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The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study
  1. Nóra Kovács1,
  2. Orsolya Varga1,
  3. Attila Nagy1,
  4. Anita Pálinkás1,
  5. Valéria Sipos1,
  6. László Kőrösi2,
  7. Róza Ádány1,3,4,
  8. János Sándor1
  1. 1 Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
  2. 2 National Institute of Health Insurance Fund Management, Budapest, Hungary
  3. 3 WHO Collaborating Centre on Vulnerability and Health, Debrecen, Hungary
  4. 4 MTA-DE Public Health Research Group, University of Debrecen, Debrecen, Hungary
  1. Correspondence to Dr Orsolya Varga; varga.orsolya{at}


Objectives The objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.

Study design A nation-wide cross-sectional study was performed in 2016.

Setting and participants The study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.

Main outcome measures Multilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.

Results 48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.

Conclusion Female GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.

  • Process indicators
  • General practitioner
  • Quality of care
  • Gender

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  • Contributors NK, LK and JS performed and designed the study. LK participated in the database preparation. NK, AP, VS and AN analysed and interpreted the data. NK and OV prepared the manuscript. RÁ and JS provided professional instruction on the subject and approved the final version to be submitted. JS revised the manuscript. All authors read and approved the final manuscript.

  • Funding The reported study was carried out in the framework of the 'Public Health Focused Model Programme for Organising Primary Care Services Backed by a Virtual Care Service Centre' (SH/8/1). The Model Programme is funded by the Swiss Government via the Swiss Contribution Programme (SH/8/1) in agreement with the Government of Hungary. Additional source of funding was from GINOP-2.3.2-15-2016-00005 project which was co-financed by the European Union and the European Regional Development Fund, and from EFOP-3.6.3-VEKOP-16-2017-00009 co-financed by EU and the European Social Fund. This work was also supported by the Portugal/Hungary Bilateral Project FCT/NKFIH - (TÉT_16-1-2016-0093) and the János Bolyai Scholarship of the Hungarian Academy of Sciences (MTA) to O.V.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The databases that we analysed were anonymised. The research protocol was reviewed and permitted by and performed in concordance with the Internal Data Safety and Patient Rights Board of the National Institute of Health Insurance Fund Management (E01/317-1/2014).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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