Hungarian general practice paediatricians' antibiotic prescribing behaviour for suspected respiratory tract infections: a qualitative study.

OBJECTIVES: Inappropriate antibiotic prescribing is a major cause of antimicrobial resistance (AMR). The aim of this study was to explore paediatric general practitioners' (GP Peds) antibiotic prescription practice in suspected respiratory tract infections (RTIs), using the capability-opportunity-motivation-behaviour framework. DESIGN: The design is a qualitative study based on individual, semistructured telephone or virtual interviews. SETTING: Paediatric general practice in Hungary. We applied stratified maximum variation sampling to cover the categories of age, sex and geographical location of participants. PARTICIPANTS: We interviewed 22 GP Peds. Nine were male and 13 were female: 2 of them were less than 40 years old, 14 were between 40 and 60 years, and 6 were above 60 years. 10 worked in low-antibiotic prescription areas, 5 in areas with medium levels of antibiotic prescription, 3 in high-antibiotic prescription areas, and 4 in and around the capital city. RESULTS: Study participants had varying antibiotic prescription preferences. Personal experience and physical examination play a central role in GP Peds' diagnostic and treatment practice. Participants emphasised the need to treat children in their entirety, taking their personal medical record, social background and sometimes parents' preferences into account, besides the acute clinical manifestation of RTI. Most respondents were confident they apply the most effective therapy even if, in some cases, this meant prescribing medicines with a higher chance of contributing to the development of AMR. Some participants felt antibiotic prescription frequency has decreased in recent years. CONCLUSIONS: Our findings suggest that a more prudent attitude toward antibiotic prescribing may have become more common but also highlight relevant gaps in both physicians' and public knowledge of antibiotics and AMR. To reinforce awareness and close remaining gaps, Hungary should adopt its national AMR National Action Plan and further increase its efforts towards active professional communication and feedback for primary care physicians.

National strategies for knowledge translation in health policy-making: A scoping review of grey literature.

BACKGROUND AND OBJECTIVES: Without strategic actions in its support, the translation of scientific research evidence into health policy is often absent or delayed. This review systematically maps and assesses national-level strategic documents in the field of knowledge translation (KT) for health policy, and develops a practical template that can support Evidence-informed Policy Network (EVIPNet) Europe countries in producing national strategies for evidence-informed policy-making. METHODS: Websites of organizations with strategic responsibilities in KT were electronically searched, on the basis of pre-defined criteria, in July-August 2017, and an updated search was carried out in April-June 2021. We included national strategies or elements of national strategies that dealt with KT activities, as well as similar strategies of individual institutions with a national policy focus. Two reviewers screened the strategies for inclusion. Data were analysed using qualitative content analysis. RESULTS: A total of 65 unique documents were identified, of which 17 were eligible and analysed for their structure and content. Of the 17, 1 document was a national health KT action plan and 6 documents were institution-level KT strategies. The remaining 10 strategies, which were also included were 2 national health strategies, 5 national health research strategies and 3 national KT strategies (not specific to the field of health alone). In all, 13 structural elements and 7 major themes of health policy KT strategies were identified from the included documents. CONCLUSION: KT in health policy, as emerged from the national strategies that our mapping identified, is based on the production and accessibility of policy-relevant research, its packaging for policy-making and the activities related to knowledge exchange. KT strategies may play different roles in the complex and context-specific process of policy-making. Our findings show that the main ideas of health-specific evidence-informed policy literature appear in these strategies, but their effectiveness depends on the way stakeholders use them. Specific knowledge-brokering institutions and organizational capacity, advocacy about the use of evidence, and close collaboration and co-decision-making with key stakeholders are essential in furthering the policy uptake of research results.

Frailty prevalence in 42 European countries by age and gender: development of the SHARE Frailty Atlas for Europe.

Comparative frailty prevalence data across European countries is sparse due to heterogeneous measurement methods. The Survey of Health, Ageing and Retirement (SHARE) initiative conducted interviews with probability sampling of non-institutionalized elderly people in several European countries. Previous frailty analyses of SHARE datasets were limited to initial SHARE countries and did not provide age- and gender-stratified frailty prevalence. Our aim was to provide age- and gender-stratified frailty prevalence estimates in all European countries, with predictions where necessary. From 29 SHARE participating countries, 311,915 individual surveys were analyzed. Frailty prevalence was estimated by country and gender in 5-year age bands using the SHARE Frailty Instrument and a frailty index. Association of frailty prevalence with age, gender, and GDP per capita (country-specific economic indicator for predictions) was investigated in multivariate mixed logistic regression models with or without multiple imputation. Female gender and increasing age were significantly associated with higher frailty prevalence. Higher GDP per capita, with or without purchasing power parity adjustment, was significantly associated with lower frailty prevalence in the 65-79 age groups in all analyses. Observed and predicted data on frailty rates by country are provided in the interactive SHARE Frailty Atlas for Europe. Our study provides age- and gender-stratified frailty prevalence estimates for all European countries, revealing remarkable between-country heterogeneity. Higher frailty prevalence is strongly associated with lower GDP per capita, underlining the importance of investigating transferability of evidence across countries at different developmental levels and calling for improved policies to reduce inequity in risk of developing frailty across European countries.

An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries.

BACKGROUND: Evidence briefs for policy (EBPs) represent a potentially powerful tool for supporting evidence-informed policy-making. Since 2012, WHO Evidence-Informed Policy Network (EVIPNet) Europe has been supporting Member States in developing EBPs. The aim of this study was to evaluate the process of developing EBPs in Estonia, Hungary and Slovenia. METHODS: We used a rapid appraisal approach, combining semi-structured interviews and document review, guided by the Medical Research Council (MRC) process evaluation framework. Interviews were conducted with a total of 20 individuals familiar with the EBP process in the three study countries. Data were analysed thematically, and emerging themes were related back to the MRC framework components (implementation, mechanisms of impact, and context). We also reflected on the appropriateness of this evaluation approach for EVIPNet teams without evaluation research expertise to conduct themselves. RESULTS: The following themes emerged as important to the EBP development process: how the focus problem is prioritized, who initiates this process, EBP team composition, EBP team leadership, availability of external support in the process, and the culture of policy-making in a country. In particular, the EBP process seemed to be supported by early engagement of the Ministry of Health and other stakeholders as initiators, clear EBP team roles and expectations, including a strong leader, external support to strengthen EBP team capacity and cultural acceptance of the necessity of evidence-informed policy-making. Overall, the evaluation approach was considered feasible by the EBP teams and captured rich qualitative data, but may be limited by the absence of external reviewers and long lag times between the EBP process and the evaluation. CONCLUSIONS: This process occurs in a complex system and must be conceptualized in each country and each EBP project in a way that fits local policy-making culture, priorities, leadership and team styles, roles and available resources. The use of a rapid appraisal approach, combining qualitative interviews and document review, is a feasible method of process evaluation for EVIPNet member countries.

Prescribing Patterns and Variations of Antibiotic Use for Children in Ambulatory Care: A Nationwide Study.

The aim of this study was to analyse characteristics of paediatric antibiotic use in ambulatory care in Hungary. Data on antibiotics for systemic use dispensed to children (0-19 years) were retrieved from the National Health Insurance Fund. Prescribers were categorised by age and specialty. Antibiotic use was expressed as the number of prescriptions/100 children/year or month. For quality assessment, the broad per narrow (B/N) ratio was calculated as defined by the European Surveillance of Antimicrobial Consumption (ESAC) network. Paediatric antibiotic exposure was 108.28 antibiotic prescriptions/100 children/year and was the highest in the age group 0-4 years. Sex differences had heterogenous patterns across age groups. The majority of prescriptions were issued by primary care paediatricians (PCP). The use of broad-spectrum agents dominated, co-amoxiclav alone being responsible for almost one-third of paediatric antibiotic use. Elderly physicians tended to prescribe less broad-spectrum agents. Seasonal variation was found to be substantial: antibiotic prescribing peaked in January with 16.6 prescriptions/100 children/month, while it was the lowest in July with 4 prescriptions/100 children/month. Regional variation was prominent with an increasing west to east gradient (max: 175.6, min: 63.8 prescriptions/100 children/year). The identified characteristics of paediatric antibiotic use suggest that prescribing practice should be improved.

Содействие надлежащему использованию антибиотиков для сдерживания развития устойчивости к антибиотикам в медицине человека в Венгрии: Аналитический обзор EVIPNet для формирования политики, номер 2

Министерством человеческих ресурсов Венгрии была инициирована подготовка аналитического обзора – к публикации под эгидой Европейской сети по вопросам использования данных научных исследований при формировании политики (EVIPNet-Европа) – в целях выработки научно обоснованных вариантов реагирования на проблему ненадлежащего использования антибиотиков в стране. Эта задача выполнялась в рамках Двухгодичного соглашения о сотрудничестве (ДСС) между Министерством человеческих ресурсов и ВОЗ с участием национальных политикоформирующих учреждений высокого уровня и национальных экспертов, при поддержке технических специалистов Европейского регионального бюро ВОЗ. Национальным центром медицинских услуг Венгрии была создана рабочая группа, в которую вошли представители из областей клинической медицины, фармакологии, общественного здравоохранения и управления услугами здравоохранения. Участники рабочей группы осуществили поиск, отбор, оценку и синтез актуальных данных научных исследований по данной проблеме, определили три варианта для ее решения и рассмотрели соответствующие аспекты их реализации. К рассмотрению были предложены следующие варианты: разработка национальной программы ответственного руководства в сфере антибиотиков, предусматривающей выпуск научно обоснованных клинических руководств по диагностике и лечению распространенных инфекционных заболеваний; усиление программ высшего и последипломного образования в области медицины, стоматологии и фармацевтики и организация обучения разумному использованию антибиотиков; и повышение осведомленности о разумном использовании антибиотиков с помощью информационных кaмпаний, инфоматериалов и межличностного общения.

Az antibiotikumok felelős alkalmazásának ösztönzése az antibiotikum-rezisztencia visszaszorítására a humán gyógyászatban Magyarországon: EVIPNet Europe Szakpolitikai bizonyíték-összefoglaló, 2. szám

Az Emberi Erőforrások Minisztériuma (EMMI) megbízásából, az Egészségügyi Világszervezet (WHO) Bizonyítékokkal Támogatott Szakpolitikai Hálózatának (EVIPNet) égisze alatt szakpolitikai összefoglaló készült, amely bizonyítékokkal alátámasztott beavatkozási opciókat mutat be a nem megfelelő antibiotikum-alkalmazás problémájának kezelésére Magyarországon. A munkát vezető hazai szakpolitikai intézetek és szakértők végezték, az EMMI és a WHO közötti kétéves együttműködési megállapodás keretében, a WHO Európai Irodájának szakmai támogatásával. Az Állami Egészségügyi Ellátó Központ által létrehozott munkacsoportban infektológus, gyógyszerész, epidemiológus és egészségügyi menedzsmenttel foglalkozó szakemberek vettek részt. A munkacsoport azonosította, értékelte és feldolgozta a problémával, három szakpolitikai opcióval és azok implementációs megfontolásaival kapcsolatos kutatási bizonyítékokat. A három opció a következő: (1) nemzeti antibiotikum stewardship program (ASP) kialakítása, a gyakori fertőzések diagnosztizálására és kezelésére vonatkozó, bizonyítékalapú klinikai ajánlásokkal; (2) az antibiotikumok felelős felírásának hangsúlyosabb oktatása a graduális és posztgraduális orvosi, fogorvosi és gyógyszerészi tanulmányok és képzések során; és (3) a figyelem felhívása a helyes antibiotikum-alkalmazásra tájékoztató kampányok, szórólapok és interperszonális kommunikáció segítségével.

Promoting the appropriate use of antibiotics to contain antibiotic resistance in human medicine in Hungary: EVIPNet evidence brief for policy, number 2

The Ministry of Human Capacities of Hungary commissioned a policy brief, to be published under the aegis of the WHO Evidence-informed Policy Network (EVIPNet) Europe, to develop evidence-informed options for the country to consider in tackling the problem of antibiotic misuse. The task was implemented in frame of the Biennial Collaborative Agreement (BCA) between the Ministry of Human Capacities and WHO, involving high level national policy institutions and national experts, supported by the technical experts of WHO Regional Office for Europe. The National Healthcare Service Center of Hungary convened a working group comprising representatives from the clinical field, pharmacology, public health and health care management. The working group identified, selected, appraised, and synthesized relevant research evidence on the problem, three options for tackling it and considerations in implementing them. The three options are: developing a national antibiotic stewardship programme, complemented by evidence-informed clinical guidelines on the diagnosis and treatment of common infections; strengthening undergraduate and postgraduate medical, dental, and pharmacy education and training on the prudent use of antibiotics; and raising awareness of prudent antibiotic use through information campaigns, leaflets and interpersonal communication.

[25 years of the DRG-based health-financing system in Hungary]. / A Homogén Betegségcsoportok és a hozzá kapcsolódó finanszírozási rendszer elmúlt 25 éve.

After a thourough development phase, a new system of health financing was introduced in Hungary in 1993. One of the cornerstones of the system was the financing of acute hospital care through Diagnosis-Related Groups (DRGs). This method was part of a comprehensive healthcare model, elaborated and published around 1990 by experts of Gyógyinfok, a public institute. The health financing system that was finally introduced reflcted in large part this theoretical model, while the current Hungarian system differs from it in some important respects. The objective of this article is to identify these points of divergence.

[Novelties in the ongoing 11th revision of the International Classification of Diseases]. / Újdonságok a Betegségek Nemzetközi Osztályozásának készülo 11. kiadásában.

The development of the 11th revision of the International Classification of Diseases has been underway since 2007. The World Health Organisation, its coordinator, currently has scheduled its completion for 2017. The novel classification system has a similar high-level structure than the 10th revision of the International Classification of Diseases, while the entities are significantly more detailed and contain more parameters. The development process aims to harmonize the 11th revision definitions with the codes of other information technology systems, potentially allowing the statistical use of far more clinical information than at present. Meanwhile, this complex development process has confronted several difficulties. The developers are awaiting the comments of all professionals concerning the B-version of the system, available on the Internet.