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      Comparison of Cardiovascular Risk Screening Methods and Mortality Data among Hungarian Primary Care Population: Preliminary Results of the First Government-Financed Managed Care Program Translated title: Primerjava Metod Presejanja Ogroženosti Srčno-žilnega Sistema in Podatkov o Smrtnosti Madžarskega Prebivalstva z Osnovno Zdravstveno Oskrbo: Predhodni Rezultati Prvega Programa Vodene Oskrbe, Ki Ga Je Financirala Vlada

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          Abstract

          Introduction

          Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the characteristics of individual primary care practices and doctors’ screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings.

          Method

          4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data.

          Results

          The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data.

          Conclusion

          This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.

          Translated abstract

          Uvod

          Poleg primarne preventive je presejanje kot sekundarna preventiva pomemben člen pri storitvah osnovnega zdravstvenega varstva. Na uspešnost tovrstnega dela vplivajo značilnosti posameznih splošnih ambulant varstva in pripravljenost zdravnikov za izvajanje presejalnih pregledov kot tudi ureditev procesov presejanja in razpoložljivih finančnih virov. Med leti 1999 in 2009 je bil v Madžarski uveden in izpeljan program vodene oskrbe, ki ga je financirala vlada. Ta finančna podpora in spodbuda je omogočila priložnost za povečanje števila presejalnih pregledov.

          Metode

          4462 pacientov iz 40 splošnih ambulant je bilo vključenih v presejalni pregled v sklopu ocene tveganja SCORE. Rezultate presejanja se je primerjalo na podlagi dveh skupin pacientov, in sicer tistih, ki so bili predhodno presejani (metoda predhodnega presejanja) za znane dejavnike tveganja v njihovi zdravstveni anamnezi (kajenje, indeks telesne mase, starost, zgodovina srčno-žilnih obolenj) ter tistih, ki so bili presejani naključno. Avtorji so primerjali tudi podatke sodelujočih splošnih ambulant o smrtnosti z regionalnimi in nacionalnimi podatki.

          Rezultati

          Povprečen rezultat je bil bistveno višji v predhodno presejani skupini pacientov, ne glede na to, ali so bili dejavniki tveganja upoštevani posamično ali v kombinaciji. Smrtnost je bila bistveno nižja pri sodelujočih splošnih ambulantah, kot je bilo pričakovati na podlagi nacionalnih podatkov o smrtnosti.

          Zaključek

          Ta program, ki ga je financirala država, je pomenil velik korak naprej k ustanovitvi ustrezne metode presejanja znotraj madžarskega sistema osnovne zdravstvene oskrbe. Izvajanje presejanja za ogroženost srčno-žilnega sistema pri izbrani skupini je očitno bolj primerno od naključnih pregledov. Obe metodi sta vidno prispevali k izboljšanju regionalnih podatkov o smrtnosti, čeprav je precej verjetno, da se s predhodnim presejanjem doseže bolj stroškovno učinkovita izbira presejanj.

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          Most cited references13

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          Screening for cardiovascular risk: public health imperative or matter for individual informed choice?

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            Do family physicians need more payment for working better? Financial incentives in primary care

            Introduction Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. Objective Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. Methods Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. Results Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. Conclusions The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well.
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              International Classification of Diseases Version 10

              (2005)
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                Author and article information

                Journal
                Zdr Varst
                Zdr Varst
                SJPH
                Slovenian Journal of Public Health
                De Gruyter Open
                0351-0026
                1854-2476
                September 2015
                09 June 2015
                : 54
                : 3
                : 154-160
                Affiliations
                [1 ]Irinyi Health Center, General Practice, 22.sz.Irinyi utca, Kecskemét, 6000, Hungary
                [2 ]University of Debrecen, Department of Family and Occupational Medicine, Egyetem tér 1, 4032 Debrecen, Hungary
                Author notes
                [* ] Corresponding author: Tel: +363 0229 37 95; E-mail: moczarcsa@ 123456gmail.com
                Article
                sjph-54-03-154
                10.1515/sjph-2015-0022
                4820151
                27646722
                7df0dda2-04ec-4ae5-936f-a8f35424affb
                © National Institution of Public Health, Slovenia

                This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License (CC BY-NC-ND 3.0).

                History
                : 07 July 2014
                : 06 January 2015
                Categories
                Original Scientific Article

                cardiovascular screening,mortality,hungary,managed care,primary health care

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