O Konstantakopoulou

Barriers in access to pharmaceutical care in Greece: the case study of the out-of- hospital management of patients with acute asthma

Aim: The objectives of this study were to evaluate the effectiveness of information and administrative assistance regarding patient adherence to asthma guidelines and investigate the nature of the barriers in access to pharmaceutical care in Greece based on the case study of the out-of-hospital management of patients with acute asthma. Materials and Methods: The sample of the study consisted of 100 patients with acute asthma who visited the Emergency Department of a General Hospital of Athens. A comparative cross-sectional study using convenience sampling was conducted during October 2014 and June 2015 regarding the adherence to the follow up. Results: Patients who complied with the follow up visit constituted 61% of the total sample (82% of the patients from the intervention group and 40% from the control group) and for those for whom the follow up visit had been scheduled by the researchers had been compliant with the physicians instructions more often than patients for whom the follow up had not been scheduled by the researchers (OR = 8.2, 95%CI = 2.9–23.2). Patients with increased hospitalization days during the previous year and who did not consume the appropriate medication prescribed for asthma due to lack of a prescription, visited the ED more frequently than the rest of the patients (OR = 271.47, 95%CI = 14.53–5070.8). More than one out of three patients (36.4%) reported that they had not bought their asthma medications because they had no prescription while almost one out of five stated that they had purchased their medications but had used them with savings in doses. Patients who had not taken their asthma medication due to lack of prescription, visited more than once the ED, resulting in non-admission, when compared to patients who had a prescription for their medications. (OR = 3.5, 95%CI = 1.3–9.3). Discussion–Conclusions: Out-of-hospital management of asthma in Greece presents significant gaps and shortcomings, mainly due to important unresolved issues regarding availability, accessibility and use of services. The findings of the present study confirm the cause-effect relationship between ineffective out-of-hospital management of asthma and the increase in the frequency of the use of hospital emergency departments, resulting in an increase in health costs.

Living with breast cancer: Patients’ journey within the Greek National Health System

Abstract Background: Process mapping (a patient-centred method) and recording the medical, nursing and administrative staff’s views involved in the provision of care help us understand patients’ experience regarding the constraints, delays and bottlenecks of healthcare service processes and identify areas of improvement. Patients and Methods: Time information and data were collected through time and motion study with regard to the path patients with breast cancer follow in two public hospitals (sample of 86 patients) and a semi-structured questionnaire was administered to medical, nursing and administrative staff (sample of 14 employees). Results: The amount of time required in total for the prescription process was increased up to seve7 times compared to the beneficial amount of time, and the longest delays in patients’ waiting time were observed with regard to the process of chemotherapy (more than 2 hours and 40 minutes, in some cases). About 92.3% of the staff of the two hospitals prioritized the malfunctioning of theCcentralIinformationSsystem as the most important factor and more than 75% of the study participants mentioned that several administrative and technical aspects have a negative and significant effect on the time required to prescribe the necessary medicines for the treatment of patients. Conclusions: The lack of understanding of the hospital’s processes and spatial infrastructure by most patients, the lack of an electronic patient record system and central information system are highlighted as the main issues that contribute decisively to the increase in the non-beneficial time that patients with breast cances have to spend nowadays in hospitals of the NHS in Greece.