Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians

BACKGROUND: Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. METHOD: The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. RESULTS: The knowledge about multimorbidity, a main consequence of obesity, was balanced.Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue.There were wider differences regarding attitudes and practice, influenced by the the doctors' age, gender, known BMI, previous qualification, less by working location.GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77%vs68%). They measured their patients' waist circumference and waist/hip ratio (72%vs62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more frequently / commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors.Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65%vs44%) and offered dietary records for patients significantly more frequently (65%vs52%). Most of the younger doctors agreed that obesity management was a primary care issue.Doctors in the normal BMI range were unanimous that they should be a model for their patients (94%vs81%). CONCLUSION: More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary

Mit gondolnak a családorvos-rezidensek a hálapénzről?: [What do family medicine trainees think about gratitude payment?]

Absztrakt: Bevezetés: A hálapénz az egyik legfontosabb egészségpolitikai kérdés Magyarországon. Célkitűzés: A szerzők célul tűzik ki, hogy megvizsgálják a magyarországi családorvos-rezidensek hálapénzzel kapcsolatos vélekedéseit. Módszer: Kvantitatív, papíralapú felmérés a négy magyarországi családorvosi tanszék rezidensei körében (n = 152). Eredmények: A rezidensek több mint 50%-a elutasító a hálapénzzel szemben. A férfiak (p<0,026), a végzős rezidensek (p<0,036) szignifikáns mértékben, a gyermekesek tendenciaszerűen több hálapénzt fogadnak el (p<0,051). A jelenség okául leginkább a megfelelő ellátás hiányát (65%), a kiszolgáltatottságot és a valódi hálát (52%) gondolják. A „megfelelő egészségügyi ellátás” kifejezésen a hatályos egészségügyi törvény (1997. évi CLIV. törvény) definícióját értik. Véleményük szerint a legkevésbé befolyásoló tényező az alacsony orvosi bér (14,4%). A hálapénzt korrupciónak és az orvosok számára megalázónak gondolják (80-80%). Következtetések: A családorvos-rezidensek a korábbi vizsgálati eredményekhez képest elutasítóbbak a hálapénzzel szemben, de a hálapénzzel kapcsolatos egyéb kérdések esetében a korábbi kutatásokban megfogalmazottakhoz hasonló véleményeket fogalmaztak meg. Orv Hetil. 2017; 158(26): 1028–1035. | Abstract: 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