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匈牙利初级保健服务评估:基于 QUALICOPC 匈牙利分部研究结果,对服务提供、专业能力、合作、筹资和基础设施进行的全面描述。

Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study.

机构信息

Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.

出版信息

Prim Health Care Res Dev. 2021 Jul 1;22:e36. doi: 10.1017/S1463423621000438.

Abstract

BACKGROUND

Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system.

METHODS

The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data.

FINDINGS

Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.

摘要

背景

不同国家的初级卫生保健在质量、公平性和成本方面存在差异。质量和初级保健成本(QUALICOPC)研究使用统一的方法和经过验证的问卷,由家庭医生/全科医生(GP)填写,评估了 35 个国家的这些领域和参数。本文旨在提供 QUALICOPC 研究匈牙利部分的数据,并概述匈牙利最近的初级保健(PC)系统。

方法

通过现场工作人员在地理上具有代表性的分布,向 222 家匈牙利全科医生诊所提供问卷并完成填写。对数据进行描述性分析。

结果

融资主要基于人头费,并辅以额外的补偿因素和少量经济激励措施。守门人功能薄弱。GP 与专家之间的沟通往往不足。可用设备和仪器的数量适当。单人执业占主导地位。预约而非排队是一种新的选择,并且越来越受欢迎,主要是在受过更好教育和城市的患者中。GP 参与管理所有年龄段的几乎所有慢性疾病。尽管行政任务负担沉重,但一半的 GP 认为他们的工作仍然很有意义,很少出现倦怠症状。在评估的过程指标中,可及性、连续性、全面性和协调性以及健康结果指标的公平性得到了满意的评价。融资不足;因此,许多 GP 参与了额外的创收活动。GP 的老龄化和年轻一代 GP 的缺乏导致人力短缺。不同级别的医疗保健提供者之间的合作和沟通应得到改善,更加注重社区导向和预防服务。融资需要不断改进,并应实施适当的激励措施。需要制定具体的以 PC 为导向的指南,以正确定义 GP 的任务和能力。

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