The economic burden of tuberculosis in Cyprus. A probabilistic cost of illness study.

Background: Tuberculosis remains a major public health problem with considerable economic burden worldwide. The aim of this study was to estimate the economic burden of tuberculosis in Cyprus during 2009.  Methods: A retrospective probabilistic incidence-based cost of illness model was developed to calculate, from the societal perspective, the economic burden of the disease including direct medical costs, direct non-medical costs and indirect costs. The bottom-up approach (person-based data) was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, probabilistic sensitivity analysis with 1000 Monte Carlo simulations was performed in order to calculate a 95% Confidence Interval (CI). Results: Mean per patient cost of tuberculosis in Cyprus in 2009 was estimated at €12,882 (95% CI: €12,747.35 – €12,964.32). Direct medical costs accounted for 83.07% of the overall expenses, €10,675 per patient (95% CI: €10,462.07 – €10,780.59). Total direct non-medical costs of €355 (95% CI: €353.04 – 364.29) accounted for 2.77% of the overall expenses whereas 14.16% of the overall expenses were associated with the indirect cost of €1,820 (95% CI: €1,815.20 – €1,873.65). Conclusion: For the first time in Cyprus, the cost of tuberculosis was estimated using a probabilistic incidence-based cost of illness model.  Our study confirms that tuberculosis is an expensive disease for the society. In addition, it provides important information to policy makers for the comprehension of the economic consequences of tuberculosis so as they can draft the national health policy accordingly and strengthen surveillance of the disease

Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus

Background The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computer-na've public primary care centres in Cyprus. Methods One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters. Results Two public primary care centres participated, and a total often health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. Conclusion The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population

Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus

<p>Abstract</p> <p>Background</p> <p>Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve quality of care in primary care, properly tailored for a country such as Cyprus where general practice is currently seeking recognition.</p> <p>Methods</p> <p>Our methodological approach was focused on the design of an open label, community-based intervention controlled trial using all patients from two urban and two rural public primary care centers diagnosed with hypertension and type II diabetes mellitus. The design of our intervention was grounded on a strong theoretical framework that included the Unified Theory of Acceptance and Use of Technology, and the Chronic Care Model, which synthesize evidence-based system changes in accordance with the Theory of Planned Behavior and the Theory of Reasoned Action. The primary outcome measure was improvement in the quality of care for two chronic diseases evaluated through specific clinical indicators, as well as the patient satisfaction assessed by the EUROPEP questionnaire and additional personal interviews.</p> <p>Results</p> <p>We designed a multifaceted quality improvement intervention model, supported by a varying degree of scientific evidence, tailored to local needs and specific country characteristics. Overall, the main components of the intervention were the development and adoption of an electronic medical record and the introduction of clinical guidelines for the management of the targeted chronic diseases facilitated by the necessary model of organizational changes.</p> <p>Conclusion</p> <p>Health planners and policy makers need to be aware of the potential use of certain theoretical models and applied methodology as well as inexpensive tools that may be suitably tailored to the local needs, in order to effectively design quality improvement interventions in primary care settings.</p

Implementing the European guidelines for cardiovascular disease prevention in the primary care setting in Cyprus: Lessons learned from a health care services study

<p>Abstract</p> <p>Background</p> <p>Recent guidelines recommend assessment and treatment of the overall risk for cardiovascular disease (CVD) through management of multiple risk factors in patients at high absolute risk. The aim of our study was to assess the level of cardiovascular risk in patients with known risk factors for CVD by applying the SCORE risk function and to study the implications of European guidelines on the use of treatment and goal attainment for blood pressure (BP) and lipids in the primary care of Cyprus.</p> <p>Methods</p> <p>Retrospective chart review of 1101 randomly selected patients with type 2 diabetes mellitus (DM2), or hypertension or hyperlipidemia in four primary care health centres. The SCORE risk function for high-risk regions was used to calculate 10-year risk of cardiovascular fatal event. Most recent values of BP and lipids were used to assess goal attainment to international standards. Most updated medications lists were used to compare proportions of current with recommended antihypertensive and lipid-lowering drug (LLD) users according to European guidelines.</p> <p>Results</p> <p>Implementation of the SCORE risk model labelled overall 39.7% (53.6% of men, 31.3% of women) of the study population as high risk individuals (CVD, DM2 or SCORE ≥5%). The SCORE risk chart was not applicable in 563 patients (51.1%) due to missing data in the patient records, mostly on smoking habits. The LDL-C goal was achieved in 28.6%, 19.5% and 20.9% of patients with established CVD, DM2 (no CVD) and SCORE ≥5%, respectively. BP targets were achieved in 55.4%, 5.6% and 41.9% respectively for the above groups. There was under prescription of antihypertensive drugs, LLD and aspirin for all three high risk groups.</p> <p>Conclusion</p> <p>This study demonstrated suboptimal control and under-treatment of patients with cardiovascular risk factors in the primary care in Cyprus. Improvement of documentation of clinical information in the medical records as well as GPs training for implementation and adherence to clinical practice guidelines are potential areas for further discussion and research.</p

Primary health care and general practice in Cyprus: describing the current situation and designing a pilot intervention in urban and rural areas in the district of Nicosia

Background: The role and effectiveness of General Practise/ Family Medicine has been under a lot of discussion in the literature. In Cyprus, a new National Health System will soon be introduced. In the context of this reform a collaboration agreement was signed between the Ministry of Health of Cyprus and the Clinic of Social and Family Medicine of the University of Crete. This dissertation was part of the aforementioned collaboration. Aim: The aim of this thesis is to describe the current situation in the primary healthcare of Cyprus and to design a pilot intervention in rural and urban areas in the district of Nicosia. The objectives were the following: 1) To determine the most common chronic conditions that General Practitioners (GPs) manage in the primary health care of Cyprus. 2) To examine whether the management of patients with selected chronic conditions follows international guidelines. 3) To examine whether the use of European standardised tools (SCORE risk model) can be implemented in the primary healthcare of Cyprus in order to identify high risk patients. 4) To describe the contents of a pilot intervention that can be implemented in the primary healthcare setting of Cyprus in order to improve the quality of the delivered health services. Subjects and methods: The thesis was performed in four Primary Care Health Centres (PCHCs), [two urban and two rural] in Nicosia area using specific selection criteria. At first, a pilot study was performed in 2,754 patients in order to determine the most common chronic conditions that GPs manage in the primary healthcare. The ten GPs filled in a questionnaire for every patient who visited the four PCHCs for eleven consecutive working days which included the demographic characteristics of the patients, the reason for encounter, diagnosis, and treatment. From a total of 4,633 of patients with one or more of from the three most common conditions identified in the pilot study, we randomly selected 1,140 medical files using specific selection criteria. We examined the management of those patients during one year according to international guidelines using the most recent values of Blood Pressure (BP) and lipids recorded in the medical files. In order to collect unregistered information in the medical records (smoking habits) a telephone survey was performed by the ten trained nurses in the four PCHCs. The SCORE risk function for high-risk regions was used to calculate 10-year risk of cardiovascular fatal event. The results of the above studies were used for the design of a pilot intervention in the primary healthcare setting of Cyprus. Results: The three most common chronic conditions identified from the pilot study were: Hypertension (40.6%), Type 2 Diabetes Mellitus [DM2] (14.8%) and Hyperlipidemia (10.5%). Chart review of the selected patients identified 26.8% of the patients with DM2, 79.5% with hypertension and 38.8% with hyperlipidemia. The goal of glycated Hemoglobin (HbA1c) < 7% was achieved in 38.7% of patients with DM2, whereas total cholesterol (TC) target < 200 mg/dl and LDL-C goal < 100 mg/dl were achieved in 36.1% and 20.7% of diabetic patients respectively. The target of LDL-C < 100 mg/dl was achieved in 28.6% of patients with cardiovascular disease. BP goal of < 130/80 mmHg and < 140/90 mmHg was reached in 7.5% and 54.0% of patients with DM2 and without diabetes respectively. The use of SCORE risk chart labelled overall 39.9% of the study population as high risk individuals (10 year risk ? 5%) for fatal cardiovascular event. Diabetic patients had statistically significant lower mean values of ΤC και LDL-C as compared to non diabetic patients (TC 214 vs 225 mg/dl, p= 0.009, LDL-C 127 vs 137 mg/dl, p= 0.026) whereas mean systolic blood pressure (SBP) and mean triglyceride (TG) values were significantly higher (SBP 137 vs 134 mmHg, p= 0.006, TG 205 vs 173 mg/dl, p= 0.003).Εισαγωγή: Ιδιαίτερη συζήτηση γίνεται στη βιβλιογραφία για το ρόλο και την αποτελεσματικότητα της Γενικής/ Οικογενειακής Ιατρικής στα διάφορα συστήματα υγείας. Στην Κύπρο θα εφαρμοστεί σύντομα ένα νέο σύστημα υγείας. Εν όψη της επικείμενης μεταρρύθμισης υπογράφηκε σύμβαση συνεργασίας ανάμεσα στο Υπουργείο Υγείας Κύπρου και στην Κλινική Κοινωνικής και Οικογενειακής Ιατρικής του Πανεπιστημίου Κρήτης, μέρος της οποίας, αποτέλεσε η παρούσα διδακτορική διατριβή. Σκοπός: Ο σκοπός της διδακτορικής διατριβής είναι η περιγραφή της υφιστάμενης κατάστασης στην Πρωτοβάθμια Φροντίδα Υγείας (Π. Φ. Υ.) και στη Γενική Ιατρική στην Κύπρο και ο σχεδιασμός μίας πιλοτικής παρέμβασης σε δύο Κέντρα Υγείας (Κ. Υ.) στην επαρχία Λευκωσίας. Οι στόχοι ήταν οι εξής: 1) Να προσδιοριστούν τα συχνότερα χρόνια νοσήματα και παράγοντες κινδύνου που διαχειρίζονται οι γενικοί ιατροί (Γ. Ι.) στην Π. Φ. Υ. στην Κύπρο. 2) Να εξεταστεί το επίπεδο ρύθμισης των ασθενών με επιλεγμένα χρόνια νοσήματα και παράγοντες κινδύνου σύμφωνα με Διεθνείς Κατευθυντήριες Οδηγίες. 3) Να εξεταστεί σε ποιο βαθμό η χρήση Ευρωπαϊκών εργαλείων (SCORE risk model) μπορεί να αναδείξει άτομα υψηλού κινδύνου στο επίπεδο της Π. Φ. Υ. στην Κύπρο. 4) Να περιγραφούν εκείνα τα συστατικά που θα πρέπει να περιλαμβάνει μία πιλοτική παρέμβαση που θα εφαρμοστεί στην Π. Φ. Υ. για τη βελτίωση της ποιότητας των παρεχόμενων υπηρεσιών. Πληθυσμός και μέθοδοι: Η διδακτορική διατριβή πραγματοποιήθηκε σε τέσσερα Κ. Υ. στην επαρχία Λευκωσίας (δύο αστικά και δύο αγροτικά) τα οποία επιλέχθηκαν με συγκεκριμένα κριτήρια. Αρχικά διεξάχθηκε μία πιλοτική μελέτη σε 2,754 ασθενείς για τον προσδιορισμό των πιο συχνών χρόνιων νοσημάτων που διαχειρίζονται οι Γ. Ι. στην Π. Φ. Υ. Η μελέτη αφορούσε τη συμπλήρωση ερωτηματολογίου από τους Γ. Ι. για κάθε ασθενή που επισκεπτόταν τα 4 Κ. Υ. για οποιοδήποτε λόγο για χρονικό διάστημα έντεκα συνεχόμενων εργάσιμων ημερών. Από την ανάλυση των διαγνώσεων που καταγράφηκαν προέκυψαν τα τρία συχνότερα χρόνια νοσήματα. Ακολούθησε τυχαία επιλογή 1,140 ιατρικών φακέλων ασθενών με ένα ή περισσότερα από τα τρία συχνότερα νοσήματα από το σύνολο 4,633 που πληρούσαν προκαθορισμένα κριτήρια και έλεγχος της ρύθμισης των επιλεγμένων ασθενών σύμφωνα με διεθνείς κατευθυντήριες οδηγίες κατά τη διάρκεια ενός έτους. Για τη συλλογή πληροφορίας που απουσίαζε από τους ιατρικούς φακέλους (καπνιστική συνήθεια) πραγματοποιήθηκε τηλεφωνική έρευνα από το νοσηλευτικό προσωπικό των Κ. Υ. Για τον υπολογισμό του 10ετούς κινδύνου για μοιραίο καρδιαγγειακό σύμβαμα χρησιμοποιήθηκε το διάγραμμα SCORE. Τα αποτελέσματα που προέκυψαν από τις πιο πάνω μελέτες οδήγησαν στην ανάδειξη των συστατικών εκείνων που θα πρέπει να περιλαμβάνει μία πιλοτική παρέμβαση που θα απευθύνεται στην Π. Φ. Υ. Αποτελέσματα: Οι τρεις συχνότερες διαγνώσεις ήταν η αρτηριακή υπέρταση (40.6%), ο τύπου 2 σακχαρώδης διαβήτης (14.8%) και η υπερλιπιδαιμία (10.5%). Από την ανασκόπηση των ιατρικών φακέλων ασθενών με ένα ή περισσότερα από τα πιο πάνω νοσήματα, 26.8% είχαν τύπου 2 σακχαρώδη διαβήτη (Τ2 Σ. Δ.), 79.5% είχαν ιστορικό υπέρτασης και 38.8% είχαν ιστορικό υπερλιπιδαιμίας. Τιμές γλυκοζυλιωμένης αιμοσφαιρίνης (HbA1c) < 7%, επιτεύχθηκαν σε 38.7% των διαβητικών ασθενών ενώ οι στόχοι ολικής χοληστερόλης (ΤC) < 200 mg/dl και LDL χοληστερόλης < 100 mg/dl επιτεύχθηκαν σε ποσοστά 36.1% και 20.7% αντίστοιχα. Ποσοστό 28.6% των ασθενών με καρδιαγγειακή νόσο πέτυχαν το στόχο για LDL-C < 100 mg/dl. Ρύθμιση της Αρτηριακής Πίεσης (Α. Π. < 130/80 mmHg και < 140/90 mmHg) επιτεύχθηκε σε ποσοστό 7.5% για τους ασθενείς με Τ2 Σ. Δ. και 54% για τους μη διαβητικούς ασθενείς αντίστοιχα. Η χρήση του εργαλείου SCORE κατέδειξε υψηλό κίνδυνο σε ποσοστό 39.9% του συνολικού πληθυσμού (10-ετής κίνδυνος ? 5% για μοιραίο καρδιαγγειακό σύμβαμα). Οι ασθενείς με Τ2 Σ. Δ. είχαν στατιστικά σημαντικά μικρότερη μέση τιμή ΤC και LDL-χοληστερόλης σε σύγκριση με τους μη διαβητικούς ασθενείς (TC 214 vs 225 mg/dl, p= 0.009, LDL-C 127 vs 137 mg/dl, p= 0.026) ενώ η μέση τιμή της συστολικής Α. Π. και των τριγλυκεριδίων (TG) ήταν στατιστικά σημαντικά υψηλότερες (ΣΑΠ 137 vs 134 mmHg, p= 0.006, TG 205 vs 173 mg/dl, p= 0.003)

Smoking prevalence and associated risk factors among healthcare professionals in Nicosia general hospital, Cyprus: A cross-sectional study

Background: In recent years, a significant progress has been achieved globally in reduction of smoking among physicians and nurses, however, in some countries the smoking prevalence of health professionals is maintained at very high levels, without significant difference from the general population. This study aims to investigate the prevalence of smoking among physicians and nurses working at Nicosia General Hospital, as well as their knowledge and attitudes towards smoking cessation strategies. Methods: This is a cross-sectional questionnaire-based study. The study consisted of 119 doctors and 392 nurses currently working at Nicosia General Hospital in Cyprus. Study participants were recruited from all hospital wards between May and June 2008. Both physicians and nurses were asked to answer an anonymous questionnaire, which included questions regarding their smoking habits, knowledge and attitudes about smoking and smoking cessation strategies. Results: Overall smoking prevalence among healthcare professionals was 28.2 % (28.6 % among physicians and 28.1 % among nurses). Multivariate analysis revealed that being male, younger than 34 years old, unmarried and with a family history of smoking were associated with increased likelihood of being a current smoker. An impressive 72 % of current smokers reported that they wished to quit smoking, however, only 5.6 % of physicians and 6.9 % of nurses, reported ever using any smoking cessation aids. Never- smokers counseled their patients to quit smoking more often (96.4 %) compared to former (84.6 %) and current smokers (72.7 %), (p < 0.001). In addition, those who felt more confident about their knowledge regarding smoking cessation, reported counseling their patients to quit smoking more often compared to those who did not (92 % vs 60 %, p < 0.001). Conclusions: Smoking prevalence among physicians and nurses working at Nicosia General Hospital was similar to that of the general Cypriot population. Further training of healthcare professionals towards smoking cessation strategies is needed in order to improve their knowledge and consequently their efforts on counseling and support to their patients who wish to quit smoking

The economic burden of adult asthma in Cyprus; a prevalence-based cost of illness study

Abstract Background Asthma is one of the main non-infectious diseases of the respiratory system with substantial economic burden worldwide. The objective of this study was to estimate the economic burden of adult asthma in Cyprus during 2015. Methods A retrospective probabilistic prevalence-based cost of illness model was developed to calculate the economic burden of asthma including direct and indirect costs. The bottom-up approach (person-based data) was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, bootstrapped sensitivity analysis with 1000 bootstrap simulations was performed in order to calculate a 95% Confidence Interval (CI). Results Mean patient cost of asthma in Cyprus in 2015 was estimated at €579.64 (95% CI: €376.90–€813.68). Direct costs accounted for 82.08% of the overall expenses, €475.75 per patient (95% CI: €296.94–€697.69). Indirect costs of €103.89 (95% CI: €49.59–€181.46) accounted for 17.92% of the overall expenses. Conclusion This was the first study in Cyprus, which used bootstrapped prevalence-based cost of illness model to estimate the cost of asthma. This study confirms that asthma is an expensive disease for the society. In addition, it provides important information and analysis of the economic consequences of asthma to policy makers in order to strengthen surveillance of the disease as well as draft the national health policy accordingly

Additional file 1: of The economic burden of adult asthma in Cyprus; a prevalence-based cost of illness study

Screening questionnaire. (DOCX 22 kb

Additional file 2: of The economic burden of adult asthma in Cyprus; a prevalence-based cost of illness study

Interviewer-led questionnaire. (DOCX 26 kb