George Samoutis

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.

Eliciting general practitioners' salient beliefs towards prescribing: a qualitative study based on the theory of planned behaviour in Greece

Prescribing represents an important medical action especially in primary care. However, irrational prescribing is common and has an impact on clinical and economic outcomes. Therefore, there is a growing need to rationalize prescribing. Knowledge of influential factors is crucial for achieving this. The aim of the present study was to identify the behavioural, normative and control beliefs of GPs regarding prescribing in Greece.

When will the sun shine on Cyprus's National Health Service?

www.thelancet.com Vol 377 January 1, 2011 29 ineff ectiveness of the existing control mechanisms of health insurance funds who incur the costs. We strongly believe that the above problems could be addressed by ensuring adequate political will and social consensus. The integration of all primary-care providers, the establish ment of the multidisciplinary primary-care team, and the enactment of the family doctor institution are necessary to obtain comprehensive, continuous, and effi cient health care. The introduction and implementation of diagnostic and treatment guidelines in daily clinical practice could result in a better quality of care and a rational isation of health-care expenditure. The induced demand for medical services seems an intractable problem, but might be controlled by a reduction in the production of new physicians. Greece is struggling to manage its fi scal problems, overcome recession, and maintain a social welfare state. To achieve these goals and get out of the crisis, it is time for Greece to capitalise on moral, economic, political, and scientifi c support from international bodies and advanced nations by making drastic organisational reforms in all aspects of the public sector, including health care.

Time-motion analysis as a novel approach for evaluating the impact of environmental heat exposure on labor loss in agriculture workers

ABSTRACT Introduction: In this study we (i) introduced time-motion analysis for assessing the impact of workplace heat on the work shift time spent doing labor (WTL) of grape-picking workers, (ii) examined whether seasonal environmental differences can influence their WTL, and (iii) investigated whether their WTL can be assessed by monitoring productivity or the vineyard managers estimate of WTL. Methods: Seven grape-picking workers were assessed during the summer and/or autumn via video throughout four work shifts. Results: Air temperature (26.8 ± 4.8°C), wet bulb globe temperature (WBGT; 25.2 ± 4.1°C), universal thermal climate index (UTCI; 35.2 ± 6.7°C), and solar radiation (719.1 ± 187.5 W/m2) were associated with changes in mean skin temperature (1.7 ± 1.8°C) (p < 0.05). Time-motion analysis showed that 12.4% (summer 15.3% vs. autumn 10.0%; p < 0.001) of total work shift time was spent on irregular breaks (WTB). There was a 0.8%, 0.8%, 0.6%, and 2.1% increase in hourly WTB for every degree Celsius increase in temperature, WBGT, UTCI, and mean skin temperature, respectively (p < 0.01). Seasonal changes in UTCI explained 64.0% of the seasonal changes in WTL (p = 0.017). Productivity explained 36.6% of the variance in WTL (p < 0.001), while the vineyard managers WTL estimate was too optimistic (p < 0.001) and explained only 2.8% of the variance in the true WTL (p = 0.456). Conclusion: Time-motion analysis accurately assesses WTL, evaluating every second spent by each worker during every work shift. The studied grape-picking workers experienced increased workplace heat, leading to significant labor loss. Monitoring productivity or the vineyard managers estimate of each workers WTL did not completely reflect the true WTL in these grape-picking workers.

Acquire, apply, and activate knowledge: A pyramid model for teaching and integrating cultural competence in medical curricula

The importance of cultural competence in health care has been more acknowledged since modern societies are becoming increasingly multi-cultural. Research evidence shows that cultural competence is associated with improved skills and patient satisfaction, and it also seems to have a positive impact on adherence to therapy. Based on this evidence, the acknowledged importance of cultural competence and its poor integration into medical curricula, we present a pyramid model for building cultural competence into medical curricula whereby medical students can enhance their skills through acquiring, applying and activating knowledge.

Single-payer or a multipayer health system: a systematic literature review

OBJECTIVES Healthcare systems worldwide are actively exploring new approaches for cost containment and efficient use of resources. Currently, in a number of countries, the critical decision to introduce a single-payer over a multipayer healthcare system poses significant challenges. Consequently, we have systematically explored the current scientific evidence about the impact of single-payer and multipayer health systems on the areas of equity, efficiency and quality of health care, fund collection negotiation, contracting and budgeting health expenditure and social solidarity. STUDY DESIGN This is a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS A search for relevant articles published in English was performed in March 2015 through the following databases: Excerpta Medica Databases, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online through PubMed and Ovid, Health Technology Assessment Database, Cochrane database and WHO publications. We also searched for further articles cited by eligible papers. RESULTS A total of 49 studies were included in the analysis; 34 studied clinical outcomes of patients enrolled in different health insurances, while 15 provided a qualitative assessment in this field. CONCLUSION The single-payer system performs better in terms of healthcare equity, risk pooling and negotiation, whereas multipayer systems yield additional options to patients and are harder to be exploited by the government. A multipayer system also involves a higher administrative cost. The findings pertaining to the impact on efficiency and quality are rather tentative because of methodological limitations of available studies.

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.

Helping patients to die well through education

One of us recently attended highly useful antenatal classes, where a “birth plan” was promoted. The aim of anticipating what to expect of the midwife and doctors at every stage of the …