Health mediators as members of multidisciplinary group practice: lessons learned from a primary health care model programme in Hungary

Abstract

Background A Model Programme of primary care group practices was implemented in Hungary between 2013 and 2017 – where virtually all GPs had worked in single practices – aiming to increase preventive service uptake and reduce inequalities based on a bilateral agreement between the Swiss and Hungarian governments. Group practices employed a wide variety of health professionals as well as support workers called health mediators. Employment of the latter was based on two decades of European experience of health mediators who specifically facilitate access to and use of health services in Roma minority groups. Health mediators had been recruited from local communities, received training on the job, and were tasked to increase uptake of new preventive services provided by the group practices by personal contacts in the local minority populace. The paper describes the contribution of the work of health mediators to the uptake of two new services provided by group practices. Methods Quantitative analysis of depersonalized administrative data mandatorily reported to the Management of the Programme during 43 months of operation was carried out on the employment of health mediators and their contribution to the uptake of two new preventive services (health status assessment and community health promoting programmes). Results 80% of all clients registered with the GPs participated at health status assessment by invitation that was 1.3–1.7 times higher than participation at the most successful national screening programmes in the past 15 years. Both the number of mediator work minutes per client and participation rate at health status assessment, as well as total work time of mediators and participants at community health events showed high correlation. Twice as many Roma minority patients were motivated for service use by health mediators compared to all patients. The very high participation rate reflects the wide impact of health mediators who probably reached not only Roma minority, but vulnerable population groups in general. Conclusion The future of general practices lays in multidisciplinary teams in which health mediators recruited from the serviced communities can be valuable members, especially in deprived areas.

Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model programme in Hungary

“…Health mediators recruited from the serviced vulnerable communities had been employed as members of the primary care teams as described in detail in the Programme's Operations Manual [14]. The work responsibilities and contribution of health mediators in this Programme were described in detail elsewhere [15]. Briefly, four groups of general practitioners were established as primary care group practices (called "GP clusters").…”

“…The main task of the health mediators was mediating between professionals in primary care and the local population, with special attention to those living in disadvantaged socio-economic conditions. In particular, they were responsible for increasing attendance at the health status assessment, a general screening for all adults of the GPs based on a specified screening protocol [15]. Adult patients of the GPs were invited by letter for the assessment, and health mediators had to get in touch with those who did not show up and persuade these people to go.…”

Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model program in Hungary

“…The main task of the health mediators was mediating between professionals in primary care and the local population, with special attention to those living in disadvantaged socio-economic conditions. In particular, they were responsible for increasing attendance at the health status assessment, a general screening for all adults of the GPs based on a speci ed screening protocol [15]. Adult patients of the GPs were invited by letter for the assessment, and health mediators had to get in touch with those who did not show up and persuade these people to go.…”

Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model program in Hungary

“…Health mediators recruited from the serviced vulnerable communities had been employed as members of the primary care teams as described in detail in the Programme's Operations Manual [ 14 ]. The work responsibilities and contribution of health mediators in this Programme were described in detail elsewhere [ 15 ]. Brie y, four groups of general practitioners were established as primary care group practices (called "GP clusters").…”