Influence of patient characteristics on preventive service delivery and general practitioners’ preventive performance indicators: A study in patients with hypertension or diabetes mellitus from Hungary

Figures & data

Figure 1. Selection of study patients from participants of the baseline survey of a primary healthcare service development programme.

Table 1. Proportion of adult patients with hypertension or diabetes mellitus, who strongly agreed with statements related to health attitudes, and the factors identified in the principal component analysis (n = 1659).

Statements/health attitudes	Proportion of strong agreement		Factor loading
	%	95%CI	Factor 1	Factor 2	Factor 3
Responsibility-averting:
I have to be very ill before I go to the doctor	34.0	31.7–36.3	0.767	0.044	0.109
If you overthink about your health, you are more likely to be ill	30.0	27.8–32.2	0.575	0.151	0.298
The most important thing is the constitution you are born with	29.4	27.2–31.6	0.528	0.223	0.319
People like me don’t really have time to think about their health	14.8	13.1–16.5	0.671	−0.114	0,061
Dedicated-to-health:
To have good health is the most important thing in life	90.2	88.7–91.6	0.104	0.810	0.000
It’s sensible to do exactly what the doctors say	81.4	79.6–83.3	0.000	0.818	0.115
Faithful:
Generally, health is a matter of luck	14.2	12.5–15.8	0.241	0.091	0.759
Suffering sometimes has a divine purpose	12.2	10.6–13.8	0.147	0.014	0.776

Table 2. Distribution of patients’ characteristics in the study sample (1659 adult patients with hypertension or diabetes mellitus).

Patient characteristic	Category	n (%)
Sex	Men	701 (42.3)
	Women	958 (57.7)
Age groups	15–44	189 (11.4)
	45–64	753 (45.4)
	65–X	717 (43.2)
Level of education	Primary or less	640 (38.6)
	Vocational	410 (24.7)
	High school	419 (25.3)
	Tertiary	163 (9.8)
	Not declared	27 (1.6)
Roma ethnicity		73 (4.4)
Eligible for prescription exemption certificate*		195 (11.8)
Regular (every day) smoker		303 (18.3)
Alcohol misuse (CAGE score ≥ 2)		158 (9.5)
BMI	Underweight (BMI < 20)	18 (1.1)
	Normal (20 ≤ BMI < 25)	340 (20.5)
	Overweight (25 ≤ BMI < 30)	600 (36.2)
	Obese (BMI ≥ 30)	701 (42.3)
Healthy waist circumference (men ≤ 94cm, women ≤ 80 cm)		1464 (88.2)

BMI: body mass index.

*Free of charge access to medicines and medical devices for patients living in deprivation.

Table 3. Unadjusted service utilization frequencies for the investigated preventive services among adult patients with hypertension or diabetes mellitus (n = 1659).

Preventive services	Service utilization frequencies
	%	95%CI
Measurement of blood pressure in 12 months	97.9	97.2–98.6
Measurement of serum glucose in 12 months	80.2	78.3–82.2
Measurement of serum lipid parameters in 12 months	73.2	71.0–75.3
Measurement of body weight in 24 months	63.0	60.7–65.3
Cervical cancer screening (women, 25–65 years) in 36 months	62.7	58.4–67.1
Measurement of urinary proteins in 12 months	61.5	59.1–63.8
Breast cancer screening (women, 45–65 years) in 24 months	60.8	56.0–65.6
Measurement of urinary creatinine in 12 months	48.5	46.1–50.9
Assessment of family history in 24 months	40.3	38.0–42.7
Prostate cancer screening (men, 65+ years) in 36 months	38.6	32.4–44.8
Test of visual acuity in 36 months	36.2	33.9–38.5
Assessment of dietary habits in 24 months	33.5	31.2–35.8
Measurement of waist circumference in 24 months	32.9	30.7–35.2
Examination for atherosclerosis in 24 months	31.7	29.5–34.0
Screening for alcohol misuse in 24 months	29.5	27.3–31.7
Assessment of smoking habits in 24 months	24.7	22.6–26.8
Oral cavity cancer screening in 24 months	21.5	19.5–23.4
Test for hearing loss in 36 months	18.0	16.2–19.9
Colorectal cancer screening (50–75 years) in 36 months	18.0	15.6–20.4

Table 4. Preventive service utilization in the studied sample of adult patients with hypertension or diabetes mellitus, and the median ratio^a of patients’ preventive service utilization within groups of preventive services (n = 1659).

	In the sample
Groups of preventive services	Number of implemented interventions	Number of required interventions	Service utilization frequency	Median (interquartile range) ratio of service utilization
Single preventive services
Referral to laboratory investigations^b	4369	6636	65.8%	75% (25–100)
Physical examination by GP^c	4889	9612	50.9%	42.9% (28.6–57.1)
Referral to organized cancer screening^d	812	2116	38.4%	0% (0–66.7)
Counselling by GP^e	2125	6636	32.0%	25% (0–50)
Combined preventive services
GP services: counselling and physical examination^b^+^d	7014	16248	43.2%	36.4% (18.2–54.6)
Secondary care services^b^+^d	5181	8752	59.2%	66.7% (40–83.3)
Overall use of preventive services^b^+^c^+^d^+^e	12195	25000	48.8%	44.4% (30.8–62.5)

^a As the number of utilized to the number of recommended preventive services.

^b Serum glucose, serum lipid, urinary creatinine, and urinary protein measurements.

^c Body weight, waist circumference, blood pressure, oral cavity status, vision loss and hearing loss examinations.

^d Cervical, breast, prostate, and colorectal cancer screening.

^e Family history, alcohol use, smoking and nutrition-related counselling.

Table 5. Patient characteristics influencing the utilization of preventive services by GPs according to hierarchical multivariate logistic regression models with general practice effects (ORs with 95%CIs; n = 1659).

	Counselling by GP^a	Physical examination by GP^b	GP services: counselling and physical examination^a^+^b	Referral to laboratory investigations^c	Referral to organized cancer screening^d	Secondary care services^c^+^d	Overall use of preventive services^a^+^b^+^c^+^d
Sociodemographic factors
Sex (women/men)	0.67 (0.57–0.79)	0.81 (0.70–0.94)	0.69 (0.60–0.81)	0.97 (0.84–1.12)	4.38 (3.68–5.22)	1.30 (1.14–1.50)	0.83 (0.72–0.95)
Age (<45/65+)	1.22 (0.96–1.56)	0.68 (0.54–0.85)	0.78 (0.62–0.99)	0.74 (0.59–0.93)	4.53 (3.17–6.47)	1.57 (1.26–1.95)	1.08 (0.86–1.35)
Age (45–64/65+)	0.95 (0.81–1.13)	0.91 (0.78–1.06)	0.83 (0.71–0.97)	0.94 (0.81–1.09)	2.67 (2.26–3.17)	1.08 (0.94–1.25)	0.81 (0.70–0.95)
Education (vocational/primary or less)	1.04 (0.84–1.28)	1.29 (1.07–1.56)	1.25 (1.03–1.51)	1.44 (1.20–1.72)	1.18 (0.96–1.46)	1.17 (0.98–1.38)	1.34 (1.12–1.6)
Education (high school/primary or less)	1.31 (1.07–1.6)	1.82 (1.52–2.18)	1.60 (1.33–1.93)	1.90 (1.59–2.28)	1.45 (1.17–1.78)	1.51 (1.27–1.79)	1.82 (1.52–2.17)
Education (tertiary/primary or less)	1.75 (1.35–2.28)	1.99 (1.56–2.53)	1.88 (1.47–2.41)	2.27 (1.78–2.90)	1.88 (1.43–2.48)	1.41 (1.11–1.77)	2.25 (1.76–2.87)
Ethnicity (Roma/non-Roma)	1.67 (1.11–2.5)	1.43 (1.01–2.00)	2.39 (1.68–3.41)	1.02 (0.74–1.42)	2.06 (1.37–3.08)	1.08 (0.79–1.49)	1.24 (0.89–1.74)
Prescription exemption certificate (eligible/ineligible)	1.72 (1.38–2.15)	1.80 (1.47–2.20)	1.80 (1.46–2.21)	1.91 (1.56–2.35)	1.12 (0.88–1.42)	1.70 (1.4–2.07)	2.18 (1.77–2.67)
Lifestyle factors
Regular smoking	1.74 (1.43–2.11)	0.91 (0.76–1.09)	1.22 (1.01–1.46)	0.71 (0.59–0.84)	0.85 (0.69–1.04)	0.73 (0.62–0.87)	1.19 (1.00–1.42)
Alcohol misuse	1.96 (1.53–2.5)	1.13 (0.90–1.42)	1.52 (1.21–1.92)	0.84 (0.67–1.05)	0.74 (0.56–0.98)	0.89 (0.72–1.10)	0.88 (0.70–1.1)
BMI (obese/normal)	1.18 (0.94–1.47)	1.02 (0.84–1.24)	1.02 (0.83–1.24)	1.62 (1.33–1.97)	0.64 (0.51–0.81)	1.31 (1.09–1.57)	1.17 (0.97–1.42)
BMI (over-weigh/normal)	1.28 (1.03–1.59)	0.87 (0.71–1.06)	0.98 (0.80–1.19)	1.30 (1.07–1.58)	0.83 (0.66–1.04)	1.15 (0.96–1.37)	1.00 (0.83–1.21)
BMI (underweight/normal)	2.36 (1.09–5.12)	0.65 (0.30–1.44)	0.53 (0.22–1.27)	0.87 (0.46–1.65)	0.18 (0.05–0.57)	0.72 (0.40–1.33)	0.84 (0.42–1.65)
Central obesity	0.83 (0.64–1.08)	1.22 (0.95–1.55)	0.94 (0.73–1.20)	1.01 (0.80–1.27)	1.41 (1.06–1.88)	1.09 (0.87–1.37)	1.04 (0.83–1.32)
Health attitudes
Responsibility-averting	0.90 (0.83–0.97)	0.91 (0.84–0.97)	0.81 (0.75–0.87)	0.84 (0.79–0.90)	0.84 (0.77–0.91)	0.88 (0.83–0.94)	0.80 (0.74–0.85)
Dedicated to health	1.13 (1.04–1.22)	1.08 (1.01–1.17)	1.22 (1.13–1.31)	1.02 (0.95–1.09)	1.01 (0.92–1.11)	0.99 (0.93–1.06)	1.21 (1.13–1.3)
Faithful attitude	1.11 (1.03–1.2)	1.07 (0.99–1.14)	1.13 (1.05–1.21)	1.11 (1.04–1.19)	0.94 (0.87–1.03)	1.10 (1.03–1.18)	1.15 (1.07–1.23)

Bold: significant result.

^a Family history, alcohol use, smoking and nutrition-related counselling.

^b Body weight, waist circumference, blood pressure, oral cavity status, vision loss and hearing loss examinations.

^c Cervical, breast, prostate, and colorectal cancer screening.

^d Serum glucose, serum lipid, urinary creatinine, and urinary protein measurements.

OR: odds ratio; 95%CI: 95% confidence interval; BMI: body mass index.