Expectations, values, preferences and experiences of Hungarian primary care population when accessing services: Evaluation of the patient's questionnaires of the international QUALICOPC study.

BACKGROUND: Preferences and wishes of patients is an important indicator of primary health care provision, although there are differences between national primary care systems. AIM: The aim of this paper is to describe and evaluate the preferences and values of Hungarian primary care (PC) patients before accessing and to analyse their experiences after attending PC services. METHODS: In the Hungarian arm of the European QUALICOPC Study, in 2013-2014, information was collected with questionnaires; the Patient Values contained 19 and the Patient Experiences had 41 multiple-choice questions. FINDINGS: The questionnaires were filled by 2149 (840 men, 1309 women) using PC services, aged 49.1 (SD ± 16.7) years, 73% of them having chronic morbidities. Women preferred to be accompanied and rated their own health better. Patients in the lowest educational category and women visited their GPs more often, and they are consulted more frequently by other doctors as well. Men, older and secondary educated people reported more frequently chronic morbidities. Longer opening hours were preferred by patients with higher education. The most preferred expectations were availability and polite communication of doctors, not pressures on consultation time, clear instructions provided during consultations, shared decisions about treatments and options for consultations, the knowledge of the doctors concerning the living conditions, social and cultural backgrounds of patients, updated medical records, short waiting times, options for home visits, wide scope of professional competences and trust in the doctor. CONCLUSION: Wishes, preferences of patients and fulfilment were similar than described in other participating countries of the study. Although there are room to improve PC services, most of the questioned population were satisfied with the provision.

Discharge Criteria for Bronchiolitis: An Unmet Need.

BACKGROUND: Admission criteria and standardized management strategies for bronchiolitis are addressed in several guidelines and have shown to be beneficial; however, guidance regarding discharge criteria is limited and widely variable. We assessed the impact on clinical outcomes of a discharge protocol for children <2 years of age hospitalized with bronchiolitis in a tertiary care pediatric hospital. METHODS: In October 2013, a protocol to standardize the discharge of children with bronchiolitis was implemented in the infectious diseases (ID) ward but not in other pediatric units caring for these children (non-ID). The protocol included objective clinical criteria and a standardized oxygen weaning pathway. Patients were identified via International Classification of Diseases-9 codes and data manually reviewed. We compared length of stay (LOS) and readmission rates within 2 weeks of discharge according to protocol implementation (ID versus non-ID), adjusted for demographic factors, comorbidities, viral etiology and stratified by pediatric intensive care unit admission. RESULTS: From October 2013 to May 2015, 1118 children were hospitalized in ID and 695 in non-ID units. Median age was 4.5 months, 55% were males and 28% had comorbidities. LOS was 36% longer in non-ID units (risk ratio: 1.36 [1.27-1.45]; P < 0.001) adjusted for age, gender, comorbidities and viral etiology. Difference in LOS remained significant after excluding children with comorbidities and stratifying by pediatric intensive care unit admission. Readmission rates were comparable between units (ID, 2.9% versus non-ID, 2.6%). CONCLUSIONS: A standardized discharge protocol for bronchiolitis reduced LOS without increasing readmission rates. Unifying bronchiolitis discharge criteria and oxygen weaning pathways could positively impact hospital-based patient care for this condition.

[Patient satisfaction with care in gastrooesophageal reflux disease]. / A gastrooesophagealis refluxban szenvedo betegek elégedettségének felmérése.

INTRODUCTION: Besides medical treatment, adequate communication and personal relationships between physicians and patients are the most important determinants of patient satisfaction. AIM: To explore doctor-patient relationships, and factors that may determine patient satisfaction with care. METHOD: Patients with gastroesophageal reflux (n = 80) were divided into subgroups treated by family doctors or by gastroenterologists. Patients were asked to fill in a questionnaire about communication and patient satisfaction. RESULTS: Significantly more patients visited family doctors than gastroenterologists with health problems (80%; 20%, p < 0.001). Patients were significantly more satisfied with the information they received about the process of care provided by family doctors (95%) compared to that they obtained from gastroenterologists (65%; p = 0.002). Significantly more patients in family practices indicated that their doctors spent enough time with them compared to subspecialists (96.7%; 80% p = 0.032). CONCLUSIONS: Patients develop a closer personal relationship and more appropriate communication with family doctors compared to specialists, which can be an important component of successful treatment.

[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.

[Level of knowledge among patients treated with oral anticoagulant]. / A per os antikoagulált betegek tudásszintje.

UNLABELLED: Hospitalization attributable to gastrointestinal and other major bleeding is frequently associated with acenocoumarol treatment. AIMS: To assess the level of knowledge among patients in respect to harmful adverse effects, interactions with medication and nutrition regarding acenocoumarol treatment. METHODS: Questionnaires consisting of 66 questions were completed in offices of family doctors (77), and during consultations at the 3rd Department of Internal Medicine (80). RESULTS: 157 patients (male:female=45:55; age=65.5 years) were involved. In the group informed by the whole team (doctors, nurses and dietitians) everyone heard about the possible adverse effects. In the group where family doctors or other specialists provided information, 14.5% or 31.1% did not hear about any side-effect. The importance of diet was unknown by 71.4% of the patients. The knowledge of interactions between acenocoumarol and other medications is low: aspirin was known by 24.4%, analgetics by 23.0% and vitamin K by 18.6% of the patient. CONCLUSIONS: Regarding acenocoumarol treatment, patients' knowledge should be enlarged. However, it can be significantly improved by the contribution of other team members such as nurses and dietitians.