Integrated service provision in rehabilitation medicine I. – national background, strengths, weaknesses

Abstract

Provision of hospital-based rehabilitation services are typical for Hungary. Professionals working in rehabilitation medicine have recognized some decades ago that due to ageing of the society and increasing frequency of chronic health conditions the needs will not be met by the existing services. Experimental community-based rehabilitation services have been initiated in cooperation with World Health Organization European Office. Important and promising experiences have been gathered in the field of community psychiatric rehabilitation services. Rehabilitation Medicine Division and Council of the Healthcare Professional Board have developed Rehabilitation Care Programmes. Those also include recommended optimal care pathway for different health conditions. Evidence of the Rehabilitation Care Programmes have been collected and published in a handbook. The ongoing health care reform in Hungary calls for summarizing earlier experiences and review of available resources as well as strengths and weaknesses supporting or hindering the development of community-based rehabilitation services. The Rehabilitation Care Programmes have been developed on basis of multiple test phases where significant number of hospital rehabilitation wards from different service levels and territorial regions of Hungary have been participated. Beside suggested care pathways basic conditions of rehabilitation care services as well as recommended methods of effectiveness evaluation of service provision are part of the programme descriptions. Introduction of present situation is based on data of the National Statistical Data-Collection Programme in rehabilitation medicine and data provided by the National Health-Insurance Fund. Our findings demonstrate the dominance of hospital-based service provision and the inequal availability of services by regions. Several favourable changes have occurred at the training in rehabilitation of medical students and other students of professionals employed in rehabilitation medicine, like physiotherapists and psychologists. Experiences gained in recent primary-care practice fellowships have also brought useful information in development of community-based rehabilitation services. Communication of different healthcare providers is supported by the e-Health Care Cloud Hosting. Authors regard as limitation of their study the inability of providing a full-scale data base. Preferences of the effected population remained unknown as well. Concluding, the isolation of elderly population is increasing, the social care services are experiencing reorganization and modifications. Those features call for both vertical and horizontal coordination among all care providers with a potential role in rehabilitation, as well as strengthening the gate-keeper function of general practitioners. The later need calls for goal-oriented education programmes.