A preliminary evaluation of a health monitoring programme in Hungary.

BACKGROUND: In 1998 a joint initiative of the Hungarian School of Public Health and the National Public Health Service created a network of sentinel stations based in primary care facilities in four Hungarian counties. The aim was to establish a system that will provide valid data on morbidity of selected diseases in Hungary. METHODS: Based on standardized protocols, the participating centres have continuously reported data on the prevalence of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and some malignant diseases, as well as supplying denominator data. The four counties represent both eastern and western parts of Hungary, reflecting the known geographical disparities in health. Each county office enrolled general practitioners maintaining representation in terms of both geography and distribution of settlement size. RESULTS: A total of 73 general practitioners agreed to participate, providing care for 15.6% (138,088 people) of the population in the counties. The population registered with the practices were representative in terms of age and sex of both the participating counties and the entire country. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in each county but varies considerably, with higher levels in the western counties, especially among older age groups of both sexes. CONCLUSIONS: The establishment of sentinel stations to collect morbidity data is feasible and sustainable in Hungarian primary care. The data that have been generated provide a valid and comprehensive picture of important aspects of the Hungarian population's health, with important implications for health policy and health service planning. In regions where low prevalence rates of diseases and high mortality rates simultaneously exist special attention is required to explore the background of this caveat. KEY POINTS: Till the end of 1998 no program operated in Hungary engaged with non-communicable disease morbidity data collection, except some hospital-based registries, which failed to produce reliable information. The establishment of sentinel stations to collect morbidity data is feasible and sustainable in Hungarian primary care, the valid morbidity data can be built into the decision making process in health service planning. Regular training, quality control and feedback are important contributors to the success of the program. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in each county but varies considerably, with higher levels in the western counties, especially among older age groups of both sexes. More research needed to determine the possible contribution of unknown morbidity and health service utilisation to the different prevalence values in the two parts of Hungary.

[Establishment and preliminary evaluation of the General Practitioners' Morbidity Sentinel Stations Program in Hungary. Prevalence of hypertension, diabetes mellitus and liver cirrhosis]. / Háziorvosi Morbiditási Adatgyújtés Program kidolgozása, elindítása és múködtetése Magyarországon. A magas vérnyomás, cukorbetegség és májzsugor prevalenciája.

STUDY OBJECTIVE: To develop, introduce and test a methodology, which provides valid data about the prevalence and incidence of chronic, non-communicable diseases of great public health importance. DESIGN: The School of Public Health, University of Debrecen, Hungary and the National Public Health and Medical Officer Service the first time launched a morbidity sentinel stations network of general practitioners in four counties in Hungary in May 1998. Within the framework of this program the participating general practitioners reported the prevalence data of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and major malignant diseases at the beginning, and from than on continuously report the incidence of these diseases. The authors built quality assurance into the program at different levels in order to ensure high quality data. PATIENTS: The study population consists of people belonging to the participating general practitioners' practices at any time, selected in a way to represent the eastern and western part of the country as well as the participating practices in the counties (Gyór-Moson-Sopron, Hajdú-Bihar, Szabolcs-Szatmár-Bereg, Zala) would give a geographically and according to settlement size representative sample of general practitioners in those counties. Eighty general practitioners were approached in the four counties by the county offices and overall 73 of them, 1.4% of the total practices in Hungary (5212), agreed to participate in the study, therefore information can be collected on 1.37% of the Hungarian population's (138,088 people) morbidity status. MAIN RESULTS: The population of practices participating in the program gives a representative sample of the counties population by age and sex. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in all the counties involved. In most of the selected diseases the authors have found differences in the prevalence between the eastern and western part of Hungary with higher values in the western counties. The differences were most apparent in the older age groups in both sexes. CONCLUSIONS: The development and sustainability of primary care based, sentinel stations type, euroconform morbidity data collection system is undoubtedly justified in Hungary. The collected and thoroughly analysed data provide not only a valid and comprehensive basis to describe some aspects of the health status of the Hungarian population but also gives an opportunity to continuously monitor the changes in morbidity of the selected diseases. Thus, the program serves an important basis for health care capacity building, priority setting and the evaluation of the effectiveness of public health interventions.