Primary Health Care In Greece Research Articles

Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage?

The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings. The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality. Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers. Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.

Evaluation of Lower Urinary Tract Symptoms in Males and Urinary Incontinence in Females in Primary Health Care in Greece.

Background and Objectives: The significant prevalence of Lower Urinary Tract Symptoms (LUTS), erectile dysfunction (ED), and associated adverse effects calls for increased attention in primary care settings. In Greece, there is a lack of sufficient data for LUTS and ED screening in primary care. Therefore, the aim of our study was to estimate the prevalence of LUTS and ED, identify associated risk factors, and evaluate their impact on quality of life among adult primary healthcare users aged 40 years and older in Crete, Greece. Materials and Methods: A cross-sectional study was conducted to explore the prevalence of LUTS and ED in 1746 primary health care users visiting rural primary health care practices in Crete, Greece. Participants underwent a comprehensive evaluation including demographic parameters, screening for LUTS utilizing the validated International Prostate Symptoms Score (IPSS) questionnaire and for ED using the International Index of Erectile Function (IIEF-5), in males, and for urinary incontinence in women with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Participants with a prior diagnosis of LUTS or ED were excluded (n = 183). Results: Out of 536 participants finally included (n = 1746 screened), 32% of males and 36% of females exhibited moderate to severe LUTS. Following adjustments, we identified advanced age, retirement, and the presence of diabetes type 2 as factors associated with the occurrence of LUTS in men. Patients with LUTS also had a substantially increased likelihood of experiencing ED. Moreover, it was observed that women with hypertension or diabetes type 2 and lower education levels face an increased likelihood of developing LUTS, which adversely affects their quality of life. Conclusions: In conclusion, the findings of this study reveal a high occurrence of LUTS and ED in adults aged 40 years and older who utilize primary healthcare services, with a negative impact on their quality of life.

Detection and Reporting of Adverse Drug Reactions Related to Antibiotics in Primary Healthcare in Greece.

Detection of adverse drug reactions (ADRs) is a challenging matter for healthcare professionals who contribute significantly to the pharmacovigilance system through their participation inspontaneous reporting. The objective of this study was the detection and reporting of ADRs related to antibiotics in primary health care in the region of Peloponnese. A cross-sectional study was conducted in all national health system primary health units of the Peloponnese region in Greece. A self-administered questionnaire was distributed to a total of 404 physicians who provided services in these settings. Descriptive and multivariate statistical analysis was performed using the SPSS 25.0. Levels of significance were two-tailed and statistical significance was set at p =0.05. 306 out of 404 physicians responded to the questionnaire, giving a response rate of 75.8%. 81.6% of physicians stated that they rarely observe ADRs related to antibiotic administration during their practice, 49.8% rarely report them, and 33.7% never report them. Non-serious side effects (42.5%), physicians' workload (24.1%), and the lack of knowledge about the reporting obligation (20.6%) have been declared as the main reasons of non - reporting. In addition, physicians with ≤10 years of clinical practice rarely reported that they experienced ADRs after antibiotics' administration compared to those with more work experience and specialized physicians (p= 0.001). ADRs reporting rates among physicians in primary healthcare are low. Changes in physicians' attitudes are vital and can be achieved through consistent and continuous training programs as well as the inclusion of ADRs and pharmacovigilance themes into the tertiary education curricula.

Perceived risk and pandemic response awareness in low-capacity public primary health care in Greece.

Primary health care (PHC), the cornerstone of health systems, has an important role in infectious disease control. The SARS-CoV-2 (COVID-19) pandemic has put a burden on health systems worldwide and especially on healthcare workers at the first line delivering their services in remote areas of Greece. This study investigates preparedness and awareness level of primary healthcare workers (PHCWs) and their risk perception in managing the pandemic during its initial phase. A cross-sectional survey was conducted in public PHC units in Greece. A web-based 14-item questionnaire, tested in a pilot study, was administered by a pre-existing panel of the Education and Research Network in PHC of Aristotle University of Thessaloniki, Greece. Associations were assessed between epidemic response awareness, risk perception, participant demographics and work settings. Participants were grouped by profession in first-line physicians (general practitioners, internal medicine specialists, pediatricians), first-line non-physicians (nurses, health visitors, paramedics) and second-line PHCWs (dentists, microbiologists, administrators, midwifes, laboratory technicians, nutritionists and social workers). Univariate logistic regression and multivariable analysis were performed and linear regression was performed to examine the effect of participants' awareness of the preparedness plan to their working area characteristics. A total of 441 PHCWs participated in the survey. Risks were perceived at a lower level by second-line PHCWs than by first-line PHCWs (B=-0.78, 95% confidence interval (CI) -1.49- -0.08; p=0.028). Older PHCWs had less concerns than younger PHCWs (B=-0.04, 95%CI -0.08- -0.01; p=0.025) and more experienced participants had more concerns than less experienced (B=0.04, 95%CI 0.00,0.07; p=0.050). PHCWs in rural settings presented with more preparedness awareness, compared to PHCWs in urban areas (B=1.10, 95%CI 0.28,1.92; p=0.008), while PHCWs living with high risk individuals showed less situation awareness (-0.55, 95%CI -0.95-0.16; p=0.006). PHCWs in rural areas revealed a relatively high awareness of the response measures and management protocol requirements that were in place, compared to their colleagues in urban areas. As expected, first-line PHCWs directly exposed to emergencies expressed more concerns than second-line PHCWs. Learning from the challenges occurring during the initial phase of the pandemic could help PHC facilities address COVID-19 effectively and PHCWs' sense of security and confidence could be augmented, even when working in remote areas of the country. When planning training, distributing equipment and proposing protocols, the characteristics of the area and the needs of PHCWs, and population should be cautiously considered.

Influenza vaccination rate among high risk group patients in primary health care in Greece.

Seasonal influenza vaccination is the main method for influenza prevention. The main objective of this study is to estimate the frequency of vaccinations in patients with chronic illnesses presented to a primary health care (PHC) centre. This cross-sectional study was performed in patients admitted to the Kapandriti Health Centre. Their vaccination status with an influenza vaccine and their underlying diseases were recorded. 34.8% of the subjects had been vaccinated against seasonal influenza. Vaccination coverage was found to be 53.9% in pulmonary, 55.6% in chronic kidney disease, 43.7% in cardiovascular disorders, 40.6% in diabetes, 40.6% in any kind of malignancy, and finally 33.3% in neurological patients. The most significant predictors for vaccination were the age group of 60 to 79 years (OR = 3.08, 95% CI: 1.79-5.29), age over 80 years (OR = 2.91, 95% CI: 1.58-5.36), respiratory disease (OR = 2.25, 95% CI: 1.33-3.76), cardiovascular disorder (OR = 1.46, 95% CI: 1.02-2.10), and 3 to 5 visits to the unit annually (OR = 1.57, 95% CI: 1.12-2.24). Finally, it was discovered that coexistence of one to three diseases reduced the likelihood ratio for vaccine uptake (OR = 0.15, 95% CI: 0.03-0.79, p < 0.05). The influenza vaccination rate for the population of the present study has been found higher than that reported previously in literature. We believe that there is a need to implement new and more effective strategies such as educating vulnerable groups on the benefits of vaccination and so reducing the incidence of influenza and its complications especially in vulnerable groups.

Integrated people-centred primary health care in Greece: unravelling Ariadne’s thread

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.

Psychiatrists role in primary health care in Greece: findings from a quantitative study

BackgroundAlthough the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population’ needs.MethodsThe present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies.ResultsThe vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists’ participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners’ usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually fail to comply.ConclusionsRespondents in the present study are receptive to participate in primary care. They believe that their inclusion to primary care will result to decreased social stigmatization for mental health problems, increased patient’ access and improved detection and management rates for common mental health conditions.

Kryzys finansowy i podstawowa opieka medyczna w Grecji. Czy to czas dla medycyny rodzinnej?

Kryzys finansowy i podstawowa opieka medyczna w Grecji. Czy to czas dla medycyny rodzinnej?

Adaptation and validation of the Beliefs about Medicines Questionnaire (BMQ) in primary care patients in Greece

Objective: Cultural adaptation and validation of the Beliefs about Medicines Questionnaire in Primary Health Care patients in Greece. Methods: For the assessment of the psychometric properties of the Greek version of the Beliefs about Medicines Questionnaire, 150 chronic patients visiting primary healthcare settings throughout the island of Crete, Greece, were recruited. They all completed both BMQ-general and BMQ-specific scales of the BMQ version which was previously culturally adapted and translated into the Greek language. Results: The subscales of the Beliefs about Medicines Questionnaire demonstrated adequate internal consistency with Cronbach’s alphas of 0.852 for Specific Necessity, 0.763 for Specific Concern, 0.784 for General Harm and 0.676 for General Overuse. On both parts of the BMQ, the inter-item correlations were found to be sufficient. Factor analysis revealed identical patterns for all questions between the Greek and the original scales. Conclusion: The Greek Version of the Beliefs about Medicines Questionnaire is a valid and reliable instrument for evaluating patients’ beliefs about medicines in primary healthcare in Greece. Further research is needed in order to study the relationship between beliefs about medication and non-adherence to medications.

Cost-Sharing as a Financing Mechanism in the Greek Primary Health Care: An Assessment from the Managers’ Perspective

Cost-sharing was recently introduced in the Greek Primary Health Care, as a supplementary mechanism to finance spiraling health expenditure and to make patients cost-conscious.A specific questionnaire was distributed to the 188 managers of the health centres in Greece (response rate 93 per cent). The research was conducted from June 2011 to May 2012. Statistical analysis was performed using the Pearson x2 test, the Kolmogorov-Smirnov test, the t-test and the Mann-Whitney test at p<0.05 level of significance. 73 per cent of the managers stated that the introduction of the cost-sharing had a positive impact on patients’ compliance and 66.3 per cent that the financing mechanism has contributed to cost consciousness from both the patients and personnel. The revenues from medical fees do not cover the running costs of health centres (81.5 per cent) and they do not promote a more effective delivery of services (80 per cent). 61 per cent of managers characterise cost-sharing as a positive step and 80 per cent support the economic autonomy of health centres.Managers stated that cost-sharing has a positive impact on patients’ cost-consciousness and in the financing of the primary health care in Greece, but this policy option alone doesn’t assure the financial and administrative viability of the health centres.

Translation and validation of Berlin questionnaire in primary health care in Greece

BackgroundThe aim of our study was to validate a Greek translation of the Berlin Questionnaire (BQ) for obstructive sleep apnoea syndrome (OSAS) and to explore whether this screening questionnaire could be used to help identify primary care patients at greater risk of having OSAS.MethodsWe recruited 189 patients visiting a primary health care setting on the island of Crete, Greece. They all completed the Greek Version of the BQ. Patients were then referred to a Sleep Disorders Unit for evaluation of suspected sleep-disordered breathing.ResultsA PSG study was performed in 129 of the 189 subjects (68.3%). BQ identified 74.4% (n = 96) of the patients as high-risk for OSAS and the remaining 25.6% (n = 33) as low-risk. The sensitivity and specificity of BQ for OSAS diagnosis were 76% and 40%, respectively, for an apnoea–hypopnoea index (AHI) ≥5 per hour but <15 per hour, 84% and 61% for an AHI ≥15 per hour but ≤30 per hour, and 79% and 39% for an AHI >30 per hour.ConclusionsIn conclusion, the Greek Version of the BQ is a useful instrument for identifying patients at risk for OSAS in primary health care in Greece. The findings of our study confirm that such screening tools should be used by primary care clinicians for OSAS prediction.

Cost-effectiveness in primary health care in Greece.

Health is a public good and in the free market is not distributed equally in the society due to the inefficient allocation of resources. According to the economic approach of health, illness prevents the infected individual to participate in processes (work), instead causes costs to the society as a whole. The purpose of this study is the demonstration of existing studies with the main purpose to pinpoint the significance of the cost effectiveness procedures in primary health care services in Greece.

Cardiac arrest in Greek primary health care and willingness of general practitioners to use automatic external defibrillator

AimThe aim of this study was to calculate the incidence of out-of-hospital cardiac arrest (OHCA) in primary health care in Greece and assess general practitioners’ (GPs) willingness towards the use of automatic external defibrillator (AED). MethodsWe conducted a survey in GPs working in both private and public sectors. The survey consisted of 32 questions and was distributed via email in 180 randomly selected GPs. To estimate OHCA incidence, data concerning the number of examined patients and the number of cardiac arrests were used. ResultsBased on the population of our study, the incidence of OHCA in primary health care in Greece is 15.3/100,000 population per year. Most of the arrests occur in health centers, while ventricular fibrillation/ventricular tachycardia are the first monitored rhythms. Almost all GPs were willing to use an AED even though some of them did not know how to use it. ConclusionsThe incidence of OHCA in primary health care in Greece is 15.3/100,000 population per year. Greek GPs may have an important role in managing OHCA victims and are willing to use an AED. This is the first study estimating OHCA in primary health care in Greece.

Insufficient primary care services to the rural population of Greece

. Primary healthcare in Greece remains poorly organised and highly fractured, as it is delivered by a variety of providers that differ in quantity, quality, effectiveness and efficiency of care provision. As a consequence, Greeks often have unequal access to standard services, depending on factors such as entitlement, geographical accessibility and ability to pay

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review.

Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

Dementia and depression: two frequent disorders of the aged in primary health care in Greece.

Dementia and depression are very common disorders among elderly people and their presence decreases the well-being of the aged. The purpose of this study was to assess the magnitude of dementia and depression among elderly people living in different settings in the catchment area of the Chrisoupolis health centre (HCCh) in northern Greece. A total of 536 patients aged 65 years and over, including 48 subjects living in an old people's home, 75 subjects who were taking part in the activities of the open centre for the elderly and 413 subjects randomly selected from those visiting the HCCh, were interviewed by the primary health care team of the HCCh. Medical and family history data were recorded, while cognitive and mood disorders were assessed by using the Mini Mental State Examination and Geriatric Depression Screening Scale. At the time of the examination, 37.6% of the men and 41.6% of the women showed various degrees of cognitive impairment, while 29.9% of the women and 19.6% of the men showed mild to moderate depression. Diabetes mellitus and hypertension frequently were found to co-exist with depression and dementia. The results reaffirm that there is a high prevalence of the studied mental disorders in older patients in the out-patient setting in Greece. A set of recommendations to Greek GPs has now been formulated, with specific emphasis on the use of different screening tools and the appropriate treatment of the most frequently co-existing chronic diseases.

Patient-number-based computerized medical records in Crete. A tool for planning and assessment of primary health care

Primary Health Care (PHC) in Crete is in a state of rapid development. The strategy for introducting PHC involves an orientation towards the population and the creation of possibilities for evaluation. A case records system, “EginO”, was installed in the University of Heraklion and at the Health Centre in Spili in 1988, and was further developed according to local needs during 1989, when also a Greek version of the statistical system, “DoIt”, was installed. The main reasons for establishing a computerized medical information system were (i) to assess the health needs in Crete, (ii) to monitor activities of the primary health care organizations, and (iii)_ to introduce epidemiological research into primary health care in Greece. The information system was based on specially assigned patient numbers containing several pieces of information about the individual; the system was developed at the Dalby Health Sciences Centre in Sweden. Each month, data were extracted in Spili Health Centre, and these data were regularly used to present incidence and prevalence indices. Some of the data extracted were reported to the health authorities in Greece. “EginO” and “DoIt” gave possibilities to evaluate health services by following the morbidity, while also making it possible to describe and analyse health needs in the population of Spili and other primary health care catchment areas in Greece.

Establishment of Research in Primary Health Care in Greece. Experiences of Greek-Swedish Collaboration

The last few decades have seen great changes in health care and medical care in Greece, as well as in the Greek university system. A new law on health care and medical care has come into force, a new university hospital and new health centres have been built, and a faculty of medicine has been established at Heraklion in Crete. People are speaking of a change of paradigm. Simultaneous with the introduction of the new national health care system, the Department of Family and Social Medicine (DFSM) in Crete started a major project on public health, known as the Primary Health Care and Nutrition Programs (abbreviated as PPD). The purpose was to chart the state of health and living conditions of the Cretan population in the period 1986-1990. Cooperation in research and training began between DFSM and the Dalby Health Sciences Centre, Lund University in 1987. This was natural since there was a shared interest in research into family medicine and social medicine. In addition, a new Health Care Act had come into force in Sweden in 1982. The establishment phase of primary health care started in Sweden at the end of the 1960s. In the 1970s health centres were established, along with research and training in family medicine, in a way that is comparable in many respects to the situation in which Crete found itself a decade later. This paper concerns the organization and implementation of PPD and the research cooperation between Greek and Swedish institutions. This can be seen as an expression of the internationalization of research for which the two universities have striven.