Greek National Healthcare System Research Articles

Introducing a robotic surgery program in the Greek National Healthcare System: Obstacles we need to overcome

A National Healthcare Systems’ primary objective is to ensure equal access to its members. Every advancement in medicine, which has proven to be safe and efficient, must be provided to every patient regardless of their socioeconomic background or financial status. However, the systems’ nonprofit guiding principle results in inadequate financial support, which generates a vicious cycle of disproportionate access to its resources. A recent technological breakthrough in surgery, with several bestowed advantages, is the robotic surgical platform. However, its implementation in the Greek National Healthcare System, for the common good, is associated with several obstacles. The purpose of this article is to outline these obstacles and to suggest potential solutions, in order to eliminate any disparities between patients operated in public or private sector hospitals.

Medication Safety in Breastfeeding Mothers. The Current Situation in the Greek National Healthcare System

Mothers during lactation may encounter barriers including the need of medication intake due to a chronic or acute illness, which may affect mainly the duration of breastfeeding. In these cases, the issue of medication safety during lactation arises and maternal decisions usually depend on professional counseling. Providing scientifically valid information on the benefits of breastfeeding and the risk of exposure of the newborn/infant to medicines through breast milk is a responsibility of healthcare professionals. Reliable sources on the compatibility of medicines with breastfeeding vary and the information among them is conflicting or even insufficient, creating as a consequence difficulty for healthcare professionals to provide counseling. Given the fact that breastfeeding mothers are excluded from clinical trials as they are considered a vulnerable population, the scientific community has turned to alternative methods based on pharmacokinetic population modeling for medication safety during lactation. In addition, through pharmacovigilance science, databases related to drug compatibility with breastfeeding can be enriched with new data. Undoubtedly, the contribution of midwives and other healthcare professionals involved in breastfeeding plays a key role in the pharmacovigilance process through the observation and reporting of side effects. In the Greek national healthcare system, telephone helplines have been established to provide information on medication safety during lactation. Finally, information is provided on the guiding principles for midwives and other healthcare professionals regarding medication safety in breastfeeding mothers. The ultimate goal is to support and prolong breastfeeding with evidence-based knowledge.

The Perspectives on Barriers and Facilitators in Communication by the Healthcare Professionals and Older Healthcare Users: The Role of Health Literacy

Introduction: Older people are the basic users of health services. However, studies have shown that they have relatively low health literacy (HL) levels which results in many negative health outcomes. HL is a major challenge in public healthcare systems and an important determinant of optimised health outcomes and better quality of life for older people. On the other hand, professionals lack knowledge and skills to identify older people’s HL level and therefore, the delivery of care may be insufficient.
 The study aimed to report the perspectives on the barriers and facilitators in communication during the medical encounter by both the healthcare professionals and older healthcare users.
 Method: A qualitative study design was applied. One group with seven healthcare professionals and another one with five people over 60 years old discussed about HL knowledge and their experiences (attitudes and behaviors, barriers, and facilitators) of the healthcare professional -patient interaction. The focus groups took place virtually and were coordinated by the senior author. The discussions were analysed using the content analysis method.
 Results: Communication facilitators during the healthcare professional-patient interaction as reported by the healthcare professionals included: the need to trust and collaborate with the older people, patients’ specific characteristics (high level of education, psychological resilience and good judgmental), carers’ participation, the use of clear language and a person-centred approach. Communication barriers were considered the older people’s rigid beliefs about their lifestyle, the age-related cognitive, psychological, and sensory deficits, the function, and the structure of the healthcare system (e.g., professionals’ excessive workload). On the other hand, older people mentioned the importance of being prepared to ask questions during the medical encounter, being respected and included in the decision-making process.
 Conclusion: Easy-to-use Health Literacy training tools adapted to healthcare professionals’ everyday needs are considered necessary to improve the professionals-patients interaction, enhance their communication skills and promote the person-centred care within the framework of the Greek National Healthcare System. The integration of the tools as part of the training courses could prepare healthcare professionals with the enhanced the HL skills needed to improve the quality of care they provide and reduce the cost of care in general.

Maternity care for refugees living in Greek refugee camps: What are the challenges to provision?

Over a two-year period between 2015 and 2016, unprecedented numbers of people arrived in Greece fleeing conflict, persecution, and poverty. With new arrivals every day, there is a significant unmet need for health care provision, posing a challenge to the Greek Healthcare System. For pregnant refugees, a known vulnerable group, this has resulted in a complex partnership of shared maternity care between humanitarian organizations, the Greek national health care system, and European multi-state initiatives. Our aim was to understand the challenges to providing maternity care services in Greek refugee camps as perceived by health care providers. A qualitative study comprising observation and semi-structured interviews with health care providers working with pregnant refugees was conducted in five refugee camps in May 2017. Interviews were transcribed and analyzed with thematic coding. Twenty-one health care providers were interviewed and field notes taken from observational study of services in five refugee camps. Health care providers describe difficult cross-cultural communication to be their biggest challenge to caring for pregnant refugee women. The limited availability of female only safe spaces is also identified as a barrier. Lastly, the overburdened Greek public health system limits their ability to provide care. Our research supports other literature describing difficult communication and the overburdened Greek health system as significant health care barriers for pregnant refugees in Greece. There is limited literature examining the role of "safe space," and further research is needed. Stakeholders providing maternity care to refugees should look to tackle these key issues as they seek to provide care to this population.

Financial, Economic Crisis and Quality in Health Services Provision, New Challenges to Improve Quality Policy in the Healthcare System of Greece

Greece has been severely affected by the global financial and economic crisis, with far-reaching economic, social and political consequences. In 2013, the country was already experiencing its fifth year of recession and was operating within suffocating tax measures. Prior to the crisis, the Greek healthcare system suffered from a wide range of problems. Therefore, it was vulnerable to economic fluctuations and was not properly prepared to meet the changing needs of the population. The aim of this study was firstly to investigate the effect of the economic crisis on the quality of health care in Greece and secondly to propose methods to improve the quality policy of the Greek Health System. A literature review was carried out in order to collect all available information of the relevant literature sources in both Greek and international English-language bibliography. The effects of the economic crisis on the Greek national healthcare system were recorded extendedly. In particular, the effects of the economic crisis on access to health services, the effectiveness of hospital care, the quality of health care provided, the transparency and oversight are analysed. In summary, the need to re-examine and promote a public debate on the health budget, not only in economic terms, but as a development tool for the well-being of citizens, is emphasized. In conclusion, restoring the social values that govern the health care system is a prerequisite for creating a new model for sustainable development

Initial Real-Life Experience from a Designated COVID-19 Centre in Athens, Greece: a Proposed Therapeutic Algorithm.

We report our initial experience with the management of a mixed group of patients with COVID-19 infection, admitted and treated in a designated COVID-19 centre in the Athens Metropolitan area over a 4-week period. The SARS-CoV-2 pandemic presented a huge challenge to the Greek National Healthcare System and healthcare workers. Their response so far has been miraculously effective. Since there are essentially no therapeutic guidelines yet for this disease, we relied mainly on our medical intuition, our empathy for our patients and team work to do the best possible for 49 people with this infection. We present the therapeutic algorithm we gradually developed (on the job) and applied in our patients, based on continuous creative brainstorming and monitoring of the literature.

Health Professionals' Perception about Big Data Technology in Greece.

Big data is massive amounts of information that can work wonders. In the healthcare industry, various sources for big data include hospital records, medical records of patients, results of medical examinations, and devices that are a part of internet of things. The research aim of this study is to investigate the perceptions of the Health Professionals about the Big Data Technology in Healthcare. An empirical study was conducted among 151 health professionals (doctors and nurses) to assess their knowledge about the Big Data Technology and their perceptions about using this technology in healthcare. A questionnaire was developed in order to measure the aforementioned dimensions. The survey's population was formed by 151 doctors and nurses who are working at private and public hospitals in Greece. The majority of the population have never heard about Big Data. As a result, most of them were not aware of the format of Big Data. Based on the study findings, it can be assumed that the majority of the responders did not have knowledge about the Big Data Technology. It is also important that most of them had never been informed about Big Data. It can be assumed that the Healthcare Sector in Greece is not familiar with Big Data Technology yet. Finally,the current study reveals a rather positive attitude toward the usage of Big Data in the Helathcare domain, although there are some doubts about the implementation of the aforementioned technology in the Greek national healthcare system.

Lacosamide as a first-line treatment option in focal epilepsy: a cost-utility analysis for the Greek healthcare system

Background and aims: Epilepsy is the most common serious neurological disorder worldwide. Approximately 40% of patients with focal epileptic seizures remain uncontrolled with antiepileptic drug (AED) monotherapy or polytherapy. Lacosamide has been recently approved by the European Medicines Agency as monotherapy for the treatment of focal seizures. The aim of this study was to estimate the cost-effectiveness of lacosamide compared with zonisamide as first-line treatment of focal epilepsy in patients with epilepsy aged ≥ 16 years to inform clinical decision-making in Greece.Methods: A discrete event simulation model was adapted to reflect treatment pathways and resource use within the Greek national healthcare system, as specified by clinical experts. The model captures time-varying events and patient characteristics. Clinical inputs were sourced from pivotal trials and a network meta-analysis comparing lacosamide with other AEDs. The model predicts disease progression and seizures, relevant and most common adverse events, withdrawal due to lack of efficacy or adverse events, and epilepsy-specific and all-cause mortality over a 2-year time horizon. Unit costs were retrieved from published Greek sources. Health outcomes were measured as quality-adjusted life years (QALYs); secondary outcome was the cost per seizure avoided. Robustness of the results was tested with univariate and probabilistic sensitivity analyses.Results: The lacosamide treatment pathway was associated with higher costs (i.e. €1,064) and an additional 0.119 QALYs when compared with zonisamide, resulting in an incremental cost-effectiveness ratio of €8,938 per QALY gained. The sensitivity analyses demonstrated that the results are most sensitive to the efficacy and utility estimates.Limitations: There are a number of limitations which stem from the process of model adaptation and lack of local real-world evidence.Conclusions: Lacosamide is a cost-effective option at a willingness-to-pay threshold of €30,000 per QALY, representing a valuable monotherapy treatment option for patients with focal epileptic seizures in the Greek setting.

The impact of the financial crisis and austerity policies on the service quality of public hospitals in Greece

The influence of the financial crisis on the efficiency of Greek public hospitals has been widely debated. Despite this increasing interest in such research, the question of to what extent the recent reforms in the Greek National health care system were effective in establishing a health care structure and process that provide better results for patients has yet to be fully investigated. As a step in this direction, the paper focuses on patient's experience with public hospital care quality before and during the economic crisis. A questionnaire survey was carried out among 1872 patients discharged from 110 out of the total of 124 Greek public hospitals. Patients' perceptions were analysed using a structural equation modelling approach. The findings reveal that public hospital service quality is at a medium level (66.2 on a scale from 1 to 100) over 2007–2014, presenting a decreasing trend during the recession. Policies to address the crisis may have contributed to a reduction in hospital expenditures, but at the same time patients were increasingly dissatisfied with the technical care. Consequently, there is a need for reforms aimed at the achievement of productivity gains, responsibility, and transparency in the management of productive resources, by enabling health organisations to reduce their costs without a deterioration in the quality of care.

Bullying and Sexual Discrimination in the Greek Health Care System

Modern medicine is based on teamwork and communication. Bullying and discrimination can have a serious effect on these, affecting the standard of medical training and patient care. To determine the incidence of bullying and sex discrimination in the Greek health care system. An online questionnaire was designed and circulated among Greek medical professionals. We received 1349 completed questionnaires with a response rate of 48% and with 45% of them being female. Equal opportunities in specialty training were reported by 55% of the participants. Female doctors in medicine and in surgery reported no equal opportunities at an incidence of 15% and 30%, respectively (p < 0.001). Family obligations and lack of family support were considered as the main obstacles in female doctors' professional development by 92% and 59% of the participants, respectively. Both sexes appeared to have suffered from various forms of abusive behavior with characteristics that vary between them. Verbal abuse, threatening behavior, and sexual harassment were reported by 50%, 38%, and 20%, respectively, with women being 3 times more likely to be victims of sexual harassment (34% vs. 9%, p < 0.001). Finally, the availability of official support mechanisms was reported in only 15% of the cases, whereas friends and colleagues were the main support for 46.17% of the cases. This is the first study attempting to preliminary describe the extent of bullying and sexual discrimination in the Greek national health care system. Despite the limitations of this study, it is imperative that more research is performed on this issue from the appropriate national authorities.

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

Examining Patterns of Information Behavior Among Healthcare Professionals: A Case Study on Health Psychologists

Psychologists are an understudied population in terms of information needs and information seeking behavior. This article provides theoretical analysis accompanied with some empirical evidence drawn from a nationwide survey of psychologists working in the Greek National Healthcare System (GNHS). The empirical study was conducted during the spring of 2011, through a specially designed questionnaire distributed to all psychologists within GNHS. Psychologists seek information for patient consultation purposes and for knowledge updating; they prefer using their personal library, internet search engines, and their colleagues as information sources, while the main obstacles they face include the lack of hospital libraries. This research identified the need to more strongly link hospital library services to health psychologists on the grounds of their information needs and behaviors.

A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures

Objectives The purpose of this study is to measure the Greek public healthcare delivery efficiency from a regional perspective by applying conditional nonparametric models. Methods The study reviews the existing literature on performance measurement and proposes models on these grounds. By using data envelopment analysis (DEA) and free disposal hull (FDH) models, the performance of public health delivery services of the Greek prefectures is evaluated. The efficiency levels of the Greek prefectures are compared and analyzed in a regional context. By using convex and non-convex models alongside with bootstrap techniques and conditional full frontier applications the paper develops models for regional public health delivery policy evaluation. Results The paper shows that higher levels of GDP per capita (GDPc) have a negative influence on the efficiency of regional healthcare delivery, indicating that regional economic growth does not ensure better healthcare delivery service. Furthermore the results reveal that population density increases the prefectures’ efficiency of public health provision, indicating the over-supply of health services by urban hospitals. Finally, several healthcare delivery inefficiencies have been reported among the Greek prefectures emphasizing a poor state of healthcare delivery. Conclusions The results indicate that after the reform of the Greek national healthcare system in 2000–2002, the absence of a unified healthcare policy was accompanied with misallocation of healthcare resources among the Greek prefectures creating socioeconomic health inequalities.

Causes of Non-Attendance at an Open-Access Endoscopy Outpatient Clinic

We read with interest the article by Adams et al. concerning nonattendance at outpatient endoscopy clinics [1]. The results of a study we conducted in our own department may also be of interest in this connection. Due to the convenience of the service [2] [3], the majority of patients who require gastroenterological assessment in Greece are usually referred to an outpatient endoscopy department. In Greece, endoscopy services are offered by both the Greek national health-care system and by the Hellenic Social Security Institute (Idroma Koinonikon Asphaliseon, IKA). A considerable nonattendance rate, mainly involving upper gastrointestinal endoscopies, is observed in both systems. The result is that the number of endoscopies conducted in each department can vary by up to 60 % from day to day, since the nonattending patients usually do not cancel their appointments. This is frustrating for the staff and services concerned, especially since the main problem is that the demand for endoscopy appointments far exceeds the existing departments’ capacity. Long waiting lists are therefore quite usual, and there is considerable pressure for early appointments. The end result are further delays - plus, of course, increased financial costs, since the IKA is obliged to pay private health-care providers for endoscopic examinations.

A model for introducing telemedicine to the Greek National Health Care System

This paper discusses the prospect of operating a new telemedical system in the Greek National Health Care System, as a means to overcome the hospitalisation and diagnostic problems in non-urban areas of the country (patients transfer from county to centre, decongestion of hospitals). Details its functions and benefits and introduces a model of determining and analysing the cost of the conventional health care services and the cost of telemedicine. Finally, it analyses the economic results of the model and proposes a mode for successfully introducing telemedicine to the Greek National Health Care System.