Hungarian palliative medicine reaches another milestone

This week in the EAPC blog we are focusing on Hungary. Dr Ágnes Csikós, a palliative care physician and founder of the Department of Hospice-Palliative Medicine in Pécs, starts us off with some exciting news…

Dr  Agnes Csikós

I am delighted to announce that, beginning in autumn 2014, physicians in Hungary will be able to take a one-year course to qualify for a licence in palliative medicine. This milestone is the fruit of collaborative efforts of many dedicated professionals working in the field since the birth of the Hungarian hospice movement. In September 2013, a Ministerial Decree was signed confirming approval of a licensure programme, which supersedes the previous 80-hour training requirement for physicians wishing to qualify for a hospice-palliative care position. The programme will be built on basic clinical specialties such as internal medicine, surgery, family medicine, paediatrics, or oncology, and will be offered through the four participating Hungarian medical schools in Pécs, Debrecen, Szeged, and Budapest. The first people to sit the licensure exams will be the Hungarian faculty themselves, at the Third Annual Palliative Medicine Symposium at the University of Pecs.

The course includes both theoretical and practical sections, and requires candidates to do clinical rotations in inpatient and home hospice programmes.  Participating physicians will be trained in communications skills as well as pain and symptom management and bereavement. Physicians who pass the final exam will be awarded a licence to practice palliative medicine in Hungary.

The programme will be co-ordinated through the Department of Hospice-Palliative Medicine at the University of Pécs Medical School Institute of Family Medicine in close collaboration with the Hungarian Hospice-Palliative Association and national experts. The licensure programme will produce better-trained physicians, and result in the establishment of more desperately needed palliative care programmes across the country. The curriculum has been designed, and further work remains to be done to finalise the logistics and coordination, so the programme should be up and running by late 2014.

As part of their licensure, doctors will learn about the management of breakthrough pain, of great concern to patients and families in the homecare service. Our teams have not had access to the recommended short or ultra short-acting oral opioid analgesics, which are currently not reimbursable in the country. Sevedrol, the only previously available short-acting oral opioid, was pulled from the market at the end of 2012, because the government health insurance programme did not fully reimburse it and industry did not consider it sufficiently profitable. Only morphine injections, which are challenging to use in the homecare setting, are currently available for breakthrough pain. However, as a result of increased education of government officials through the ATOME (Access to Opioid Medication in Europe) programme, the Ministry of Health will reintroduce Sevedrol in late autumn 2014.¹ This makes me feel that not only can we really provide better pain control to our patients, especially to those who often suffer from breakthrough pain, but we can also use the short-acting morphine to titrate the daily dose of patients.

References
1.    Pettus K.“A deeply respectful” programme: Presentation of ATOME outcomes side event 67th World Health Assembly in Geneva on the  European Association for Palliative Care blog (2014, accessed 4 July 2014).

Links and resources

• The Hungarian Hospice-Palliative Association (information available in Hungarian and English) 
• Pécs – Baranyai Hospice Alapítvány 
• ATOME project 

Coming up…
More news from Hungary on Thursday when Dr Agnes Zana will be writing about the 11th National Congress of the Hungarian Hospice-Palliative Association.