Psychometric properties of the Greek Diabetes Treatment Satisfaction Questionnaire

<p>Abstract</p> <p>Objectives</p> <p>Measurement of treatment satisfaction in diabetes is important as it has been shown to be associated with positive outcomes, reduced disease cost and better health. The aim of this study was to assess the construct validity and internal consistency reliability of the Greek version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ).</p> <p>Methods</p> <p>A sample of type II diabetes patients (N = 172) completed the DTSQ status version, the SF-36 health survey and also provided data regarding treatment method, clinical and socio-demographic status. Instrument structure, reliability (Cronbach's a) and construct validity (convergent, discriminative, concurrent and known-groups) were assessed.</p> <p>Results</p> <p>The DTSQ measurement properties were confirmed in the Greek version with confirmatory factor analysis (CFA). Scale reliability was high (Cronbach's a = 0.92). Item-scale internal consistency and discriminant validity were also good, exceeding the designated success criteria. Significant correlations were observed between DTSQ items/overall score and SF-36 scales/component scores, which were hypothesized to measure similar dimensions. Known groups' comparisons yielded consistent support of the construct validity of the instrument.</p> <p>Conclusions</p> <p>The instrument was well-accepted by the patients and its psychometric properties were similar to those reported in validation studies of other language versions. Further research, incorporating a longitudinal study design, is required for examining test-retest reliability and responsiveness of the instrument, which were not addressed in this study. Overall, the present results confirm that the DTSQ status version is a reasonable choice for measuring diabetes treatment satisfaction in Greece.</p

The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location.</p> <p>Methods</p> <p>The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000–30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression.</p> <p>Results</p> <p>Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney <it>P </it>< 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis <it>P </it>< 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney <it>P </it>= 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney <it>P </it>= 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis <it>P </it>< 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney <it>P </it>< 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency.</p> <p>Conclusion</p> <p>Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.</p

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Comparing Health-Related Quality of Life of Cancer Patients under Chemotherapy and of Their Caregivers

Introduction. Cancer is a major disorder physically and psychologically affecting both patients and their caregivers. In this study, health-related quality of life (HRQoL) of patient-caregiver dyads during the period of chemotherapy was assessed. Material and Methods. Two hundred twenty-two cancer patient-caregiver dyads were enrolled in the study, which was conducted from October 2008 to March 2009. HRQoL was evaluated with EQ-5D. Results. The mean age of the sample was 57.4 and 48.9 for patients and caregivers, respectively. The EQ-5D descriptive system indicates that female patients more frequently experience anxiety and depression than male patients. Male and higher-education caregivers had higher VAS scores, while demographic factors did not seem to influence patients' HRQoL. Anxiety and depression of caregivers were correlated with patients' problems in self-care and usual activities. Conclusions. Quality of life is highly influenced during the period of chemotherapy for both patients and caregivers and is often under reported. Interventions that can improve HRQoL, especially in the domain of mental health for both cancer patients and their caregivers, need to be implemented

Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between <it>job satisfaction </it>and <it>motivation</it>. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance.</p> <p>Methods</p> <p>A previously developed and validated instrument addressing four work-related motivators (<it>job attributes, remuneration, co-workers and achievements</it>) was used. Two categories of health care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and motivation and job satisfaction was compared across socio-demographic and occupational variables.</p> <p>Results</p> <p>The survey revealed that <it>achievements </it>was ranked first among the four main motivators, followed by <it>remuneration</it>, <it>co-workers </it>and <it>job attributes</it>. The factor <it>remuneration </it>revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater mean scores (p < 0.005). The medical staff showed statistically significantly lower job satisfaction compared to the nursing staff. Surgical sector nurses and those >55 years of age reported higher job satisfaction when compared to the other groups.</p> <p>Conclusions</p> <p>The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested.</p

Developing and testing an instrument for identifying performance incentives in the Greek health care sector

BACKGROUND: In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity. METHODS: A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure. RESULTS: Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied. CONCLUSION: Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system

Predictors of health-related quality of life in type II diabetic patients in Greece

<p>Abstract</p> <p>Background</p> <p>Diabetes Mellitus (DM) is a major cause of morbidity and mortality affecting millions of people worldwide, while placing a noteworthy strain on public health funding. The aim of this study was to assess health-related quality of life (HRQOL) of Greek Type II DM patients and to identify significant predictors of the disease in this patient population.</p> <p>Methods</p> <p>The sample (N = 229, 52.8% female, 70.0 years mean age) lived in a rural community of Lesvos, an island in the northeast of the Aegean Archipelagos. The generic SF-36 instrument, administered by trainee physicians, was used to measure HRQOL. Scale scores were compared with non-parametric Mann-Whitney and Kruskal-Wallis tests and multivariate stepwise linear regression analyses were used to investigate the effect of sociodemographic and diabetes-related variables on HRQOL.</p> <p>Results</p> <p>The most important predictors of impaired HRQOL were female gender, diabetic complications, non-diabetic comorbidity and years with diabetes. Older age, lower education, being unmarried, obesity, hypertension and hyperlipidaemia were also associated with impaired HRQOL in at least one SF-36 subscale. Multivariate regression analyses produced models explaining significant portions of the variance in SF-36 subscales, especially physical functioning (R²= 42%), and also showed that diabetes-related indicators were more important disease predictors, compared to sociodemographic variables.</p> <p>Conclusion</p> <p>The findings could have implications for health promotion in rural medical practice in Greece. In order to preserve a good HRQOL, it is obviously important to prevent diabetes complications and properly manage concomitant chronic diseases. Furthermore, the gender difference is interesting and requires further elucidation. Modifying screening methods and medical interventions or formulating educational programs for the local population appear to be steps in the correct direction.</p

An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy

Objectives To estimate lifelong costs and quality adjusted life years (QALYs) of hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (Tx) in Greece, based on individual patient life expectancy.Methods A nationally representative patient sample on each modality, HD: N = 642, PD: N = 65 and Tx: N = 167, was self-administered the SF-36 Health Survey, from which the preference-based SF-6D utility index was derived. Lifelong QALYs were estimated from literature-based expected remaining life years according to age, gender and modality. Cost analyses were performed from the perspective of the health system. Costs and QALYs were discounted at 5% and sensitivity analyses were performed.Results Estimated lifelong QALYs were 4.37 (HD), 3.94 (PD) and 16.11 (Tx) (P