Qualitative assessment of opportunities and challenges to improve evidence-informed health policy-making in Hungary - an EVIPNet situation analysis pilot.

BACKGROUND: In evidence-informed policy-making (EIP), major knowledge gaps remain in understanding the context and possibilities for institutionalisation of knowledge translation. In 2014, the WHO Evidence-informed Policy Network (EVIPNet) Europe initiated a number of pilot countries, with Hungary among them, to engage in a 'situation analysis' (SA) in order to fill some of those gaps. This contribution discusses the results of the SA in Hungary on research-policy interactions, facilitating factors and potential barriers to establish a knowledge translation platform (KTP). METHODS: In line with the EVIPNet Europe SA Manual, a document analysis, 13 interviews, 3 focus group discussions with 21 participants, and an online survey with 31 respondents were carried out from April to October, 2015. A SA aims to assess the context in which EIP takes form and seeks opportunities to establish a KTP, so information was gathered on the current practice of EIP and knowledge translation, its relevant actors, enablers and barriers for EIP, and opinions on a future KTP. Methodological and researcher triangulation resulted in a narrative synthesis of data, including a comparison with literature. A stakeholder consultation was organised to validate findings. RESULTS: This study reveals that stakeholders show commitment to produce and use research evidence in Hungarian health policy-making. All stakeholders endorsed the idea of strengthening the systematic use of evidence in decision-making and favoured the idea of establishing a KTP. In line with literature on other countries, some good practices exist on the uptake of evidence in policy-making; however, a systematic approach of developing, translating and using research evidence in health policy processes is lacking. EIP is currently hampered by scattered capacity, coordination problems, high fluctuation in government, an often legalistic and a more 'symbolic' rather than practical support for knowledge translation and EIP. The article summarises recommendations on a Hungarian KTP. CONCLUSIONS: Pragmatic adaptation of the SA Manual to local needs proved to be a useful mechanism to provide insight into the Hungarian EIP field and the establishment of a potential KTP. Despite the success of a KTP pilot, it remains unclear how a KTP in Hungary will be institutionalised in a sustainable way.

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.

Perceptions of quality in primary health care: perspectives of patients and professionals based on focus group discussions.

BACKGROUND: The EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness. METHODS: The focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis. RESULTS: There were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness. CONCLUSIONS: This study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future.