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Kampouraki M, Paraskevopoulos P, Fachouri E, Terzoudis S, Karanasios D. Building Strong Primary Healthcare Systems in Greece. Cureus 2023; 15:e41333. [PMID: 37546097 PMCID: PMC10397111 DOI: 10.7759/cureus.41333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
The healthcare system in Greece has undergone significant changes over the past 10 years. While there have been some positive developments, such as improvements in primary care and public health, there are still many challenges that need to be addressed. One of the major changes in the Greek healthcare system over the past decade has been the impact of the country's economic crisis. The government has had to implement a series of austerity measures, including significant cuts to healthcare funding. This has had a negative impact on the availability and quality of care, particularly for those on low incomes or living in rural areas.
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Affiliation(s)
| | | | - Evelin Fachouri
- Primary care, 6th TOMY (Topical Organised Medical Units), Thessaloniki, GRC
| | - Sotiris Terzoudis
- Gastroenterology and Hepatology, Biokliniki Hospital, Thessaloniki, GRC
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2
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Thireos E, Markaki A, Symvoulakis EK, Lionis C. University Student Health Services, Local Experience, and Emerging Needs: Bridging the Past With the Future. J Psychosoc Nurs Ment Health Serv 2023; 61:27-31. [PMID: 35993727 DOI: 10.3928/02793695-20220809-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
University students' health and well-being is critical, especially in the aftermath of the coronavirus disease 2019 pandemic; however, a comprehensive and integrated approach in academic institutions remains neglected. In this context, the local experience from a pilot university-based Student Health Center at an urban campus in Greece is presented. Select health promotion and disease prevention screening and monitoring initiatives are summarized from the viewpoint of a Strengths, Weaknesses, Opportunities, and Threats analysis, with emerging health needs and policy implications. Long-term sustainability is feasible, only if synergies and close collaboration with other university units and local health authorities are developed. A post-pandemic call to action for intervention programs that integrate physical and mental health care, as well as raise awareness among university stakeholders and health policy makers, is issued. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 27-31.].
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Galanakos SP, Bablekos GD, Tzavara C, Karakousis ND, Sigalos E. Primary Health Care: Our Experience From an Urban Primary Health Care Center in Greece. Cureus 2023; 15:e35241. [PMID: 36968861 PMCID: PMC10034218 DOI: 10.7759/cureus.35241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
This observational study reported patient data derived from the emergency files of a primary health care (PHC) center in Greece, with the aim of providing potential solutions for a well-organized, well-structured, and effective social healthcare system. This series was conducted at a single urban PHC center in Greece between August 2017 and March 2020. A total of 83,592 patient visits were registered. The mean patient age was 42.5 years (range: three months to 93 years). Demographics, presenting complaints, and the need for patients who visited the healthcare center to be referred to tertiary hospitals were examined. Further perspectives and future strategies to strengthen the national PHC system were addressed. The most common reasons for visits were pathological (33.6%), followed by general surgery (21.2%) and orthopedics (18.1%). Pediatric conditions accounted for 12% of visits, cardiological conditions accounted for 8.6%, and dental problems accounted for 6.8%. The majority of the patients (n = 81,317, 97.3%) were managed within the health center, and only 2.7% of cases (n = 2275) needed to be referred to a secondary or tertiary healthcare structure. Reasons for patient referral included the severity or complexity of the patient's situation, lack of a specific medical specialty, and the unavailability of overnight laboratory tests. The PHC center remains the cornerstone of a high-quality healthcare system. A well-structured PHC unit can improve health outcomes and decongest secondary and tertiary health care.
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Roginski M, Sifaki-Pistolla D, Stomby A, Velivasaki G, Faresjö T, Lionis C, Faresjö Å. Paradoxes of breast cancer incidence and mortality in two corners of Europe. BMC Cancer 2022; 22:1123. [PMID: 36319987 PMCID: PMC9628067 DOI: 10.1186/s12885-022-10243-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Breast cancer incidence is rising globally, while mortality rates show a geographical heterogenous pattern. Early detection and treatment have been proven to have a profound impact on breast cancer prognosis. The aim of his study was to compare breast cancer incidence, mortality, and survival rates in two contrasting corners of Europe, Sweden and Crete, to better understand cancer determinants with focus on disease burden and sociocultural factors. METHODS Breast cancer data from Sweden and Crete was derived from registries. Incidence and mortality were expressed as Age-Standardized Incidence Rates (ASIR), Age-Standardized Mortality Rates (ASMR). FINDINGS Breast cancer incidence has for decades risen in Sweden and on Crete. In 2019, ASIR was 217.5 in Sweden and 58.9 on Crete, (p < 0.001). Mortality rates showed opposite trends. ASMR in Sweden was reduced from 25.5 to 16.8 (2005-2019) while on Crete, ASMR increased from 22.1 to 25.3. A successive rise in survival rate in Sweden with a 5-year survival rate of 92% since 2015, but a converse development on Crete with 85% 5-year survival rate the same year. INTERPRETATION The incidence of breast cancer is slowly rising in both studied regions, but mortality increases on Crete in contrast to Sweden with sinking mortality rates. The interpretation of these findings is that differences in health care systems and health policies including differences in early detection like screening programs and early treatment, as well as sociocultural factors in the two countries might play an important role on the differences found in breast cancer burden.
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Affiliation(s)
- Mikaela Roginski
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Dimitra Sifaki-Pistolla
- grid.8127.c0000 0004 0576 3437Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Andreas Stomby
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Georgia Velivasaki
- grid.8127.c0000 0004 0576 3437Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Tomas Faresjö
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Christos Lionis
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden ,grid.8127.c0000 0004 0576 3437Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Åshild Faresjö
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Galanos G, Dimitriou H, Pappas A, Perdikogianni C, Symvoulakis EK, Galanakis E, Lionis C. Vaccination coverage of patients with type 2 diabetes mellitus: Challenging issues from an outpatient secondary care setting in Greece. Front Public Health 2022; 10:921243. [PMID: 35979460 PMCID: PMC9376377 DOI: 10.3389/fpubh.2022.921243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023] Open
Abstract
Background Increased morbidity/mortality due to vaccine preventable diseases (VPD) is encountered in type 2 diabetes (T2D) people. Aim of this study was to assess their vaccination coverage and describe trends possibly affecting compliance. Methods Information on vaccination coverage was retrieved from either documents or interview provided by patients, and/or their vaccination record card at a specialized outpatient diabetes center. The selection of the patients was arbitrary. Results An increasing vaccination rate for influenza was observed from 2018 to 2020 among 372 participants. The vaccination coverage for S.pneumoniae was 67.2% (PCV13), 20.4% (PPSV23), 26.3% for herpes zoster in individuals ≥60 years, 1.9% for tetanus-diphtheria-pertussis and 1.1% for hepatitis B. A 10.2% of participants were found to be unvaccinated. Vaccination uptake for influenza and PCV13 was related to age, ≥3 comorbidities and long-term follow-up. T2D individuals consecutively vaccinated for influenza were 3.78 times more likely to be also vaccinated with PCV13. Conclusions Vaccination rates of patients with T2D show an increasing trend, especially for influenza and S. pneumoniae, although the one for S. pneumoniae was low. Older people seem more prone to vaccination, the one for herpes zoster was low with infected patients remaining unvaccinated while significantly low coverage was observed for other VPDs. The findings are important to improve effectiveness of preventative services.
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Affiliation(s)
- Georgios Galanos
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Health Center of Arkalohori, 7th Health District of Crete, Crete, Greece
| | - Helen Dimitriou
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Laboratory of Child Health, School of Medicine, University of Crete, Heraklion, Greece,*Correspondence: Helen Dimitriou
| | - Angelos Pappas
- Diabetic Center, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Chrysoula Perdikogianni
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Department of Pediatrics, University Hospital, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Galanakis
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Department of Pediatrics, University Hospital, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Yfantopoulos J, Protopapa M, Chantzaras A, Yfantopoulos P. Doctors' views and strategies to improve patients' adherence to medication. Hormones (Athens) 2021; 20:603-611. [PMID: 33914291 PMCID: PMC8082220 DOI: 10.1007/s42000-021-00294-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- John Yfantopoulos
- MBA-Health, National and Kapodistrian University of Athens, 6 Themistokleous Str, Athens, Greece.
| | - Marianna Protopapa
- MBA-Health, National and Kapodistrian University of Athens, 6 Themistokleous Str, Athens, Greece
| | - Athanasios Chantzaras
- MBA-Health, National and Kapodistrian University of Athens, 6 Themistokleous Str, Athens, Greece
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Myloneros T, Sakellariou D. The effectiveness of primary health care reforms in Greece towards achieving universal health coverage: a scoping review. BMC Health Serv Res 2021; 21:628. [PMID: 34193124 PMCID: PMC8247133 DOI: 10.1186/s12913-021-06678-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Between 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector. We conducted a scoping review to examine whether the Primary Health Care reforms during that period assisted the country in moving towards Universal Health Coverage. METHODS We performed a review of the literature on the following databases: Scopus, PubMed, Epistemonikos, Web of Science, and Google Scholar, including published research articles and grey literature. Findings were synthesised thematically, using the World Health Organization Universal Health Coverage dimensions: population coverage, service coverage, and financial protection. RESULTS Forty-four documents were included in this review. Out of these, thirty-eight were research-based (thirty-three qualitative, two quantitative, and three mixed design studies), two grey literature, and four legislative bills. The evidence suggests that despite the systemic interventions addressing longstanding distortions, population coverage, service coverage and financial protection have not significantly improved. CONCLUSIONS This review suggests that Primary Health Care reforms in Greece have not managed to substantially improve Universal Health Coverage, although some positive steps towards that direction have taken place with the establishment of community-based multidisciplinary health teams. Before further interventions are implemented, an evidence-based monitoring and evaluation mechanism is necessary in order to clearly evaluate their effectiveness and progress.
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Affiliation(s)
- Thanos Myloneros
- Formerly London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1 7HT UK
| | - Dikaios Sakellariou
- Cardiff University, School of Healthcare Sciences, Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB UK
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Sbarouni V, Symvoulakis EK, Lionis C. ¿Está la atención primaria en Grecia a salvo del «tsunami» de la crisis? ENFERMERIA CLINICA 2020; 30:128-130. [DOI: 10.1016/j.enfcli.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/01/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
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Sbarouni V, Petelos E, Kamekis A, Tzagkarakis SI, Symvoulakis EK, Lionis C. Discussing issues of health promotion and research in the context of primary care during the ongoing austerity period: an exploratory analysis from two regions in Greece. Med Pharm Rep 2020; 93:69-74. [PMID: 32133449 PMCID: PMC7051814 DOI: 10.15386/mpr-1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/04/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Greece, both Primary Health Care (PHC) system and National Health System (NHS) in general, were plagued by several inefficiencies even prior to the financial crisis; the imposed austerity measures dramatically worsened the level of health provision and access, especially for vulnerable social groups, resulting in an exacerbation of existing disparities and access gaps. AIM AND METHODS The current branch study was conducted in two regions of Greece, namely Crete and Epirus, with the main aim of eliciting responses to gather baseline information regarding crucial PHC-related aspects, using questionnaires with dichotomous questions. Directors or managers (physicians who have been assigned administrative/governance duties), of the Primary Health Care Centres (PHCCs) in two Greek geographic and administrative regions of Crete and Epirus, were invited to participate and to contribute to the investigation of issues on the provision of prevention and health promotion services, e-health topics and primary care research. Thirty directors/managers were approached and twenty-eight agreed to participate. Data processing and analysis of the responses was performed for the completed questionnaires. RESULTS Data analysis did not demonstrate a surprisingly substantial deviation in the average score of positive responses of directors/managers in the PHCCs of Crete in comparison to those of directors/managers in the PHCCs of Epirus. The findings show that several gaps exist in terms of prevention and health promotion resources and activities in both regions, while e-health, electronic health record (EHR) and telemedicine services are poorly developed. CONCLUSION The study confirms that the Greek PHC is characterized by several inefficiencies, which may affect the quality of the services provided. An overall deficit has been emerged for PHCCs in both regions, a fact that indicates crucial points lacking in terms of overall PHC provision, thus adversely impacting upon living conditions, health quality and prevention.
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Affiliation(s)
- Vicky Sbarouni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Elena Petelos
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Apostolos Kamekis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Abstract
The 40th anniversary of the World Health Organization Alma-Ata Declaration in Astana offered the impetus to discuss the extent to which integrated primary health care (PHC) has been successfully implemented and its impact on research and practice. This paper focuses on the experiences from Greece in implementing primary health care reform and lessons learned from the conduct of evidence-based research. It critically examines what appears to be impeding the effective implementation of integrated PHC in a country affected by the financial and refugee crisis. The key challenges for establishing integrated people-centred primary care include availability of family physicians, information and communication technology, the prevention and management of chronic disease and migrant and refugees' health. Policy recommendations are formulated to guide the primary health care reform in Greece, while attempting to inform efforts in other countries with similar conditions.
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Lionis C, Anastasaki M. Integrated health care services as a current challenge for primary health care: reflections from Crete, Greece. MEDICAL SCIENCE PULSE 2019. [DOI: 10.5604/01.3001.0013.1740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper addresses the issue of integrated care services as a current challenge for primary health care in Europe. It is focused on an operational definition of integrated care and documents its relevance to the recent declaration of the World Health Organization regarding primary health care. The paper also reports on experiences gained and lessons learned in Greece, a country where initial attempts towards integration of public health into primary care are currently unfolding. Additionally, it discusses the limited involvement of patients, families, and communities in health care, as well as relative absence of advocacy and care coordination at a policy level. The need for training stakeholders to define and promote integrated care is highlighted as an essential component of translating new concepts into concrete health care actions. Finally, when discussing development and implementation of a well-coordinated and integrated primary health care system, the paper provides ideas for further consideration. The present report is anticipated to open the dialogue between health care professionals, stakeholders, policy makers, and the public towards the integration of health services in contemporary Europe.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece
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Papatheodoridis GV, Goulis J, Sypsa V, Lionis C, Manolakopoulos S, Elefsiniotis I, Anagnostou O, Tsoulas C, Hatzakis A, Dalekos GN. Aiming towards hepatitis C virus elimination in Greece. Ann Gastroenterol 2019; 32:321-329. [PMID: 31263353 PMCID: PMC6595935 DOI: 10.20524/aog.2019.0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.
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Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (George V. Papatheodoridis)
| | - John Goulis
- 4 Department of Internal Medicine, Αristotle University of Thessaloniki Medical School (John Goulis)
| | - Vana Sypsa
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion-Crete (Christos Lionis)
| | - Spilios Manolakopoulos
- 2 Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens (Spilios Manolakopoulos)
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, Athens (Ioannis Elefsiniotis)
| | - Olga Anagnostou
- Greek Organisation Against Drugs (OKANA), Athens (Olga Anagnostou)
| | - Christos Tsoulas
- Medical Department, Gilead Sciences Hellas, Athens (Christos Tsoulas)
| | - Angelos Hatzakis
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa (George N. Dalekos), Greece
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Tham TY, Tran TL, Prueksaritanond S, Isidro JS, Setia S, Welluppillai V. Integrated health care systems in Asia: an urgent necessity. Clin Interv Aging 2018; 13:2527-2538. [PMID: 30587945 PMCID: PMC6298881 DOI: 10.2147/cia.s185048] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A rapidly aging population along with the increasing burden of patients with chronic conditions in Asia requires efficient health systems with integrated care. Although some efforts to integrate primary care and hospital care in Asia are underway, overall care delivery remains fragmented and diverse, eg, in terms of medical electronic record sharing and availability, patient registries, and empowerment of primary health care providers to handle chronic illnesses. The primary care sector requires more robust and effective initiatives targeted at specific diseases, particularly chronic conditions such as diabetes, hypertension, depression, and dementia. This can be achieved through integrated care - a health care model of collaborative care provision. For successful implementation of integrated care policy, key stakeholders need a thorough understanding of the high-risk patient population and relevant resources to tackle the imminent population demographic shift due to the extremely rapid rate of increase in the aging population in Asia.
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Affiliation(s)
- Tat Yean Tham
- Clinical Affairs Department, Frontier Healthcare Group, Singapore
| | - Thuy Linh Tran
- Department of Pharmacy, National University of Singapore, Singapore
| | - Somjit Prueksaritanond
- Department of Community, Occupational and Family Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand
| | - Josefina S Isidro
- Department of Family and Community Medicine, University of the Philippines, Manila, Philippines
| | - Sajita Setia
- Transform Medical Communications, Wanganui, New Zealand
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Yfantopoulos JN, Chantzaras A. Drug Policy in Greece. Value Health Reg Issues 2018; 16:66-73. [PMID: 30195093 DOI: 10.1016/j.vhri.2018.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To provide a detailed overview of the recent reforms in pharmaceutical pricing and reimbursement processes as well as in other important areas of the pharmaceutical policy in Greece. METHODS Information was collected via a structured questionnaire. The study used publicly available resources, such as publications, relevant legislation, and statistical data, while health experts were also consulted. RESULTS Recent pharmaceutical reforms included significant price cuts, increased co-payments and some provisions for vulnerable groups, rebates/clawbacks, mandatory electronic prescribing and prescription by international nonproprietary name, generics substitution, prescription limits and detailed auditing, centralized procurement, as well as changes in the pricing and reimbursement processes, with the introduction of positive and negative lists and an internal price referencing system. Price lists are compiled by the National Organization for Medicines and are issued by the Ministry of Health (MoH). An advisory pricing committee comprising representatives of stakeholder groups was abolished in early 2018. Nevertheless, under the new provisions, a health technology assessment body for the economic evaluation of reimbursed drugs is to be established for the first time in Greece. The committee is to be staffed by experts appointed by a ministerial decision of the MoH. The specific features of the process are yet to be determined. CONCLUSIONS The pricing and reimbursement decision-making processes are centralized under the competence of the MoH. Despite the good intentions of the reformers, there are still some aspects of transparency, equity, and long-term sustainability that remain under question in Greece.
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Affiliation(s)
- John N Yfantopoulos
- School of Economics and Political Sciences, National and Kapodistrian University of Athens, Athens, Greece.
| | - Athanasios Chantzaras
- School of Economics and Political Sciences, National and Kapodistrian University of Athens, Athens, Greece
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15
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Lionis C, Petelos E. Do we need more training for interdisciplinary and interprofessional collaboration prior to implementing any primary care research action? MEDICAL SCIENCE PULSE 2018. [DOI: 10.5604/01.3001.0011.7487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There has been a continuously increasing focus and discussion on interdisciplinary collaboration in primary
care, across various settings and in different forums, during the past few years. Interprofessional and interdisciplinary
collaboration should be a cornerstone of daily practice and context-relevant research. We considered
it important for this manuscript to attempt to address some of the key issues linked to the recognised need for
competence-based training, focusing on interdisciplinary and interprofessional collaboration, so as to promote
and enhance context-relevant research in primary care. This article provides a general introduction and an overview
of this topic, along with some key concepts and operational definitions. These key definitions and their
interrelated nature are examined in detail, including those of practice-based research network, patient-centred
primary care research, and interdisciplinary partnership for research. Furthermore, this paper outlines the reasons
for the strong focus on composition and the development of strategies to enhance the research capacity of
interdisciplinary partnerships throughout training. Workforce training, retention and academic collaboration
are considered, with a particular focus on primary care, and existing interprofessional relationships and perceptions
thereof. Organizational aspects influencing relationships and practice are considered along with their
contribution in terms of practice, research and discourse. Finally, conclusions and recommendations, formed
under the prism of rapidly changing population needs, person-centred values and the imperative need of bringing
innovation to the patient in an effective and efficient manner, are presented for further discussion.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
| | - Elena Petelos
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
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Lionis C, Petelos E, Mechili EA, Sifaki-Pistolla D, Chatzea VE, Angelaki A, Rurik I, Pavlic DR, Dowrick C, Dückers M, Ajdukovic D, Bakic H, Jirovsky E, Mayrhuber ES, van den Muijsenbergh M, Hoffmann K. Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:11. [PMID: 29422090 PMCID: PMC5806359 DOI: 10.1186/s12914-018-0150-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, Heraklion, 70013, Crete, GR, Greece.
| | - Elena Petelos
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, Heraklion, 70013, Crete, GR, Greece
| | - Enkeleint-Aggelos Mechili
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, Heraklion, 70013, Crete, GR, Greece
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, Heraklion, 70013, Crete, GR, Greece
| | - Vasiliki-Eirini Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, Heraklion, 70013, Crete, GR, Greece
| | - Agapi Angelaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, Heraklion, 70013, Crete, GR, Greece
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Danica Rotar Pavlic
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Michel Dückers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Dean Ajdukovic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Helena Bakic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Elena Jirovsky
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Sophie Mayrhuber
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Sifaki-Pistolla D, Chatzea VE, Markaki A, Kritikos K, Petelos E, Lionis C. Operational integration in primary health care: patient encounters and workflows. BMC Health Serv Res 2017; 17:788. [PMID: 29187189 PMCID: PMC5706391 DOI: 10.1186/s12913-017-2702-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 11/07/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. METHODS The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. RESULTS Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. CONCLUSIONS Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web platform, based on a strong theoretical framework, can serve as a robust integration evaluation tool. This could be a first step towards restructuring and improving PHC services within a financially restrained environment.
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Affiliation(s)
- Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, P.O. Box 2208, Heraklion, 71003, Crete, Crete, Greece
| | - Vasiliki-Eirini Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, P.O. Box 2208, Heraklion, 71003, Crete, Crete, Greece
| | - Adelais Markaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, P.O. Box 2208, Heraklion, 71003, Crete, Crete, Greece
- School of Nursing, University of Alabama at Birmingham, Birmingham, USA
| | - Kyriakos Kritikos
- Institute of Computer Science, FORTH, Vassilika Vouton, 70013, Crete, Greece
| | - Elena Petelos
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, P.O. Box 2208, Heraklion, 71003, Crete, Crete, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, University Campus, Voutes, P.O. Box 2208, Heraklion, 71003, Crete, Crete, Greece.
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Adamakidou T, Kalokerinou-Anagnostopoulou A. Home health nursing care services in Greece during an economic crisis. Int Nurs Rev 2016; 64:126-134. [PMID: 27861858 DOI: 10.1111/inr.12329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this review was to describe public home healthcare nursing services in Greece. BACKGROUND The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. SOURCES OF EVIDENCE A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. RESULTS The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. CONCLUSION There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. IMPLICATIONS FOR NURSING AND HEALTH POLICY At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided.
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Affiliation(s)
- T Adamakidou
- Nursing Department of Technological Educational Institute of Athens, Athens, Greece
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Tsiachristas A, Stein KV, Evers S, Rutten-van Mölken M. Performing Economic Evaluation of Integrated Care: Highway to Hell or Stairway to Heaven? Int J Integr Care 2016; 16:3. [PMID: 28316543 PMCID: PMC5354211 DOI: 10.5334/ijic.2472] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/26/2016] [Indexed: 01/04/2023] Open
Abstract
Health economists are increasingly interested in integrated care in order to support decision-makers to find cost-effective solutions able to tackle the threat that chronic diseases pose on population health and health and social care budgets. However, economic evaluation in integrated care is still in its early years, facing several difficulties. The aim of this paper is to describe the unique nature of integrated care as a topic for economic evaluation, explore the obstacles to perform economic evaluation, discuss methods and techniques that can be used to address them, and set the basis to develop a research agenda for health economics in integrated care. The paper joins the voices that call health economists to pay more attention to integrated care and argues that there should be no more time wasted for doing it.
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Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, GB
| | | | - Silvia Evers
- Department of Health Services Research, CAPHRI – School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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