The path to becoming a general practitioner (GP, also known as family doctor) in Hungary is paved with years of unwavering dedication ¨C after 6 grueling years in medical school, physicians must then complete a 26-month common program, followed by an additional three-year specialized family medicine training. It is only through this arduous journey that they assume the weighty responsibility of being the first point of care for citizens in need - the trusted confidants, compassionate listeners, and skilled diagnosticians.

However, in recent years, the number of vacant family clinics has steadily risen, reaching 10% by 2022 ^[1]. Increasingly, Hungarians are turning to outpatient and hospital-based specialist care.

Recognizing the growing disconnect, a national project was initiated by the end of 2022 to address this challenge.

In the quaint Hungarian city of H¨®dmez?v¨¢s¨¢rhely, home to fewer than 50,000 residents, Dr. Katalin Havasi has served as the local pediatric general practitioner for over a quarter-century. Her purview extends far beyond merely the medical record - it encompasses a full understanding of the children's physical, neurological, psychological, and even mental development.

Dr. Katalin Havasi

PhD, Pediatrician, Pediatrics General Practitioner
President of Hungarian Pediatric Association

The work of a general practitioner is a wonderful job, a wonderful profession, because we are in close contact with many families. But it is also a great challenge from a medical point of view, because we are the first to encounter all types of illness.

"As the first point of entry, we general practitioners serve as a one-stop center, through which patients can access the full spectrum of healthcare services,"   Dr. Mikl¨®s Antal from Csorna explained. As an adult GP in the town for two decades, Dr. Antal delivers primary care and shoulders the duty of on-call emergency response.

In Hungary, as in much of the world, the greatest burdens of disease are cancer and cardiovascular diseases. Statistics show that the country ranks among the European nations with the highest rates of diagnosed cardiovascular disease ^[2].

Dr. Mikl¨®s Antal

Adult General Practitioner

Especially in Central Europe, it is well known that a large segment of the population faces a very high risk of cardiovascular disease. This is partly due to lifestyle factors like smoking, drinking, high blood pressure, elevated blood sugar, and notably, diabetes - conditions that can make it difficult for patients to even recognize the warning signs of a heart attack.

The best care is to be able to provide immediate treatment on-site or even prevent it from the very beginning. However, without efficient equipment, GPs have not been able to do much other than call an ambulance.

Primary care remains more accessible to the general population.

¡°In an emergency, we are the first to reach the patient, either at the request of the ambulance service or with them. We must be prepared to care for patients in different emergency situations,¡±  Dr. Antal added. ¡°In the past, we have faced some truly serious problems on multiple occasions. Without a defibrillator readily at hand, we would have to call the emergency room, only to be redirected multiple times before the ambulance finally arrived. For me, it is of the utmost importance that emergency equipment be made immediately available on-site.¡±

Entering the 21st century, the healthcare landscape in Hungary has seen a remarkable infusion of advanced medical technology, mostly in outpatient and inpatient settings. However, this technological progress has yet to fully permeate the realm of primary care.

"Our project aimed to equip family physicians with advanced tools, enabling the establishment of a wide range of diagnoses and therapies at the primary care level, which were previously inaccessible,"  Dr. Orsolya Surj¨¢n, Deputy Chief Medical Officer from the National Public Health and Medical Officer Service, Hungary, explained the background behind the national initiative.

Orsolya Surj¨¢n MD

Deputy Chief Medical Officer
National Public Health and Medical Officer Service, Hungary

What we tried to do is to create an opportunity for primary care physicians to utilize devices and equipment that are currently only available in specialty care.

Launched at the close of 2022 to assess demand, a EU-grant supported project has since procured a total of 45,575 devices for distribution to over 3,000 general practitioners across the country. This includes 1,277 defibrillators - 400 Mindray BeneHeart D3 defibrillator/monitor were designated for pediatricians, and 877 BeneHeart C series AEDs allocated to adult GPs, following a specialized application process.

The distribution process of the equipment was carried out last December. Now, over 1,200 GPs across the country, including Dr. Katalin Havasi and Dr. Mikl¨®s Antal, are equipped with defibrillators, empowering them to more actively diagnose and treat cardiac diseases.

"This is a device that even a nurse or other specialist can use to initiate a higher level of resuscitation," Dr. Antal highlighted. "Then, there is a good chance of saving the patient's life with minimal to no damage. It is notably important that such a device be immediately at hand for timely rescue."   He underscored the significant support brought by the BeneHeart C series AED.

Designed to enable fast shock delivery through patented technology that shortens ECG analysis and pre-charging, the BeneHeart C series AED facilitates rapid defibrillation. "The sooner defibrillation occurs, the greater the chance that the patient will survive without any damage,"  Dr. Antal explained.

For GPs, nevertheless, the most important focus will also be on preventing disease as early as possible - a key necessity in establishing strong primary care.

The multi-function BeneHeart D3 defibrillator/monitor has enabled Dr. Havasi to conduct more comprehensive cardiac assessments and diagnoses for children in different conditions. "The combined analysis of ECG waveform and respiratory rate help determine if the issue is cardiac-related or stems from something else, especially for children experiencing chest-related complaints with unknown illness," she introduced. "And for children already diagnosed with a medical condition, it becomes a crucial monitoring tool, allowing me to closely track the condition's progression and make informed adjustments to the care plan."  She also utilizes these measurements to observe changes in healthy children's physical development during activity.

"I work very hard for the purpose that we are able to recognize diseases as early as possible and prevent as many as possible," Dr. Havasi said. "I am also convinced that many diseases that hinder adulthood can be prevented in childhood."

The national project did not stop at the distribution of the purchased devices. The National Public Health and Medical Officer Service has now shifted more attention to training and network building among GPs. "It is not only about the operation of the devices, but about how to use them in the most optimal way,"  Dr. Surj¨¢n explained.

Orsolya Surj¨¢n MD

Deputy Chief Medical Officer
National Public Health and Medical Officer Service, Hungary

The network connections we have built among GPs have created a professional support environment, which is maintained so that they can always have someone to turn to if they have any questions.

¡°I'm very, very optimistic, and I'm happy that patients are trusting us more and more. And I'm also confident that emergency care will be less and less.¡±  Dr. Mikl¨®s Antal said with enthusiasm.