[QUALICOPC -- primary care study on quality, costs and equity in European countries: the Hungarian branch]. / QUALICOPC -- az alapellátás minoségének, költségének és méltányosságának vizsgálata Európa országaiban: magyarországi ág.

The importance of primary care has already been recognized in the developed countries, where the structure and function of primary care is very heterogeneous. In the QUALICOPC study, the costs, quality and equity of primary care systems will be compared in the 34 participating countries. Representative samples of primary care practices were recruited in Hungary. An evaluation with questionnaire was performed in 222 practices on the work circumstances, conditions, competency and financial initiatives. Ten patients in each practice were also questioned by independent fieldworkers. In this work, the methodology and Hungarian experience are described. The final results of the international evaluation will be analyzed and published later. It is expected that data obtained from the QUALICOPC study may prove to be useful in health service planning and may be shared with policy makers.

Maternity care and birth preparedness in rural Kyrgyzstan and Tajikistan.

OBJECTIVE: To assess a baseline level of maternity care knowledge of the population and of care providers in rural areas in Kyrgyzstan and Tajikistan (Central Asia). METHODS: Interviews with pregnant women and with men about their knowledge of key danger signs, serious health problems during pregnancy, labour and childbirth, and knowledge of basic infant care. Questionnaires about maternity care knowledge for providers, and checklists about providers' communication and counselling skills and about facilities completed by observers. RESULTS: Level of knowledge among the population about possible complications during pregnancy and the postpartum period was low. Physicians in Kyrgyzstan scored an average of 55.2% correct answers on 52 knowledge questions about maternity care. Midwives and nurses in Kyrgyzstan, physicians and midwives in Tajikistan, scored on average less than 50% correct answers. In Kyrgyzstan, in seven out of 15 facilities (47%) staff was permanently available for treatment and referral of patients (24h a day, 7 days a week). In Tajikistan this was the case in only 2 of 17 facilities (12%). CONCLUSION: Kyrgyz and Tajik women and men have limited knowledge about possible complications during pregnancy, childbirth, and the period after childbirth. Service providers do not have an adequate professional level of knowledge of perinatal health issues and lack basic skills to monitor their work.

Gender-related differences in the organization and provision of services among general practitioners in Europe: a signal to health care planners.

BACKGROUND: The number of women entering general practice is rising in many countries. Thus, gender differences in work situation preferences and practice activities are important for future planning. OBJECTIVES: This article describes the differences between male and female general practitioners (GPs) in 32 European countries. It examines gender differences in curative and preventive services and relates these to features of the health care system and the practice. METHODS: The data were collected in 1993 and 1994 in the European Study of Task Profiles of General Practitioners. In 32 countries, 8,183 GPs answered standardized questionnaires written in their own languages on their self-reported involvement in curative and preventive services, as well as how their practice was organized and managed. Because the independent variables in this study were on both the national 1 and individual practice levels, the data were subjected to multilevel analysis. RESULTS: Regardless of the type of health care system, the female GPs were younger than the male GPs and more often worked part time in groups or partnerships and in cities, although not in deprived areas. They made fewer house calls and did less work outside office hours. Differences between men and women regarding workload diminished considerably after controlling for part-time work. When other characteristics of the person and the practice were taken into account, female GPs proved to be less involved in several curative services, except as the first contact for gynecological problems, but more involved in health education. Some differences were found in only certain types of health care systems. CONCLUSIONS: The results may have important implications for working arrangements, training, education, and planning of resources for general practice in the future.

Science in practice: can health care reform projects in central and eastern Europe be evaluated systematically?

Since the beginning of the 1990s, health care reform projects have taken place in many of the former Communist countries, but these projects are rarely evaluated systematically. Evaluation, however, is an important tool for increasing their rationality and continuity. The aim of this paper is to identify the difficulties in the efforts towards systematic evaluation and draw lessons for the future. For this aim, the requirements for a more rigorous, controlled evaluation are compared with our experiences of evaluating a health care reform project in the Slovak republic. From this comparison a number of discrepancies arise: it was difficult to set clear and realistic goals at the start of the project; the outcomes of the project could not always be measured, nor could 'the process' always be distinguished from the outcomes. Systematic evaluation was further hampered by an insufficient degree of structuration of the project, in advance and during the implementation, and by the absence of a tradition and infrastructure for data collection. On the basis of the experiences and relevant literature, recommendations for future evaluations are formulated. The main lesson is that, given the context, often it will not be possible to use an ambitious evaluation design, and concessions need to be made. At the same time, continuous efforts towards more systematic evaluation procedures should be made, but it is wise and more sustainable to do this in an incremental way.

The general practitioner as the first contacted health professional by patients with psychosocial problems: a European study.

BACKGROUND: There are considerable differences between and within countries in the involvement of general practitioners (GPs) in psychosocial care. This study aimed to describe the self-perceived role of GPs in 30 European countries as the first contacted professional for patients with psychosocial problems. and to examine the relationship with characteristics of the health care system, practice organization and doctors. METHODS: Data collected in the European Study of GP Task Profiles were analysed in relation to the self-perceived involvement of GPs in psychosocial care. In 30 countries 7233 GPs answered standardized questionnaires in their own languages about seven brief case scenarios. The questions focused on care given as the first health care professional contacted, and were answered in a scored scale (1-4) ranging from 'never' to 'almost always'. Independent variables examined were both on a national level and on an individual level, including: listed practice population, referral system, employment status of GPs, workload, measures of practice organization, contacts with social workers and urbanization of practice area. Data were analysed using multi-level techniques. RESULTS: Self-perceived involvement in psychosocial care was much higher in Western than in Eastern Europe and also in countries with a referral system. Cooperation with social workers, rural practice, keeping medical records, presence of an appointment system and high workload were positively associated with this perceived involvement. CONCLUSIONS: In countries with self-employed doctors and a referral system, GPs are in a better position to provide psychosocial care. GPs should be encouraged to cooperate with social workers and to keep medical records of their patient contacts routinely.

General practice in urban and rural Europe: the range of curative services.

The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely available than in the countryside, where GPs often are the only providers. With highly mobile populations and a plentiful supply of doctors, in cities the prevailing regulations for access and use of services are more difficult to maintain. It is also more difficult to control access and thus opportunities for inappropriate use are greater. Against this background an international study was conducted on variation in task profiles of GPs, especially focusing on differences between urban and rural practices. In 1993 standardised questionnaires in the national languages were sent to samples of GPs in 30 countries. Various aspects of service provision were measured as well as practice organisation, location of the practice and personal backgrounds of the GP. Completed questionnaires were received from 7,233 respondents, an overall response rate of 47%. Sources of variation have been analysed by using a two-level model. Rural practices provided more comprehensive services regardless of the health care system. Approximately half of the variation was explained by features of a country's health care system. The GP's position at the point of access to health care was strongly associated with the gatekeeper function controlling access to secondary care. In western countries where the GPs were self employed they had greater involvement in technical procedures and chronic disease management. There was a considerable gap between the task profiles of GPs in eastern and western Europe. We found evidence of a reduced gatekeeper role in inner cities in those countries where GPs held this position. GPs with an estimated overrepresentation of socially deprived people and elderly in the practice population reported a wider range of services. Differences also appeared to be related to factors which are largely controlled by the individual doctor, such as level of training and education, availability of equipment and practice staff. The results have important implications for education, policy development and health care planning both in eastern and western Europe.

Service profiles of general practitioners in Europe. European GP Task Profile Study.

BACKGROUND: General practice is the focal point of primary care. There are national differences in the structure and organization of practice, the relationship with secondary care is being redefined, and in some countries major changes are taking place. AIM: To describe and examine differences in the service profiles of general practitioners (GPs) in European countries. METHOD: Standardized questionnaires in the national languages were sent to samples of GPs in 1993. Four areas of service provision were measured: the GP's position in the first contact with selected health problems, the involvement in minor surgery and the application of medical procedures, disease management and preventive care. The importance of the gatekeeping role, remuneration system, and geographical region in Europe was examined by comparing scores in appropriate national groupings. RESULTS: Data were received from 7233 GPs in 30 countries. Most national samples were random and the average response rate was 47%. In countries where GPs have a gatekeeping role, they had a relatively stronger position as doctors of first contact. In those countries where GPs were usually self-employed, they had a stronger role in disease management and screening for blood cholesterol. In the examination of the three structural elements of health care, the most striking differences were evident in the comparison between eastern and western Europe. GPs throughout Europe had a comparatively small role in organized health education. CONCLUSION: The position of GPs is weak in eastern Europe and some Mediterranean countries, where service profiles have a limited range. General practice was more comprehensive where the doctors had a gatekeeping role.

Local housing scheme and political preference as conditions for the results of a health centre-stimulating policy in The Netherlands.

About two decades ago, changes in the demand for primary care in the Netherlands resulted in a need for more interprofessional collaboration. Health centres developed as a new supply of integrated care. The government was aware of the importance of this phenomenon in its policy to strengthen primary care. The encouragement of health centres was a crucial part of it. The development of this policy and the resulting growth in the number of health centres will be reviewed here. In general, this growth is lagging behind initial policy expectations, partly because of a lack of instruments to implement PHC policy. Examination of geographical distribution of health centres, however, shows a variation suggesting that local factors also affect the development of health centres. Empirical findings show that the number of newly built houses in an area and the political 'colour' of the alderman for public health play a role in the development of health centres and thus co-determine the results of a central promotion policy to a certain extent.