The impact of digital healthcare and teledentistry on dentistry in the 21st Century: a survey of Hungarian dentists

BACKGROUND

The era of digitalization has arrived in the field of dentistry. Teledentistry (TD), the use of digital solutions in dentistry, is already used in practice; however, only some possibilities are considered. During the COVID-19 pandemic, remote patient monitoring and patient communication had to be solved with TD, thus causing a rapid spread of new tools. In addition to digital workflows, patient communication, AI, and online forums are also available.

METHODS

An online self-administered survey was developed for the study. The Hungarian Medical Chamber contacted potential respondents in a newsletter or e-mail. The Evasys survey system was used. The weighting procedure was executed for gender, age group, and type of settlement. A digital dental index variable was created and built with a linear regression model as a dependent variable. Explanatory variables are advantages, disadvantages, what would be necessary, experienced needs from the patients, and age.

RESULTS

A total of 171 dentists completed the survey. The best-known digital technologies are online conferences (96.5%), E-prescriptions (94.6%), and digital impressions (86.0%). Unawareness is the highest in the field of artificial intelligence in dentistry (50.5%), store-forward solutions (43.5%), and real-time solutions (41.8%). The digital dental index is 14.24 (standard deviation (SD) = 5.5), with a high power of the model.

CONCLUSION

Hungarian dentists need to be made aware of all the possibilities of TD. In addition to digital workflows, store-forward and real-time solutions can be beneficial to substitute face-to-face visits. TD can be used effectively to monitor oral cavity changes and develop dental confidence and proper oral care habits. Our survey suggests that it is necessary and inevitable to integrate TD into both graduate and postgraduate education, which may form the basis of primary health care in the next decade.

Older adults in the digital health era: insights on the digital health related knowledge, habits and attitudes of the 65 year and older population

BACKGROUND

The COVID-19 pandemic has increased internet use by older age groups to an unprecedented level in Hungary mirroring the general tendency in the total population. Nevertheless, international trends indicate that this group is less likely to use digital health technologies than younger ones. The aging population raises the question of successfully integrating elderly people into the digital health ecosystem. Our research aim is to investigate the digital health usage patterns and attitudes of the population aged 65 and over through a representative sample.

METHODS

A national representative questionnaire survey was conducted by telephone (CATI), interviewing 1723 respondents. Within this sample we examined 428 people in the over-65 age group, 246 in the 65-74 age group and 182 in the over-75 age group. Predictors of demand for digital solutions were tested using binary logistic regression model.

RESULTS

50.8% of people aged 65-74 and 37.1. % of people aged 75 + use the internet for health-related purposes, mostly to access websites. 85% of respondents in 65-74 and 74% in 75 + age group have used more than one digital health device and around 70% of both age groups have a need for more than one digital solution. 90.2% (64-75 age group) and 85.7% (75 + age group) of respondents are familiar with e-prescription, 86.4% and 81.4% of them use it. 77.1% of 65-74-year-olds have heard of and nearly half 45.5% have used online appointment. More than half (52.7%) of the respondents in this age group have heard of and used electronic transmission of medical records and data. A similar proportion has heard about and used apps: 54.3% has heard of them, but only 17.3% has used them. The multivariate analyses emphasized that the need for digital solutions increases with the level of education and the more benefits one perceives in using digital solutions.

CONCLUSION

Our research has shown that the senior age group has measurable needs in the field of digital health, so helping them on this journey is in the interest of the whole health ecosystem. Their high level of interest is indicated by the fact that more than a fifth of older adults would like to have access to between 7 and 10 of the maximum number of digital devices available. The differences between the two age groups - with younger people being more open to digital solutions and using them more - and the fact that the under 65s are better adapted digitally in all respects, raises the possibility that the specific trends in digital health for older people may virtually disappear in 10 years' time (when the under 65s now enter this age group).

[E-physicians in Hungary: Experiences and opinions related to digital health among Hungarian physicians]

INTRODUCTION

The digitalization of healthcare is one of the most topical issues in terms of the present and future of healthcare. The coronavirus pandemic has shed light on the potential inherent in these technologies, and at the same time brought to the surface countless tasks and problems that need to be solved.

OBJECTIVE

In our national survey, our aim is to find out how medical doctors are adapting to digital healthcare solutions.

METHOD

Between July 2021 and May 2022, we conducted an online questionnaire survey among doctors working in Hungary. 1774 people answered our questions, including 1576 general practitioners and 198 dentists. In this paper, the 1576 general practitioners' responses are presented.

RESULTS

78.8% of the respondent doctors recommend websites to their patients on a more or less regular basis, 52.8% have recommended apps and 46.0% have recommended social media resources. The respondent doctors perceive a high demand from patients for communication by e-mail (83.7% indicated). 86.4% of doctors are aware of telemedicine solutions and 47.5% of respondents would like to use them intensively in the next 3 years. A significant proportion of respondents would like to use apps (56.2%), sensors, portable diagnostic devices (49.0%) and artificial intelligence (28.3%) in the next 3 years. Websites, apps and social media resources are significantly more frequently recommended by general practitioners and they are the ones who are most in favour of the use of the internet for patient health and telemedicine.

CONCLUSION

Our respondents manifest fundamentally positive feelings towards the digitalization of healthcare and are characterized by a cautious openness regarding the implementation and adaptation of technologies. Orv Hetil. 2023; 164(4): 132-139.

Telemedicine in community shelters: possibilities to improve chronic care among people experiencing homelessness in Hungary

BACKGROUND

Digital health has expanded during the COVID-19 pandemic, while the exclusion of vulnerable populations with limited access to these technologies widens the gap to receive proper care. There is very little data available on the feasibility of telemedicine solutions regarding the chronic care of homeless persons.

METHODS

In our study, 75 participants experiencing homelessness were recruited from four social institutions in Budapest, Hungary. The telecare pilot service consisted of six online consultations with a physician and was available in shelters biweekly. Self-developed questionnaires were used after every online session on the originating and remote sites as well, while a follow-up study was also completed among patients after four to six months of pilot closure. Parameters as frequencies, averages, and percentage distributions were analyzed and two linear regression models were built on explaining the doctors' and patients' overall rating of visits.

RESULTS

During the pilot, 92.2% (n = 415) of originally planned visits were delivered and 55 clients (73.3%) attended the full program. Both the patients' and physicians' overall satisfaction was very high (4.52 and 4.79, respectively, on a 5-point Likert scale) and the patients' overall rating remained similarly high during the follow-up. Comparing the first and sixth visits, physicians reported significant improvements in almost all aspects. The linear regression models proved that confidence in the patients' assessment and diagnosis had the most prominent effect on the physicians' overall rating, while ease of use and lack of communication gaps influenced positively the patients' rating.

CONCLUSION

The results suggest that telehealth services represent a promising tool to ensure better care continuity while using shelter infrastructure and on-site assistance might reduce the digital exclusion of people experiencing homelessness.

Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey

Background

In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care.

Objective

However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system.

Methods

Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons.

Results

The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions.

Conclusions

Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.

E-páciensek Magyarországon: Digitális egészséggel kapcsolatos ismeretek, szokások egy országos reprezentatív felmérés tükrében

Bevezetés: A digitalizáció egészségügyre gyakorolt hatása az elmúlt évek egyik legfontosabb kutatási területévé vált. E folyamatot a COVID–19-járvány is jelentősen katalizálta. Célkitűzés: Országosan reprezentatív, lakossági kutatásunkban (n = 1500) arra kerestünk választ, hogy a magyarországi páciensek miként használják a digitális egészség eszköztárát, milyen előnyöket, hátrányokat jelent ezeknek a technológiáknak a bevezetése és alkalmazása, és hogyan alakítja át mindez az orvos-beteg kapcsolatot. Módszer: Országos reprezentatív kérdőíves felmérést végeztünk, telefonos megkereséssel (CATI), 1500 fő megkérdezésével. A minta nem, kor, településtípus és iskolai végzettség tekintetében reprezentálja Magyarország nagykorú lakosságát. Eredmények: A válaszadók 81,3%-a használja az internetet, a használók 87,6%-a – ez a teljes minta 71,2%-át jelenti – egészséggel, betegséggel kapcsolatban is. Az internetes tájékozódás legfontosabb forrásai a weboldalak (76,3%) és a közösségi média (47,3%). Az e-receptet és az online időpontfoglalást ismerik a páciensek közül a legtöbben (92,6% és 85,2%), ugyanakkor a megkérdezettek közel fele kipróbálná a távvizitet, és szívesen venné, ha orvosa ajánlana neki hiteles weboldalakat, applikációkat és szenzorokat. Eredményeink azt mutatják, hogy a településtípus hatása a digitális egészségüggyel kapcsolatos kérdésekben nem jelentős, ugyanakkor az életkor, az iskolai végzettség és a nem hatása számottevő. Következtetés: Országos, reprezentatív lakossági felmérésünk adatai azt mutatják, hogy a digitális egészségügyi megoldások használata már jelenleg is az ellátás integráns része, ugyanakkor nagymértékű igény rajzolódik ki a további digitális lehetőségek irányában is. Orv Hetil. 2022; 163(29): 1159–1165.

Emlőrákban megbetegedett nők perioperatív viszonyulása a komplementer és alternatív medicinához az Országos Onkológiai Intézetben végzett felmérés alapján

Összefoglaló. Bevezetés: A komplementer és alternatív medicina (KAM) egyre népszerűbb a daganatos betegek körében világszerte. Az emlőrákkal diagnosztizált nők 45%-a használ KAM-ot, a fiatalabb betegek 62,5%-a. Magyarországon eddig egyetlen tanulmány jelent meg a témában, mely szerint a magyar, emlődaganattal küzdő nők 84,4%-a használ valamilyen komplementer terápiát. Egyes KAM-modalitások alkalmazása a gyógyszerkölcsönhatások miatt kockázatot hordoz. Fontos megismernünk a magyar páciensek igényeit és szokásait a KAM-használattal kapcsolatban, mely ismeret a klinikai gyakorlatban közvetlenül hasznosítható. Célkitűzés: Vizsgálatunk célja a magyar emlőrákos nők körében felmérni a KAM alkalmazásának mértékét, megvizsgálni ennek okait és az ezzel összefüggő demográfiai, pszichológiai és klinikai faktorokat. Módszer: Kérdőíves vizsgálatunkat az Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztályán végeztük az osztályon bent fekvők körében (n = 146). Felmértük a szociodemográfiai adatokat, a KAM-használat jellemzőit, a KAM iránti attitűdöt és az egészségkontroll-igényt. A kérdőív adatait klinikai adatokkal egészítettük ki. Eredmények: A válaszadók 36%-a felkeresett KAM-szolgáltatót, 71%-a használ KAM-készítményt, és 64%-a alkalmaz önsegítő gyakorlatot. Ezekről a betegek többsége egészségügyi szakembertől tájékozódik. A mintában a holisztikus szemlélet, valamint a belső és a társas külső kontroll dominál. A KAM-szolgáltatókat felkeresőknek és a KAM-készítményt alkalmazóknak erősebb a belsőkontroll-igényük. A KAM-szolgáltatást vagy önsegítő gyakorlatot alkalmazók kedvezőbben ítélik meg saját egészségi állapotukat. Következtetés: A betegeknek a számukra fontos személyektől, elsősorban a kezelőszemélyzettől kapott információ döntő az egészségükkel kapcsolatos viselkedésben, közöttük a KAM-választásban. Fontos látnunk a páciensek nagyfokú bizalmát az egészségügyi szakemberek iránt és erős igényét a KAM-mal kapcsolatos információk megbeszélésére, valamint az egészségük iránt érzett felelősségvállalásra és a kezelésben való aktív részvételre. Orv Hetil. 2022; 163(9): 350–361.

Summary. Introduction: The popularity of complementary and alternative medicine (CAM) is increasing among cancer patients worldwide. 45% of women diagnosed with breast cancer use CAM, 62.5% of younger patients do so. So far, only one study has been published in Hungary, according to which 84.4% of Hungarian women with breast cancer use some form of complementary medicine. The utilization of some CAM modalities carries risks due to drug interactions. It is important to get to know the needs and habits of Hungarian patients in relation to CAM, which knowledge can be directly used in clinical practice. Objective: The aim of our study was to assess the extent of CAM utilization among Hungarian breast cancer patients, to examine the reasons behind this choice, and to see the relating/connecting demographic, psychological and clinical factors. Method: In a cross-sectional survey, a self-administered questionnaire was used among inpatients at the Department of Breast and Soft Tissue Surgery in the National Institute of Oncology (n = 146). We assessed socio-demographic data, characteristics of CAM use, attitudes toward CAM, and the need for health control. Clinical data were added to the questionnaire data. Results: 36% of the respondents visited some CAM providers, 71% used CAM preparation and 64% utilized self-help practices. Most patients are informed about these by a healthcare professional. The holistic approach is dominant in the sample as well as internal and social external control. Visitors to CAM providers and CAM preparation users have a stronger need for internal control. Visitors to CAM providers and self-help practitioners judge their own health status more favorable. Conclusion: The information that patients receive from people who are important to them, especially the caregiver, is crucial in their health-related behavior, including the choice of CAM. It is important to see such a high level of patient trust in health professionals and a strong need to discuss information about CAM, as well as a sense of responsibility for their health and active participation in treatment. Orv Hetil. 2022; 163(9): 350–361.

Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust

BACKGROUND

With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample.

METHODS

Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110).

RESULTS

A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations.

CONCLUSION

Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.

"Clicks, likes, shares and comments" a systematic review of breast cancer screening discourse in social media

BACKGROUND

Unsatisfactory participation rate at population based organised breast cancer screening is a long standing problem. Social media, with 3.2 billion users in 2019, is potentially an important site of breast cancer related discourse. Determining whether these platforms might be used as channels by screening providers to reach under-screened women may have considerable public health significance.

OBJECTIVES

By systematically reviewing original research studies on breast cancer related social media discourse, we had two aims: first, to assess the volume, participants and content of breast screening social media communication and second, to find out whether social media can be used by screening organisers as a channel of patient education.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After searching PubMed, ScienceDirect, Web of Science, Springer and Ebsco, 17 studies were found that met our criteria. A systematic narrative framework was used for data synthesis. Owing to the high degree of heterogeneity in social media channels, outcomes and measurement included in this study, a meta-analytic approach was not appropriate.

RESULTS

The volume of breast cancer related social media discourse is considerable. The majority of participants are lay individuals as opposed to healthcare professionals or advocacy groups. The lay misunderstandings surrounding the harms and benefits of mammography is well mirrored in the content of social media discourse. Although there is criticism, breast cancer screening sentiment on the social media ranges from the neutral to the positive. Social media is suitable for offering peer emotional support for potential participants.

CONCLUSION

Dedicated breast screening websites operated by screening organisers would ensure much needed quality controlled information and also provide space for reliable question and answer forums, the sharing of personal experience and the provision of peer and professional support.

[Overview of human resources for health composition in the most mobile specialty groups in Hungary]

Introduction: The Human Resources for Health (HRH) mobility and migration are considered as global phenomena. The European Union often faces the mobility of health professionals on a system level. Hungary is recognised among the sending countries, therefore both international and national level health workforce monitoring, planning, and forecasting are inevitable. Aim: The purpose of this research was to investigate the national demographical profiles of the medical professions affected most significantly by the Hungarian HRH mobility process. Method: Age and regional distribution analyses of the requests for degree certificate issued by the National Healthcare Services Centre were carried out between the years of 2010 and 2017. Results: In Hungary, the rate of mobility - the number of requests for degree certificate among the licensed to practice professionals - resulted in the following: the highest rate was detected in anaesthesiology and intensive therapy with 23.5%, in surgery 17.9%, then internal medicine 7.9%, paediatrics 7.4%, and in general practice 6.4%. According to the results, in the 5 above mentioned professions, the physicians most affected by mobility are mostly from the age cohort of 50+. Furthermore, the results also highlight the territorial inequalities: the region of the capital as well as the medical university towns and counties are in the most favourable situation in terms of professional care and supply. Conclusion: Therefore, it can be concluded that in the case of the 5 investigated subspecialties, not only the overall age of the physicians is higher in the disadvantaged areas, but these regions also have to face a more severe shortage of specialists. Orv Hetil. 2019; 160(31): 1223-1230.

Willingness to migrate-a potential effect of burnout? A survey of Hungarian physicians

BACKGROUND

Burnout worldwide and migration of caregivers are among the most important challenges of the twenty-first century health care.

METHODS

Quantitative, online survey of Hungarian physicians (n = 4 784) was performed in 2013. A link to an anonymous, self-administered questionnaire was sent to all potential participants, namely to the registered members of the Hungarian Medical Chamber with a valid e-mail address. Linear regression analysis was used to determine the risk factors of burnout. The association between physicians' burnout and their willingness to migrate was determined by binary logistic regression analysis.

RESULTS

Moderate/mild level of personal accomplishment was detected in 65% of respondents, whereas moderate/severe level of emotional exhaustion and depersonalization was detected in 49% and 46%, respectively. Single male physicians younger than 35 composed the cohort with the highest risk for developing burnout. Higher daily working hours and multiple workplaces contribute to the risk of developing burnout. According to logistic regression analysis, the intention to work abroad was affected by the emotional exhaustion dimension of burnout (OR = 1.432) and depersonalization had a tendency to have an impact on the willingness to migrate.

CONCLUSIONS

We assume that there is a circular causality between burnout and the willingness to migrate. Burnout increases the willingness to work abroad, whereas contemplating migration might evoke a certain degree of depersonalization in caregivers who are in a dilemma.

The role of controllable lifestyle in the choice of specialisation among Hungarian medical doctors

BACKGROUND

Hungary has been serious facing human resources crisis in health care, as a result of a massive emigration of health workers. The resulting shortage is unevenly distributed among medical specialisations. The findings of research studies are consistent in that the most important motivating factor of the choice of the medical career and of medical specialisations is professional interest. Beyond this, it is important to examine other reasons of why students do or do not choose certain specialisations. The lifestyle determined by the chosen speciality is one such factor described in the literature.

METHODS

Using convenient sampling, first year resident medical doctors from each of the four Hungarian universities with a medical faculty were asked to participate in the study in 2008. In total 391 first year resident medical doctors completed the self-administered questionnaire indicating a 57.3% response rate. On the basis of the work of Schwartz et al. (Acad Med 65(3):207-210, 1990), the specialisation fields were divided into the two main categories of non-controllable (NCL) or controllable lifestyles (CL). We carried out a factor analysis on motivating factors and set up an explanatory model regarding the choice of CL and NCL specialisations.

RESULTS

Two maximum likelihood factors were extracted from the motivational questions: "lifestyle and income" and "professional interest and consciousness". The explanatory model on specialisation choice shows that the "professional interest and consciousness" factor increases the likelihood of choosing NCL specialisations. In contrast the "lifestyle and income" factor has no significant impact on the choice of CL/NCL specialisations in the model.

CONCLUSIONS

Our results confirm the important role of professional interest in the choice of medical specializations in Hungary. On the other hand, it seems surprising that we found no significant difference in the "lifestyle and income" related motivation among those medical residents, who opted for CL as opposed to those, who opted for NCL specialisations. This does not necessarily mean that lifestyle is not an important motivating factor, but that it is equally important for both groups of medical residents.

Managing intra-EU mobility-do WHO principles of ethical recruitment have relevance?

BACKGROUND

The WHO Global Code of Practice on the International Recruitment of Health Personnel provides for guidance in health workforce management and cooperation in the international context. This article aims to examine whether the principles of the voluntary WHO Global Code of Practice can be applied to trigger health policy decisions within the EU zone of free movement of persons.

METHODS

In the framework of the Joint Action on European Health Workforce Planning and Forecasting project (Grant Agreement: JA EUHWF 20122201 (see healthworkforce.eu)), focus group discussions were organised with over 30 experts representing ministries, universities and professional and international organisations. Ideas were collected about the applicability of the principles and with the aim to find EU law compatible, relevant solutions using a qualitative approach based on a standardised, semi-structured interview guide and pre-defined statements.

RESULTS

Based on implementation practices summarised, focus group experts concluded that positive effects of adhering to the Code can be identified and useful ideas-compatible with EU law-exist to manage intra-EU mobility. The most relevant areas for intervention include bilateral cooperations, better use of EU financial resources, improved retention and integration policies and better data flow and monitoring. Improving retention is of key importance; however, ethical considerations should also apply within the EU. Compensation of source countries can be a solution to further elaborate on when developing EU financial mechanisms. Intra-EU circular mobility might be feasible and made more transparent if directed by tailor-made, institutional-level bilateral cooperations adjusted to different groups and profiles of health professionals. Integration policies should be improved as discrimination still exists when offering jobs despite the legal environment facilitating the recognition of professional qualifications. A system of feedback on registration/licencing data should be promoted providing for more evidence on intra-EU mobility and support its management.

CONCLUSIONS

Workforce planning in EU Member States can be supported, and more equitable distribution of the workforce can be provided by building policy decisions on the principles of the WHO Code. Political commitment has to be strengthened in EU countries to adopt implementation solutions for intra-EU problems. Long-term benefits of respecting global principles of the Code should be better demonstrated in order to incentivise all parties to follow such long-term objectives.

[What do family medicine trainees think about gratitude payment?]

INTRODUCTION

The issue of gratuity is one of the most important health policy issues in Hungary.

AIM

The authors' aim is to investigate the attitude of Hungarian family medicine trainees towards gratitude payment.

METHOD

Quantitative, paper-based survey among trainees from four Departments of Family Medicine in Hungary (n = 152).

RESULTS

More than 50 percent of the residents do not approve of accepting gratitude money. Men (p<0.026), and graduating residents accept it significantly more often (p<0.036) while doctors with children tend to accept it more frequently (p<0.051). They think that the reason for this phenomenon is the lack of proper care (65%), vulnerability and the sense of real gratitude patients feel (52%). According to the participants, the least influencing factor was the low salary of physicians (14.4%). They believe that accepting gratuity is a corruption, and it's humiliating for doctors (80-80%).

CONCLUSION

Family medicine residents approve of gratitude money even less as compared to the results of previous studies, but related to other gratitude payment issues we have found similar opinions. Orv Hetil. 2017; 158(26): 1028-1035.

[Retired physicians in Hungary - nationwide, representative study]

INTRODUCTION

The aging population and the aging physician society is an important challenge of the New Millenium. Despite this, very few publications are dealing with the older generations' physical and mental well-being, quality of life and working conditions.

AIM

The aim of this study was to describe the retired physicians populations' (n = 2112) demographic data, work status, income and health status.

METHOD

Data of this representative, cross-sectional epidemiological study was obtained from online and paper-based questionnaires completed by 2112 retired physicians.

RESULTS

The retired physicians' average age is 72 years, nearly two-thirds of the respondents retired after 35-45 years of service. Currently, nearly 60% are working, almost a quarter of them more than 40 hours per week. 35% of the respondents' income is below HUF 150,000. On this issue, significant differences emerge between female doctors and their male colleagues.

CONCLUSIONS

The employment data of the results is consistent with the international trend, but the gender perspectives has unique significance in the international literature. Orv. Hetil., 2016, 157(43), 1729-1736.

Headcount and FTE data in the European health workforce monitoring and planning process

BACKGROUND

Health workforce (HWF) planning and monitoring processes face challenges regarding data and appropriate indicators. One such area fraught with difficulties is labour activity and, more specifically, defining headcount and full-time equivalent (FTE). This study aims to review national practices in FTE calculation formulas for selected EU Member States (MS).

METHODS

The research was conducted as a part of the Joint Action on European Health Workforce Planning and Forecasting. Definitions, categories and terms concerning the five sectoral professions were examined in 14 MS by conducting a survey. To gain a deeper understanding of the international data-reporting processes (Joint Questionnaire on Non-Monetary Health Care Statistics-JQ), six international expert interviews were conducted by using a semi-structured interview guide.

RESULTS

Of the 14 investigated countries, four MS indicated that they report FTE to the JQ and that they also calculate FTE data for national planning purposes. The other countries do not use FTE data for national purposes, but most of them do use special calculations and/or estimation methods for converting headcount to FTE. The findings revealed significant differences between national calculation methods when reporting FTE data to the JQ. This diversity in terms of calculations and estimations can lead to biases with respect to international comparisons. This finding was reinforced by the expert interviews, since the experts agreed that the activities of healthcare professionals are a fundamental factor in HWF monitoring and planning. Experts underscored that activity should also be measured by FTE, and not only by headcount.

CONCLUSIONS

FTE and headcount are significant factors in HWF planning and monitoring; therefore, national data collections should place emphasis on collecting data and calculating the appropriate indicators. National FTE could serve as a call to action for HWF planners due to the lack of matching international FTE data. At the international level, it is beneficial to monitor the trends and numbers regarding human resources and working time. For the moment, the exchange of information and mutual assistance for developing the capacity to apply common methodology could be a first step towards the standardisation of data collections.

Workload, mental health and burnout indicators among female physicians

BACKGROUND

Female doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians.

METHODS

Two time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis.

RESULTS

No significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment.

CONCLUSIONS

In comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.

MENTAL HEALTH OF PHYSICIANS--NATIONWIDE REPRESENTATIVE STUDY FROM HUNGARY

BACKGROUND AND AIM

Somatic and mental health and stress factors of physicians became an issue of growing interest in both national and international investigations. Our aim is to give an overview of the mental state of Hungarian physicians.

METHODS

Cross-sectional, quantitative survey on a representative sample of Hungarian physicians (n = 4784). The control group was formed by the population group of a national survey conducted by "Hungarostudy 2013" (n = 2000).

RESULTS

Suicidal thoughts (18.8% vs. 9.6%, p < 0.001), the scores of Somatic Symptom Scale (PHQ-10, 20.4% vs. 13.6%, p < 0.001) were significantly higher among physicians. The suicidal attempts (1.9% vs. 3.5%, p = 0.053) and BDI depression scores (7.9% vs. 29.5%, p < 0.001) were significantly higher in the control group. High Perceived Stress Scale (PPS) scores occurred in 43.3% of the physicians sample, and 43.4% of them had high scores in the Athenian Insomnia Scale (AIS). The young (< 35) female physicians showed significantly higher rates of suicidal thoughts, higher scores of PHQ and PPS. In the young female cohort, the AIS scores were significantly higher than of the other physicians.

CONCLUSIONS

Mental health of physicians (sleep disorders, suicidal thoughts and psychosomatic symptoms) showed poorer results than the population data. BDI scores and the rate of suicidal attempts showed favourable trends. The next step in the research of physicians' mental health is to investigate the most serious risk factors, and to refine the preventive tools.

[Burnout among Hungarian physicians. Who are the most at risk?]

INTRODUCTION

Burnout is one of the most challenging questions of the healthcare systems in the 21st century.

AIM

The aim of this study was to analyze the Hungarian physicians' burnout and its associations with workload factors (work hours, shift work, multiple workplaces).

METHOD

Data of this representative, cross-sectional, online epidemiological study was obtained from online questionnaires completed by 4784 physicians.

RESULTS

Medium or high level personal accomplishment was present in 75.9% and emotional exhaustion in 58% among physicians, while medium or high level of depersonalization subscale was 53%. All of the 3 dimensions showed association with young ages (<35 years), work in in-patient care, shift hours and multiple workplaces. The physician partner increased the risk of depersonalization, however, children were protective factors. The work-home interface was associated with higher burnout scores.

CONCLUSIONS

Physicians' burnout is an important indicator of the functioning and effectiveness of the healthcare system. The results suggest the importance of prevention and intervention.

[Workload, work satisfaction and burnout among Hungarian female residents. Results of representative, online survey]

INTRODUCTION

Years of residency are the most challenging period of a medical carrier.

AIM

The aim of this study was to analyze female residents' (n = 380) workload, work satisfaction and burnout.

METHOD

Data in this representative, cross-sectional epidemiological study were obtained from online questionnaires completed by 380 female residents. For a wider interpretation of the data, male residents (n = 176) were included in the analysis as a control group.

RESULTS

The average weakly work hours of female residents were 66 hours and 70% of them felt overloaded. The medium and high level personal accomplishment was 75.9%, the emotional exhaustion was 58% and the medium and high level of depersonalization subscale was 53%. Female residents were mostly dissatisfied with working conditions, financial status, and prestige of her work. Dissatisfaction with the Hungarian health system was about 80% and nearly a quarter of respondents were considering working abroad.

CONCLUSIONS

Female residents represent the "critical mass" of the young doctors. Residents' well-being is an important indicator of the functioning and effectiveness of the health care system.

Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary

Background

There is a worldwide rising tendency of women deciding to become physicians; hence, one of the most remarkable fields of investigation is the wellbeing of female doctors. The aim of this study was to describe female physicians’ reproductive health in Hungary and to explore the potential correlation between their reproductive disorders and burnout symptoms. Up to our present knowledge, there have not been any studies investigating the correlation between reproductive disorders and burnout of female physicians; therefore, our study represents a unique approach.

Methods

Data in this representative cross-sectional epidemiological study were obtained from online questionnaires completed by 3039 female physicians. Participants in a representative nationwide survey (Hungarostudy, 2013) served as controls (n = 1069). Differences between physicians and the control group were disclosed by chi-square test. Correlations between certain factors of reproductive health and the three dimensions of burnout were detected by Pearson correlations and X² test. Binary logistic regression analysis was used to determine the association between burnout and reproductive health.

Results

Female physicians were more often characterised by time-to-pregnancy interval longer than one year (18.4% vs. 9.8%), were bearing more high-risk pregnancies (26.3% vs.16.3%), and were more likely to be undergoing infertility therapy (8.5% vs. 3.4%) and experiencing miscarriage (20.8% vs. 14.6%) during their reproductive years, compared with the general female population. With the exception of miscarriages, the difference remained significant in all comparisons with the professional control group. Both high-risk pregnancies and miscarriages of doctors were associated with depersonalisation (p = 0.028 and p = 0.012 respectively) and personal accomplishment (p = 0.016 and p = 0.008 respectively) dimensions of burnout. Results of the multivariate analysis showed that, beside traditional risk factors, depersonalisation acted as an important explanatory factor in case of high-risk pregnancies (OR = 1.086).

Conclusions

There is a circulatory causality between burnout and the development of reproductive disorders. Burnout is an important risk factor for high-risk pregnancies and miscarriages, and it has a negative effect on the outcome of pregnancies. At the same time, women suffering from reproductive disorders are more likely to develop burnout syndrome. Improvement of working conditions and prevention of burnout in female doctors are equally important tasks.

[The health of female physicians in Hungary. A longitudinal perspective]

INTRODUCTION

There is a worldwide rising tendency of women who decide to become physician. One of the most remarkable fields of investigation is the well-being of female doctors.

AIM

To study the prevalence of somatic and reproductive morbidity in a representative sample of Hungarian female physicians and compare it with a control group of graduated women.

METHOD

Data for this epidemiological study were collected from 2515 female physicians in 2013. Graduated women from a representative survey (Hungarostudy 2013) served as controls. The results were compared to the previous (2003-2004) representative female physicians' survey.

RESULTS

We found that the prevalence of chronic somatic morbidity among female physicians was significantly higher than that in the respective control groups. A larger proportion of female medical doctors were characterized by time-to-pregnancy interval longer than one year, and undergoing infertility therapy and miscarriages, compared to the control female population, while the same prevalence of terminations of pregnancy was found.

CONCLUSIONS

The longitudinal perspective confirmed the existence of the "Hungarian female physicians' paradox".

Analysis of a survey on young doctors' willingness to work in rural Hungary

BACKGROUND

The severe shortage of qualified healthcare staff in Hungary cannot be quickly or easily overcome. There is not only a lack of human resources for health, but significant inequalities are widespread, including in geographical distribution. This disparity results in severe problems regarding access to and performance of health care services. In this context, this report, based on research carried out in 2008, deals with a particularly relevant matter: the willingness of young doctors to work outside Budapest (the capital of Hungary).

METHODS

We conducted a survey with voluntary questionnaires and focus group interviews at each of the four Hungarian medical schools, concerning career plans and related incentives among young medical doctors. In all, 524 residents responded to the question concerning their willingness to work in rural areas, and there were seven focus group interviews, with 3-7 participants in each group. The number of residents' places in Hungary were 832, 682, and 785 in 2006/2007, 2007/2008, and 2008/2009, respectively.

RESULTS

The majority of those surveyed would like to work in Budapest or a large town. Fewer than 7% were willing to work in a town with less than 50 000 inhabitants. Most young doctors would like to work in a teaching hospital (i.e. an accredited training site for medical students and postgraduate trainees) or a major regional hospital.

CONCLUSIONS

The current system of medical training in Hungary tends to produce doctors who want to live in big cities and work in central hospitals. Rural regions and non-in-patient service alternatives seem either not to be targeted or seen as unattractive work places.More doctors would be willing to work in smaller towns and villages if in-hospital training was altered and if doctors were offered adequate incentives as part of a comprehensive human resource strategy (high salaries, high professional standards, good working environment, reasonable workload). If these changes do not occur, the existing geographical and structural imbalances will not be improved.