Factors Associated with Practice-Level Performance Indicators in Primary Health Care in Hungary: A Nationwide Cross-Sectional Study

Abstract

The performance of general practitioners (GPs) is frequently assessed without considering the factors causing variability among general medical practices (GMPs). Our cross-sectional national-based study was performed in Hungary to evaluate the influence of GMP characteristics on performance indicators. The relationship between patient’s characteristics (age, gender, education) and GMP-specific parameters (practice size, vacancy of GP’s position, settlement type, and county of GMP) and the quality of care was assessed by multilevel logistic regression models. The variations attributable to physicians were small (from 0.77% to 17.95%). The education of patients was associated with 10 performance indicators. Practicing in an urban settlement mostly increased the quality of care for hypertension and diabetes care related performance indicators, while the county was identified as one of the major determinants of variability among GPs’ performance. Only a few indicators were affected by the vacancy and practice size. Thus, the observed variability in performance between GPs partially arose from demographic characteristics and education of patients, settlement type, and regional location of GMPs. Considering the real effect of these factors in evaluation would reflect better the personal performance of GPs.

Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary

“…Rather, the free choice of GPs in Hungary, which results in shifting patients from less to more intensive care, may be responsible for this finding. The negative influence of retirement, age of GP and the positive influence of more specialized (adults only) GMPs are in good concordance with the published observations [37,64,65].…”

“…Moreover, GP interventions reduce the disadvantage some social groups have in access to higher tech medical treatments. The effect of the size of a general medical practice (GMP) on health outcome and spending was inconclusive in international studies [36][37][38]. Additionally, the age, gender and vacancy of a GP seems to have only limited effect [37,39,40].…”

Effectiveness of COVID-19 Vaccination in Preventing All-Cause Mortality among Adults during the Third Wave of the Epidemic in Hungary: Nationwide Retrospective Cohort Study

“…The results of previous domestic research have shown that the quality of primary care varied by the structural characteristics of GMPs in the prepandemic period [ 27 , 28 , 29 ]; therefore, we hypothesized the same during the pandemic period. However, GMP attributes had no remarkable role, suggesting that adjustment for these factors is not important in general mortality monitoring.…”

“…GPs had to organize vaccination-related tasks in parallel with the maintenance of primary care adapted to pandemic circumstances. Because the quality of primary care varied by the structural characteristics of the general medical practices (GMPs) in the prepandemic period [ 27 , 28 , 29 ], the quality of this adapted care probably operated with variability in the pandemic period as well.…”

Reimbursed medication adherence enhancing interventions in 12 european countries: Current state of the art and future challenges

“…In the past few years, several MAEIs have been implemented in Hungary. In 2009, the National Health Insurance Fund (NEAK) established an indicator system for primary healthcare, which directly targets medication adherence ( Kovács et al, 2019 ; NEAK, 2019 ). The system provides financial incentives for general practitioners (GPs) who reach the desired target values.…”