Implementing shared-decision-making for diabetes care across country settings: what really matters to people?

Diabetes is one of the leading causes of mortality, disability and expenditure worldwide. Growing evidence of improved outcomes (patient/professional satisfaction and some evidence on controlled weight, blood glucose and blood pressure) supports shared-decision-making (SDM) as an effective primary care intervention for diabetes. However, only a few countries have actually adopted it (e.g. UK). In other European countries there is awareness that patients play a crucial role in decision-making, and SDM policies could be considered as innovative strategies to promote the actual implementation of patient rights legislation and strengthen primary care (e.g. Cyprus). Objective of this research was to inform the development and testing of a tool to value patients’ preferences for SDM model across different European settings: UK, where SDM is already in place at a national level, and we can draw from people direct experience; Cyprus, where people are new to it, although there could be room for future implementation. In doing so the study used a discrete-choice-experiment (DCE) survey. The DCE survey presents a series of choices involving alternative services on offer, described by their particular characteristics. It allows to: identify the characteristics of the health care service that respondents value; the relative values that they attach to these; and the trade-offs between them (e.g. how long patients are willing to wait to receive detailed and accurate information about their care). Data collection is under way and findings will be available for discussion at the meeting. They will inform the development of a larger European programme of research

Implementing shared-decision-making for diabetes care across country settings: what really matters to people?

Context: Growing evidence of improved clinical outcomes and patient/professional satisfaction supports shared-decision-making (SDM) services as an effective primary care interventions for diabetes. However, only a few countries have actually adopted them (e.g. England). In other European countries (e.g. Cyprus) there is awareness that patients play a crucial role in decision-making, and SDM services could be considered as innovative strategies to promote the actual implementation of patient rights legislation and strengthen primary care. Objective: to understand preferences of people with diabetes when choosing their care, and how they value alternative SDM services compared to their ‘current’ option. Preferences were collected from patients based in England, where SDM is already in place at national level, and Cyprus, where people are new to it, using a discrete-choice-experiment (DCE) survey. Results: Cypriots valued choosing alternative SDM services compared to their ‘current’ option, whereas the English preferred their status quo to other services. Having the primary-care-physician as healthcare provider, receiving compassionate care, receiving detailed and accurate information about their care, continuity of care, choosing their care management and treatment, and reduced waiting time were the SDM characteristics that Cypriots valued; the English preferred similar factors, apart from information/continuity of care. Conclusion: People with diabetes do value SDM and different SDM models may fit different groups according to their personal experience and country specific settings

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

Assessing Patient Participation in Health Policy DecisionMaking in Cyprus

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cypru

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

Re-engineering the Cypriot healthcare service system

BACKGROUND: The Cypriot healthcare system has undergone a number of major transformations since the induction of the Republic of Cyprus in the European Union over 10 years ago. Currently Cyprus is undergoing a major reform, namely the introduction of a primary care driven national healthcare system. The aim of the study was to assess the existing state of training, support, quality, guidelines and infrastructure towards a better healthcare system in Cyprus. METHODS: This is a mixed-methods study combining statistical data until October 2016 and workshop discussions delivered in Cyprus in November 2015. We used anonymised data provided: (1a) by the Cyprus Medical Association of all registered medical doctors up to October 2016; (1b); by the Ministry of Health (MoH) Health Monitoring Unit up to October 2016; (2) during a workshop organised with representatives from the Royal College of Physicians, the European Commission and the Health Insurance Organization. RESULTS: The gender ratio of men over women is disproportionate, with over 85% of the medical doctors undertaking their training in Greece, Eastern Europe and neighbouring countries, while the current record does not hold a relevant specialty information for 4 out of 10 doctors. The results show lack of statutory inspection systems, application of revalidation principles or implementation of peer-review clinical services on the island. There are eight proposed recommendations made by the workshop participants towards the transformation of the Cypriot healthcare system and the development of the Cyprus Quality Improvement Institute. These are aimed at addressing gaps in quality of care, adherence to clinical guidelines and implementation of audits, development of doctors’ revalidation and peer-review of clinical services, accreditation of service implementation, establishment of a statutory inspection system as well as the set-up of an incentives program as part of the general healthcare system (GHS) of Cyprus. CONCLUSIONS: Current efforts for the implementation of the new GHS in Cyprus call for adequate training and support of the medical workforce, transparent and safer quality of care provision through the implementation of clinical guidelines and capacity-building infrastructure

Effects of High vs. Low Glycemic Index of Post-Exercise Meals on Sleep and Exercise Performance: A Randomized, Double-Blind, Counterbalanced Polysomnographic Study

The aim of the current study was to investigate the effect of the glycemic index of post-exercise meals on sleep quality and quantity, and assess whether those changes could affect the next day’s exercise performance. Following a baseline/familiarization phase, 10 recreationally trained male volunteers (23.2 ± 1.8 years) underwent two double-blinded, randomized, counterbalanced crossover trials. In both trials, participants performed sprint interval training (SIT) in the evening. Post-exercise, participants consumed a meal with a high (HGI) or low (LGI) glycemic index. Sleep parameters were assessed by a full night polysomnography (PSG). The following morning, exercise performance was evaluated by the countermovement jump (CMJ) test, a visual reaction time (VRT) test and a 5-km cycling time trial (TT). Total sleep time (TST) and sleep efficiency were greater in the HGI trial compared to the LGI trial (p &lt; 0.05), while sleep onset latency was shortened by four-fold (p &lt; 0.05) and VRT decreased by 8.9% (p &lt; 0.05) in the HGI trial compared to the LGI trial. The performance in both 5-km TT and CMJ did not differ between trials. A moderate to strong correlation was found between the difference in TST and the VRT between the two trials (p &lt; 0.05). In conclusion, this is the first study to show that a high glycemic index meal, following a single spring interval training session, can improve both sleep duration and sleep efficiency, while reducing in parallel sleep onset latency. Those improvements in sleep did not affect jumping ability and aerobic endurance performance. In contrast, the visual reaction time performance increased proportionally to sleep improvements

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus