Adelais Markaki

Exploring training needs of nursing staff in rural Cretan primary care settings

The purpose of this exploratory study was to assess occupational profile, level of performance, and on-the-job training needs of nursing staff employed in all government primary health care centers in rural Crete, Greece. The translated, culturally adapted, and validated Greek version of the Training Needs Assessment questionnaire was used. There were no significant differences between 2-year degree graduates (LPNs) and 3- or 4-year degree graduates (RNs, midwives, and health visitors) in terms of importance for 28 of 30 assigned tasks, whereas level of performance did not differ in any tasks. Significant training needs were reported by all staff, mainly in research/audit and clinical skills. Systematic overview of skill deficits in relation to skill requirements should be implemented by regional health authorities to enhance delivery of on-the-job training targeting group-specific, local needs.

Quality assessment systems in rehabilitation services for people with a disability in Greece: A critical review

BACKGROUND Despite international interest on quality assessment systems (QAS) and their importance in health care accreditation, implementation of a Rehabilitation Services Quality Measurement System still remains a neglected subject in Greece. OBJECTIVE To identify appropriate tools for researchers and policy makers to assess the quality of rehabilitation services in Greece, within the current active debate on national health care reform. METHODS A critical review methodology was undertaken, using a systematic approach, aiming to identify the most appropriate tools in the field. Multi-step strategy was followed to gather relevant data, including bibliographical database, internet and hand searches. RESULTS Twenty-two studies, articles and documents were identified as meeting all inclusion criteria, representing four QAS, compared according to appropriateness, efficiency, and feasibility for general use. The European Quality in Social Services (EQUASS) was evaluated as meeting all of the desired features, such as proper certification, objective measuring, equality, education and training, established guidelines and person-centered approach. CONCLUSIONS EQUASS initiative, developed according to European standards and implemented in resource-limited settings, was recognized as the most adaptive and appropriate system for Greek rehabilitation settings. Health policy makers are urged to take findings into consideration in establishing an integrated, quality-assured rehabilitation system throughout the country.

Kidney organ donation knowledge and attitudes among health care professionals: Findings from a Greek general hospital

Identified barriers of organ donation advancement include lack of knowledge, personal beliefs, and a negative attitude from health professionals. This article reports on current knowledge and attitudes toward kidney donation among nurses and physicians in a Greek general hospital. A previously used questionnaire was applied. More physicians than nurses were donor card holders, with registration rates being lower than expected. Over half of the participants did not consider themselves well informed about registering as a kidney donor. Older nurses differed significantly from younger ones in their willingness to become live donors if an adult required a kidney. Nurses who were blood donors had higher odds ratio of feeling well informed when compared with nurses who were not blood donors. Integrating organ donation issues into undergraduate health science curricula and continuous education interdisciplinary programs is essential in increasing awareness, eradicating negativism, and reversing inertia.

Shifting towards an Opt-Out System in Greece: A General Practice Based Pilot Study

New legislation in Greece towards presumed consent for organ donation, effective as of June 2013, has come at a critical moment. This pilot study aims to explore awareness, specific concerns and intentions about the new organ donation framework among patients attending Greek general practices in a rural and urban setting. Only 2.6% of respondents had a donor card, a mere 9.6% was aware of new legislation, whereas only 3.8% considered that the public had been adequately informed. Higher income respondents were more likely to be aware that they would be considered organ donors upon death, unless declared differently. Urban practice respondents were less likely to have previously discussed with a significant other their intentions in regards to presumed consent. One quarter of all respondents (22.4%) intended to carry out their right to prohibit organ removal upon death. Survey results reveal that organ donation reform has yet to be disseminated by the Greek society, underscoring the urgency for targeted information campaigns.

Monitoring Reasons for Encounter via an Electronic Patient Record System: the Case of a Rural Practice Initiative

The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented.

An Evaluation of Patients' Opinions of Primary Care Physicians: the Use of EUROPEP in Gaza Strip-Palestine

The objective of this paper is to identify the level of patients’ satisfaction with primary care physicians. Data were gathered from an exit interview using a standardized questionnaire (EUROPEP) and background variables. A total of 956 patients in fifteen primary health care clinics in Gaza Strip participated. Outcome measures is positive patient satisfaction (good and excellent ratings in the EUROPEP Index). As a results, the mean percentage of positive satisfaction with medical services was poor (41.8%). The poorest performance was recorded for: getting through to the clinic on the phone, being able to speak to physician on the telephone, time spent in waiting rooms and helping the patient deal with emotional problems. The comparison between clinical behaviour dimension and organization of care showed that clinical behaviour was evaluated higher. In conclusion, Palestinian patients expressed overall dissatisfaction with services provided by primary care physicians. These findings present a real challenge for Palestinian authority policy makers and administrators in terms of designing appropriate quality improvement strategies.

Greek research capacity and economic hardships: a social network ripple effect?

The effects of the ongoing economic crisis on the Greek population have spurred a lively debate1 with calls for improved monitoring of vulnerability and prevention of poverty-related health threats at the community level. However, what happens if the necessary research capacity is seriously undermined by successive cuts in public spending, intensifying bureaucracy, and permeating uncertainty over the country’s bailout? Although Greek scientists still demonstrate good rates of research productivity and are highly esteemed, it is debatable if this will continue at the same pace. Despite the more optimistic point of view expressed by Malone,2 it is no longer ‘business as usual’ for most Greek scientists. Their ability not only to cope with difficult work conditions but also …

Self-reported health complaints in a primary care population living under stressful conditions in the Gaza Strip, Palestine

Background: The population in the Gaza Strip has been living under chronically stressful conditions as a result of the ongoing Israeli–Palestinian conflict. Objectives: To identify health complaints reported by attendants consulting primary care physicians in the Gaza Strip. Methods: The study took place in 10 governmental primary health care centres and 5 clinics of the United Nations Relief and Works Agency in the Gaza Strip, during autumn 2005. Self-reported health complaints were recorded through face-to-face interviews with 956 respondents using a validated and reliable questionnaire. Results: Abdominal pain and headache were the most frequent complaints reported among patients aged 18 to 44 years, accounting for 23.3% and 22.7% of total complaints in males and females, respectively. Fatigue and joint pain were the most common complaints among patients aged 45 years and above, accounting for 26% and 33.9% of total complaints in males and females, respectively. Conclusions: The most common complaints, as reported by patients attending PHC facilities were stress-related and could be attributed to the ongoing conflict and high level of violence and uncertainty in the area. These complaints present a challenge to primary care providers in their efforts to improve the everyday quality of life of Palestinian residents with scarce means and resources.

“Cancer Control Practices”: Translation and Cultural Adaptation of an Instrument in Crete, Greece

Background. Although early detection and systematic prevention of cancer improves outcomes and reduces mortality, General Practitioners’ (GP) effectiveness remains an issue that merits further investigation. Methods. To explore cancer control practices of Greek GPs, a version of the Cancer Control Practices questionnaire, originally developed in Western New York in 2001, was translated and culturally adapted. Results. Its reliability was found satisfactory in most the items. Conclusions. The instrument can be useful in determining Greek GPs’ knowledge and application of internationally established cancer-related guidelines, barriers they face in daily practice, and educational or training needs.

Overuse of Antibiotics in Primary Health Care: A Practitioner- or Patient-Induced Problem?

Overuse of Antibiotics in PrimaryHealth Care: A Practitioneror Patient-Induced Problem? To the EditorAntibiotic resistance secondary tomedicalmisuse represents aworldwidephenomenonwith far-reaching ramifications. Thus, we read with interest the study by Wang and colleagues1 describing trends of antibiotic overuse andmisuse acrossprimaryhealthcare (PHC)settings inChina.According to theauthors,upto93%ofrespiratory tract infections (RTIs)were treatedwithantibiotics,withmore than6of 10prescriptions reportedas inappropriate.1 Inadequateeducationand trainingof PHCpersonnelwere also among the key findings. It is estimated that more than 90% of antibiotics in PHC are prescribed by general practitioners, with approximately 70% given for RTIs.2 Greece is among the countries with the highest antibiotic consumption and antimicrobial resistance rates in Europe.3,4 In Greece, access may be offered directly from pharmacists without medical prescription, with the exception of fluoroquinolones and third-generation cephalosporins. Therefore, antibioticmisuse iswidespread andoften underreported. Inappropriate antibioticprescriptionwriting shouldbeapproached as amultifactorial problemwhere social normsplay an important role.5 Primary care physicians frequently encounter nonspecific RTIs at the early stages. Facedwith diagnostic uncertainty and potential complications, aswell as patients’ ill-founded demands and expectations, primary care physicians are known to adopt a defensive medicine approach, prescribing antibiotics to ease fears. Despite absence of evidence-based need, physicians may choose a “clinically proactive” behavior through prescription writing in order to satisfy patients’ expectations. Anecdotal data from PHC settings in Greece show that a prescription is viewed by clients as a “substantial” and “tangible” consultation outcome, addingextravalue to thephysician-patientencounter.Hence, “patient-induced” antibiotic prescription is seen as an essential intervention, potentially leading toward a faster recovery. Educationaboutantibiotic resistanceandprudentuseofantimicrobials, initiated at the undergraduate level for all health careprofessions,has totargetbothpatientsaswellaspractitioners. Increasing awareness of primary care personnel is of great importance.Inthisdirection,multifacetededucationalprograms for primary care physicians on antibiotic use for RTI treatment are showingmixed results,withvarying reduction inprescription rates.2,4Thenecessity for culturally sensitivepublichealth campaigns inhelping laypeople recognize that antibiotic resistancepresentsa seriousproblem,notonly for theaffected individualsbut also for a country, is clearly evident.Adoptingaholisticandinterdisciplinaryapproachcouldbeanewwaytomanage an old problembefore it becomes too late.