Elena Petelos

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

BackgroundIrrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region.MethodsThis feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs.ResultsMedian intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale.ConclusionsEvidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

Early detection of colorectal cancer: barriers to screening in the primary care setting

their patients. 4 There is an ongoing debate about the role of GPs and primary care physicians (PCPs) and their potential contribution to the effective implementation of screening programmes, both opportunistic and populationbased. In addition to the assessment of the risk of developing CRC, in general, the involvement and the role of the GPs and PCPs in convincing patients to participate and initiate CRC screening should be further explored and elucidated, as it is of key importance in cultural and organizational context and health policy issues. 5 This editorial highlights certain issues that have an impact on the early detection of CRC and focuses on barriers to screening at primary care and general practice levels.

Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods

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.

Management of Victimized Patients in Greek Primary Care Settings: A Pilot Study

The study explored the perceptions and practices of general practitioners (GPs) regarding the identification and management of victimized patients in primary care settings. A qualitative study was conducted employing three focus groups and a total of 18 GPs drawn from Greek General Practice Networks. Participants discussed issues of identification, assessment, recording, and referral of victimized patients at their clinical setting. Important points raised were the role ambiguity in the management of the victimized patients, the lack of confidence in diagnosing the problem, the discomfort in discussing Intimate Partner Violence (IPV) with their patients, the mistrust in the referral services, and the confidentiality issues affecting their recording practices. This preliminary information is expected to guide large-scale surveys and future interventions.

Operational integration in primary health care: patient encounters and workflows

BackgroundDespite 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.MethodsThe 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.ResultsOverall 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.ConclusionsExisting 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.

Early Detection of Colorectal Cancer and Population Screening Tests

Colorectal cancer (CRC) is the most common newly-diagnosed cancer, one of the leading causes of illness and death in the Western world, and the second most common cause of cancer morbidity in Europe. Yet, CRC is a preventable disease and, if detected early, highly treatable. Early detection and prevention are health care strategies of critical importance for the reduction of CRC morbidity and mortality. In a number of countries, screening programmes have been implemented on nationwide scale since the 1960s for other forms of cancer. The early detection of cancer increases the likelihood of successful outcomes, but in order to have early detection, education and training promoting early diagnosis and resulting in increased screening, participation is needed. Additionally, the effectiveness of screening can be measured by the reduction on mortality, but it greatly depends upon tangible and sometimes intangible factors, contingent on setting and target population; it is essential, for example, to identify and screen the appropriate target population and to overcome implementation and uptake barriers. All of these issues, with emphasis on obstacles encountered at the level of general and family practice are highlighted in a recent editorial in Family Practice (Lionis and Petelos, 2011). Although the screening is performed in the context of public health, and for the benefit of the community, the rights and welfare of the individual should also be respected. The role of the General Practitioner/Family Practitioner (GP/FP) and generally of the Primary Care Provider (PCP) is challenging yet instrumental in achieving this balance, as it is at that level screening is initiated (Viguier et al, 2011). The involvement and the role of GPs and PCPs in convincing patients to participate and initiate CRC screening should be further explored and elucidated, as it is of key importance in cultural and organisational context and health policy issues (Sarfaty, 2006). CRC screening of asymptomatic population groups is currently recommended in the USA and many European countries, and a number of pilot and nationwide programmes have been developed for this purpose. More specifically, mass screening programmes are currently established in 13 of 39 European countries (Pox et al, 2007; Manfredi et al, 2011) with feasibility studies undertaken as pilot actions in many more.

Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries.

Polypharmacy has a significant impact on patients’ health with overall expenditure on over‐the‐counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC‐SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care.