL of pediatric patients with PAH. Parents of all children (aged 2-18 years) and patients aged 5-18 years with an appropriate level of intellectual development completed general and cardiac-specific validated surveys (Pediatric Quality of Life Inventory 4.0 and Pediatric Quality of Life Inventory 3.0, respectively). Demographic and clinical information was collected to grade disease severity. Twenty-five children were enrolled, yielding 25 parent reports and 15 patient self-reports. The PAH group had significantly lower scores than healthy children in all domains. Patients with World Health Organization Functional Class I had significantly higher parent proxy scores in School Functioning (P = .029) and in Heart Problems and Symptoms domain (P = .014) Patients with tricuspid annular plane systolic excursion below -2 z score showed impairment in each parent proxy general domain and in the Cognitive Problems score of the Cardiac module (P = .006). In conclusion the QOL of patients with PAH was impaired in every domain compared with healthy children. Patients with reduced right ventricle systolic function showed significantly lower QOL in all core domains. These results point to the need for psychosocial rehabilitation in addition to somatic care to improve the QOL in this severely ill population.

Elevated Fasting Glucose and C-Reactive Protein Levels Predict Increased All-Cause Mortality after Elective Transcatheter Aortic Valve Implantation.

Surgical aortic valve replacement in the elderly is now being supplanted by transcatheter aortic valve implantation (TAVI). Scoring systems to predict survival after catheter-based procedures are understudied. Both diabetes (DM) and underlying inflammatory conditions are common in patients undergoing TAVI, but their impact remains understudied in this patient group. We examined 560 consecutive TAVI procedures and identified eight pre-procedural factors: age, body mass index (BMI), DM, fasting blood glucose (BG), left-ventricular ejection fraction (EF), aortic valve (AV) mean gradient, C-reactive protein levels, and serum creatinine levels and studied their impact on survival. The overall mortality rate at 30 days, 1 year and 2 years were 5.2%, 16.6%, and 34.3%, respectively. All-cause mortality was higher in patients with DM (at 30 days: 8.9% vs. 3.1%, p = 0.008; at 1 year: 19.7% vs. 14.9%, p = 0.323; at 2 years: 37.9% vs. 32.2%, p = 0.304). The presence of DM was independently associated with increased 30-day mortality (hazard ratio [HR] 5.38, 95% confidence interval [CI], 1.24-23.25, p = 0.024). BG levels within 7-11, 1 mmol/L portended an increased risk for 30-day and 2-year mortality compared to normal BG (p = 0.001 and p = 0.027). For each 1 mmol/L increase in BG 30-day mortality increased (HR 1.21, 95% CI, 1.04-1.41, p = 0.015). Reduced EF and elevated CRP were each associated with increased 2-year mortality (p = 0.042 and p = 0.003). DM, elevated BG, reduced EF, and elevated baseline CRP levels each are independent predictors of short- and long-term mortality following TAVI. These easily accessible screening parameters should be integrated into risk-assessment tools for catheter-based aortic valve replacement candidates.

Exploring quality of care and social inequalities related to type 2 diabetes in Hungary: Nationwide representative survey.

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.

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.

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.

Investigation of the conditions affecting the joining of Hungarian hospitals to an accreditation programme: a cross-sectional study.

OBJECTIVE: Quantitative studies have shown the various benefits for having accreditation in hospitals. However, neither of these explored the general conditions before applying for an accreditation. To close this gap, this study aimed to investigate the possible association between joining an accreditation programme with various hospital characteristics. DESIGN: A cross-sectional study was implemented using the databases of the 2013 Hungarian hospital survey and of the Hungarian State Treasury. SETTING: Public general hospitals in Hungary. PARTICIPANTS: The analysis involved 44 public general hospitals, 14 of which joined the preparatory project for a newly developed accreditation programme. MAIN OUTCOME MEASURES: The outcomes included the percentage of compliance in quality management, patient information and identification, internal professional regulation, safe surgery, pressure sore prevention, infection control, the opinions of the heads of quality management regarding the usefulness of quality management and clinical audits, and finally, the total debt of the hospital per bed and per discharged patient. RESULTS: According to our findings, the general hospitals joining the preparatory project of the accreditation programme performed better in four of the six investigated activities, the head of quality management had a better opinion on the usefulness of quality management, and both the debt per bed number and the debt per discharged patient were lower than those who did not join. However, no statistically significant differences between the two groups were found in any of the examined outcomes. CONCLUSIONS: The findings suggest that hospitals applying for an accreditation programme do not differ significantly in characteristics from those which did not apply. This means that if in the future the accredited hospitals become better than other hospitals, then the improvement could be solely contributed to the accreditation.