Exploring quality of care and social inequalities related to type 2 diabetes in Hungary: Nationwide representative survey

• Published in: Primary care diabetes 2018-06, Vol.12 (3), p.199-211
• Main Authors: Nagy, Attila, Kovács, Nóra, Pálinkás, Anita, Sipos, Valéria, Vincze, Ferenc, Szőllősi, Gergő, Csenteri, Orsolya, Ádány, Róza, Sándor, János
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Glucose - analysis; Cohort Studies; Cross-Sectional Studies; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Diabetes registry; Educational Status; European Union; Female; Glycated Hemoglobin A - analysis; Healthcare Disparities; Humans; Hungary; Logistic Models; Male; Middle Aged; Multivariate Analysis; Outcome indicators; Primary Health Care - methods; Process indicators; Quality of care; Quality of Health Care; Severity of Illness Index; Social inequalities; Socioeconomic Factors
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2017.12.004

•Representative Hungarian data on T2DM care quality was made up by our study.•Process indicators are strongly related to patients’ education.•Key intermediate outcome indicators are independent of patients’ education.•The target achievement for HbA1c and LDL-C corresponds to the European reference.•The blood pressure target achievement is less effective in Hungary than in Europe. The study aimed to launch a T2DM adult cohort that is representative of Hungary through a cross-sectional study, to produce the most important quality indicators for T2DM care, to describe social inequalities, and to estimate the absolute number of T2DM adult patients with uncontrolled HbA1c levels in Hungary. A representative sample of the Hungarian T2DM adults (N=1280) was selected in 2016. GPs collected data on socio-demographic status by questionnaire, and on history and laboratory parameters from medical records. The process and outcome indicators used in the international monitoring practice were calculated. The socio-economic status influence was determined by multivariate logistic regression models. Target achievement was 61.66%, 53.48%, and 54.00% for HbA1c, LDL-C, and blood pressure, respectively, in the studied sample (N=1176). In Hungary, 294,534 patients have above target HbA1c value out of 495,801 T2DM adults. The education-dependent positive association with majority of process indicators was not reflected in HbA1c, LDL-C, and blood pressure target achievements. The risk of microvascular complications and requirement of insulin treatment were higher among less educated. According to our observations, the education-independent target achievement for HbA1c and LDL-C is similar as, for blood pressure is less effective in Hungary than in Europe.