[Seroprevalence of Bordetella pertussis antibodies in adults in Hungary: results of an epidemiological cross-sectional study]. / A Bordetella pertussis-antitestek szeroprevalenciája magyarországi felnottekben.

INTRODUCTION: Pertussis (whooping cough) is an acute respiratory tract infection caused by Bordetella pertussis that is characterized by a chronic, severe cough. The optimum immunization schedule for pertussis is unclear, so these vary by countries. AIM: To estimate the seroprevalence of pertussis in adults in Hungary. METHOD: Serum anti-pertussis toxin immunoglobulin G (anti-PT IgG) antibody levels were analyzed using enzyme-linked immunosorbent assay in adults in general practitioners' practices during one year. Sera were classified following manufacturer's instructions as: strongly indicative of current/recent infection (≥1.5 optical density [OD] units); indicative of current/recent infection (≥1.0 OD units); seropositive (>0.3 OD units); or seronegative (≤0.3 OD units). RESULTS: 1999 adults (60.6% female; mean age 47.4 ± 17.7 years) were included. 14.8% were seropositive, 1.1% were indicative of current/recent infection, and 0.1% were strongly indicative of current/recent infection. CONCLUSIONS: 85.2% of the subjects were seronegative and therefore susceptible to pertussis infection. Approximately 1% was suspicious of current/recent pertussis infection, potentially transmissible to susceptible young infants. Vaccination of adults is a key way to indirectly protect infants. Orv Hetil. 2018; 159(13): 503-510.

[A model, by making common task force out of scientific organisation, the academic sector and governmental institute, was realised in Hungary to support the specific family physician training and to implement research and development projects in the primary healthcare. Part I]. / Tudományos szakmai szervezet, az akadémiai szektor és országos intézet összefogásának modellje a családorvos-szakképzés, az alapellátás kutatás-fejlesztési színterein. I. rész.

It is internationally recognized that the best method for practicing general medical care is family medicine, based on the correct relationship between the physician and the patients/families, where the principles of disease prevention and patient care meet, and the cost-benefit rates are better. In Hungary, a major part of the health reform had been the advancement of a primary care system by the international standards of modern family medicine. The Scientific Association of the Hungarian General Practitioners (SAHGP), founded in 1967, has adviced - from its onset - to introduce a new, independent medical specialty named 'general practice' which was finally realised in 1974. That was followed, according to the Welfare Ministry Order No. 6/1993, by the specific training program for general practice which prescribed, also for the in-service GP-s, to complete an individual postgraduate training, to be ended by a state specialty exam in family practice, under conduction of the regional medical schools. Furthermore, for strengthening the primary healthcare, in 1998 the government established - uniquely in Europe - the National Institute of Primary Healthcare (NIPHC). So a unique task force has gained shape which included the academic sector, the professional NGO and the governmental background institution in order to manage: 1) human resource supply in PHC, 2) to implement statewide professional and public health goals as well as 3) to manage research and development projects. This paper takes a look back at the early events of this process as well as tries to offer an insight into the results and conclusions of the performed research projects, highlighting those which can be potentially usable in further professional development of the Hungarian PHC. Orv Hetil. 2018; 159(32): 1310-1316.

[Primary care of refugees and migrants. Lesson learnt from the EUR-HUMAN project]. / Menekültek, migránsok az alapellátásban. Mit tanulhattunk az EUR-HUMAN projekt eredményeibol?

In 2015, local wars, starvation and misery in some Middle Eastern, Asian and African countries forced millions of people to leave their homelands. Many of these people migrated toward Europe, reaching Hungary as well. The refugee crisis created significant challenges for all national healthcare systems across Europe. Limited attention has been given to the extent to which health service provision for refugees and migrants has become a task for primary health care (PHC), which has been unprepared as a profession and pressured by the enormous workload. Hungarian primary care was involved only to an extent in the refugees' health care, as most of the migrants entering Hungary wanted to move forward to other countries. The need for evidence-based patient-centred interventions to assess refugee healthcare needs, and for training programmes for rapid capacity-building for integrated PHC was addressed by the EUropean Refugees - HUman Movement and Advisory Network (EUR-HUMAN) project, which 7 European countries developed together. The overall aim of the EUR-HUMAN project is to enhance the knowledge and expertise of European member states who accept refugees and migrants in addressing their health needs, safeguarding them from risks, while at the same time to minimize cross-border health risks. This initiative focuses on addressing the early arrival period, transition and longer-term settlement of refugees in European host countries. A primary objective of this project is to identify, design and assess interventions to improve PHC delivery for refugees and migrants with a focus on vulnerable groups. The structure, the main focus and outputs of the project are described and summarized in this paper, providing relevant information and access to educational materials for Hungarian (primary care) physicians. The EUR-HUMAN project was operated in 2016 under the auspices of the European Commission and funded by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). Orv Hetil. 2018; 159(35): 1414-1422.

[What do family medicine trainees think about gratitude payment?] / Mit gondolnak a családorvos-rezidensek a hálapénzrol?

INTRODUCTION: The issue of gratuity is one of the most important health policy issues in Hungary. AIM: The authors' aim is to investigate the attitude of Hungarian family medicine trainees towards gratitude payment. METHOD: Quantitative, paper-based survey among trainees from four Departments of Family Medicine in Hungary (n = 152). RESULTS: More than 50 percent of the residents do not approve of accepting gratitude money. Men (p<0.026), and graduating residents accept it significantly more often (p<0.036) while doctors with children tend to accept it more frequently (p<0.051). They think that the reason for this phenomenon is the lack of proper care (65%), vulnerability and the sense of real gratitude patients feel (52%). According to the participants, the least influencing factor was the low salary of physicians (14.4%). They believe that accepting gratuity is a corruption, and it's humiliating for doctors (80-80%). CONCLUSION: Family medicine residents approve of gratitude money even less as compared to the results of previous studies, but related to other gratitude payment issues we have found similar opinions. Orv Hetil. 2017; 158(26): 1028-1035.

[Evaluation of the quality of performance of general practitioners. What is the problem with primary care quality indicators in Hungary?]. / A háziorvosok teljesítményének minoségi értékelése. Mi a probléma a háziorvosi indikátorokkal?

The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary.

[Conceptual framework of integrated care and options for integration in primary care]. / Az integrált ellátás koncepcionális keretrendszere és az integráció lehetoségei az alapellátásban.

Nowadays, several countries' health governments have recognized that the complex treatment of chronic diseases, prevention and rehabilitation requires a new approach. This study presents the possible solution of integrated service delivery in health and other sectors. Furthermore, it shows how the integration of primary care services was implemented and how the integration of different levels of providers changes the organization of care. This study is based on an overview of the relevant international literature, as well as the 5th European Primary Care Forum. The comprehensive approach of integrated care and adaption of the needs of local communities encourage the development of new organizational forms and services in primary care. The integrated service forms are more suitable to satisfy the needs of patients and communities and provide wide range of services, but it is important to find the appropriate dimensions of integration which would fit our goals.

[A new questionnaire for the assessment of parental health literacy]. / Új kérdoív a szüloi egészségmuveltség mérésére.

INTRODUCTION: Parental health literacy is an important factor of pediatric health. Although it is thorougly studied in other countries, neither proper definition, nor adequate tool for its measurement exists in Hungarian. AIM: The aim of this work was to define the dimensions of parental health literacy and to introduce a questionnaire for its measurement. METHOD: Opinions of parents, pediatric nurses and pediatricians on parental health literacy were used to establish the definition and basic components. Based on these and previously standardized tests a new questionnaire was developed. RESULTS: Four dimensions of parental health literacy were formulated such as knowledge, functional literacy, self-confidence and motivation. The new questionnaire assesses all four dimension through eight topics. CONCLUSIONS: This is the first culturally adapted definition and test of parental health literacy in Hungarian. With its application the efficacy of both primary care services and health education may be improved and the correlation between parental health literacy and pediatric health may be properly studied.

[Bedside ultrasound in adult primary care.] / Ágy melletti ultrahangvizsgálat az alapellátásban.

It is hard to imagine a modern hospital ward without a mobile ultrasound, bedside (point-of-care) sonography (POCUS) is a technique of the 21st century, which in emergency medicine settings (for example during primary survey) might replace the stethoscope at times. In emergency medicine - which is the hospital discipline closest to primary care - bedside ultrasound is part of the routine care by now, and its use is based on evidences of thorough research. Given that the emergency outpatient population is getting closer to primary care patients both in presentation and demography, we believe that the current POCUS evidences are probably applicable to primary care as well. Based on the clinical experience gained in emergency medicine, we assume that bedside ultrasound may also be helpful in general practice reliably diagnosing certain, potentially life-threatening pathologies, reducing the length of time until definitive treatment, increasing the success rate of certain interventions, improving patients' experience, and potentially alleviating staff burnout. The present article summarizes experiences with bedside sonography in the Anglo-Saxon world and tries to find its place in the Hungarian primary care. The widespread use of bedside ultrasound, however, in the Hungarian general practice is still lagging due to numerous barriers, the most pressing of those are training, legal responsibility and financing. Regardless, we believe, that even in this early, unregulated phase, it is worth considering to introduce bedside ultrasound into daily primary care. Competent use, however, requires continuous practice; based on the average adult patient turnover in an urban Hungarian "adult only" surgery, it might take six months to gain the necessary skills to provide high level, safe patient care. Orv Hetil. 2022; 163(52): 2067-2071.

Effective integration of hospice palliative care into national oncology and general practice / A hospice-palliatív ellátás hatékony integrálása a hazai onkológiai és családorvosi gyakorlatba

Introduction: Hospice movement began in Hungary in 1991, today home care and impatient care is accessable na-tionwide. However, despite the growing number of patients receving palliative care, according to the survey of the Hungarian Hospice Palliative Association, the average time they have spent receiving home hospice care was only 26,7 days in 2020, when the ideal would be 8,5 months. It has been proven by studies, that involving hospice -palli-ative care early on in the treatment of oncology patients has benefits for both the quality of life and treatment and cost-effectiveness. To make this possible, we have to make certain ways of health care which lead the patients in need to specialised palliative care. Objective and method: In this statement, we introduce two forms of treatment which have proven that the early inte-gration of palliative care is efficiently attainable throughout health care systems in Hungary today.Results: Starting September of 2019, the National Institute of Oncology Palliative Mobil Team has been helping the patients of the Institute receive optimal care through consultation. In the general medicine, general practice partner-ship of Szentendre, two family doctors with palliative licence examination have been organizing trainings for their colleagues in order to show a new approach and help more patients of the region receive palliative care in time. Conclusion: These examples further prove that by accessing the current financial and human resources, through edu-cation and a change of attitude, the improvement of palliative care in Hungary is possible.

[Resource allocation effectiveness of indicator-based performance monitoring in Hungarian primary care for adults]. / Az indikátoralapú teljesítményértékelésre épülo forráselosztás hatékonysága Magyarországon a felnotteket ellátó háziorvosi praxisokban.

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.

[Primary care and providers in Hungary, 2018]. / Alapellátás, alapellátók Magyarországon, 2018.

Trends and the main problems since the introduction of primary care (PC) system in Hungary (1992) were evaluated. Shortage of human resources, reduced professional competences, enormous administrative burden, and inappropriate health policy is described. There are no primary care guidelines and reliable quality indicators. Professional education of family physicians, working nowadays in the PC system, is appropriate. Their workload and the number of patients' visit are high, mainly because of the low health literacy in the general population and due to the administrative requirements. Although financing has been increased in the previous years, it is less than desired. PC needs a priority in the healthcare system; providers need higher income and attractive professional carrier, more focus to PC in the undergraduate education. Legislations in PC should be based on conceptual planning and consensus of professional bodies. Decision making needs a previous evaluation of expected outcomes, quality insurance should be developed, appropriate performance payment, less and rational administrative tasks, new structures of PC provision should be implemented respecting the local needs, supported by a clear communication of policy makers. PC system at higher level could have more benefit for the population. Orv Hetil. 2019; 160(24): 926-935.

[Risk-based prediabetes screening in a rural general practice - oral glucose tolerance test or glycated hemoglobin?] / Kockázatalapú praediabetesszurés egy vidéki családorvosi praxisban ­ orális glükóztolerancia-teszt vagy glikált hemoglobin?

Introduction and aim: The aim of this study was to implement a two-stage diabetes screening programme in a severely disadvantaged municipality. In the first stage, diabetes risk assessment was carried out in the 18 to 75 age group, followed by screening of the high risk population for potential carbohydrate metabolism disorders using laboratory tests. Method: Stage 1: assessment of diabetes risk with the FINDRISC questionnaire; Stage 2: identification of carbohydrate metabolism status by oral glucose tolerance test and glycated haemoglobin test in patients with elevated or high risk of diabetes. Results: 406 individuals completed the FINDRISC questionnaire. Elevated or high risk for diabetes was confirmed in 129 individuals (31.77%). There was significant correlation between increased risk and age (p<0.001) and between increased risk and body mass index (p<0.001). Based on the oral glucose tolerance test, 28.3% and 9.43% of the patients were diagnosed with pre-diabetes and diabetes mellitus, respectively. According to the glycated haemoglobin test, the incidences of prediabetes and diabetes were 50.94% and 11.32%, respectively. The strongest predictors of prediabetes/diabetes mellitus was the age (p = 0.047). The correlation between prediabetes/diabetes mellitus and smoking (p = 0.635) and physical activity (p = 0.975) was the weakest. The results showed that the glycated hemoglobin value increased by mean 0.2% by metabolic syndromes patients. Conclusions: Our results highlight the necessity for improving preventative care. Based on the risks of significant mortality and disability due to diabetes, prevention and early diagnosis must be prioritised in primary care. In addition to the oral glucose tolerance test, measurement of glycated haemoglobin is also indicated, while keeping in mind the limitations of its diagnostic value. Evaluating for glycated hemoglobin results, it is also worth looking for the presence of metabolic syndrome. Orv Hetil. 2019; 160(50): 1976-1983.