What Greece can learn from UK primary care experience and empirical research

Kousoulis, Antonis A.; Symvoulakis, Emmanouil K.; Lionis, Christos

doi:10.3399/bjgp12x656928

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…One solution to this issue may be the development of more flexible primary groups along with legislative acts delegating power and fund allocation to regional administrative authorities. These policies offer opportunities to create community-oriented healthcare services and networks that can help preserve the quality of clinical practice [15]. Therefore, there is an urgent need for studies that will elicit further and current information about the rest of the regions and that could help inform the undergoing reform of the institutional and administrative framework of the Greek PHC system.…”

Section: Discussionmentioning

confidence: 99%

“…Certain articles have been published during the austerity period highlighting the necessity for PHC reform [15,16]. However, there is still lack of primary data to inform and facilitate the evaluation process and promote rational thinking about which changes to incorporate and which model to adopt in the context of the PHC reform that is currently under discussion for these regions and for the whole of Greece.…”

Section: Introductionmentioning

confidence: 99%

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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

Sbarouni

Petelos

Kamekis

et al. 2019

Medicine and Pharmacy Reports

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sbarouni

Petelos

Kamekis

et al. 2019

Medicine and Pharmacy Reports

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“…Various points within the articles included in this review highlight the influence of the setting (especially primary care) as a key determinant in the adoption of self-management behaviours. As the international discussion on health care continues, especially intertwining among the herein participating countries [ 106 – 109 ], each government, along with local organisations, can both learn and extrapolate meaningful lessons to this end. This interaction between health care professionals and patients renders a proper undergraduate education that is not the case for all the European countries.…”

Section: Discussionmentioning

confidence: 99%

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Kousoulis

Patelarou

Shea

et al. 2014

BMC Health Serv Res

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BackgroundSelf-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country.MethodsThe methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias.ResultsFollowing the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools.ConclusionsThis review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-453) contains supplementary material, which is available to authorized users.

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“…The Newly developed nations such as Brazil have also implemented national-level strategies to increase access to their PHC services [10]. An integrated system of PHC and gatekeeper system is crucial for strengthening PHC and achieving universal health coverage through overall efficiency in resources utilization [11].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya

Nshimirimana¹

2016

AJHR

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The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of outpatients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients' referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers' non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.

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What Greece can learn from UK primary care experience and empirical research

Cited by 8 publications

References 4 publications

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

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

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya

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