Do place of residence and ethnicity affect health services utilization? evidence from greece

<p>Abstract</p> <p>Background</p> <p>Equal utilization of health services for equal need, is one of the main targets for public health systems. Given the public-private structure of the Greek NHS, the main aim of the study was to investigate the impact of underlying factors, such as health care needs, socio-demographic characteristics and ethnicity, on the utilization of primary and hospital health care in an urban and rural population of the Greek region, Thessaly.</p> <p>Methods</p> <p>A cross-sectional study was carried out in 2006 in Thessaly, a Greek region of Central Greece, in a representative sample of 1372 individuals (18+ years old, response rate 91.4%) via face-to-face interview. Health care needs were determined by self-perceived health status estimated by the SF-36 Health Survey, using the summary scores of physical and mental health. The utilization of primary care was measured by last month visits to 1) primary public services and 2) private practitioners visits and utilization of secondary care was measured by past year visits to 3) public hospital emergency departments and 4) admissions to public hospitals. Multivariable stepwise logistic regression analysis was applied in the whole sample and separately for the urban and rural population, in order to determine the predictors of health services utilization. Statistical significance was determined with a p value < 0.05.</p> <p>Results</p> <p>Health care needs were the most significant determinants of primary and secondary health services utilization in both the urban and rural areas. Poor physical and mental health was associated with higher likelihood of use. In the urban areas middle-aged, elderly and Greeks were more likely to use primary health services, whereas primary education was associated with more visits to the emergency departments. Wealthier individuals were two times more likely to be admitted to hospitals. Individuals from the rural areas with university education visited more the public primary services, while wealthier individuals visited more the private practitioners. Immigrants had a higher likelihood of visiting emergency departments.</p> <p>Conclusions</p> <p>Although health care needs were the main determinant of health services utilization in both the urban and rural population, socio-economic and ethnic differences also seem to contribute to the inequities observed in some types of health services use, favouring the better-off. Such findings provide important information to policy makers, which attempt to reduce inequalities in health care according to place of residence and ethnicity.</p

Life of Greeks and Albanian Immigrants with the Generic EQ-5D Questionnaire

Background. Low socioeconomic status (SES) has been related by previous studies to low self-perceived HRQoL. Health is a major determinant of the society&apos;s welfare, and few studies have determined the relevant elements that contribute to health and quality of life in Greece. Aim. The aim of the study was to evaluate and test for differences in HRQoL of Greek and Albanian immigrant population according to ethnicity and their demographic and SES characteristics. Methods. The study was conducted in a sample of 660 age-matched and gender-matched Greeks and Albanian immigrants. Moderate or severe decrease in HRQoL was assessed with the generic tool EQ-5D. Differences were statistically analyzed by t-test and ANOVA. Also, logistic and linear regression analyses were conducted for the dependent variables of the EQ-5D dimensions and VAS scores, respectively. Results. The Albanian immigrants reported better self-perceived health than their Greek counterparts. Health problems increase moderately with age and lower SES and are slightly higher for women than for men. Urbanity and superior education in both Greeks and Albaniansare associated with worse HRQoL. Conclusion. There are some structural and compositional differences in the self-perceived quality of life between the two ethnicities, as estimated by EQ-5D. The combined information presentsto public health providers the relevant data to assess health policies according to health needs

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

Information seeking behaviour of parents of paediatric patients for clinical decision making: the central role of information literacy in a participatory setting.

Introduction. This study investigated the information seeking behaviour and needs of parents of paediatric patients and their motives for seeking Internet-based information. Method. A questionnaire survey of 121 parents was conducted in a paediatric clinic of a Greek university hospital. Analysis. The data were analysed using SPSS; descriptive statistics were used to summarise the data and non-parametric Mann-Whitney U and Kruskal-Wallis test statistics were performed to identify differences in reported information seeking behaviour. Results. Parents sought further information than that provided by their paediatrician and searched on the Internet to reduce their anxiety and cope better with their children's medical condition. The Internet was the second most important information source used after the paediatrician. The main obstacles parents encountered were the volume and unreliability of Internet health information and the infrequency of visits to the doctor. Conclusions. Informed participation of patients and paediatricians in clinical shared decision-making requires the development of information literacy in both parties. Health information professionals may act as information literacy instigators and educators for parents and paediatricians by means of offering information literacy prescriptions and other information decision aids

Emotional intelligence, emotional labor, and job satisfaction among physicians in Greece

BACKGROUND: There is increasing evidence that psychological constructs, such as emotional intelligence and emotional labor, play an important role in various organizational outcomes in service sector. Recently, in the “emotionally charged” healthcare field, emotional intelligence and emotional labor have both emerged as research tools, rather than just as theoretical concepts, influencing various organizational parameters including job satisfaction. The present study aimed at investigating the relationships, direct and/or indirect, between emotional intelligence, the surface acting component of emotional labor, and job satisfaction in medical staff working in tertiary healthcare. METHODS: Data were collected from 130 physicians in Greece, who completed a series of self-report questionnaires including: a) the Wong Law Emotional Intelligence Scale, which assessed the four dimensions of emotional intelligence, i.e. Self-Emotion Appraisal, Others’ Emotion Appraisal, Use of Emotion, and Regulation of Emotion, b) the General Index of Job Satisfaction, and c) the Dutch Questionnaire on Emotional Labor (surface acting component). RESULTS: Emotional intelligence (Use of Emotion dimension) was significantly and positively correlated with job satisfaction (r=.42, p<.001), whereas a significant negative correlation between surface acting and job satisfaction was observed (r=−.39, p<.001). Furthermore, Self-Emotion Appraisal was negatively correlated with surface acting (r=−.20, p<.01). Self-Emotion Appraisal was found to influence job satisfaction both directly and indirectly through surface acting, while this indirect effect was moderated by gender. Apart from its mediating role, surface acting was also a moderator of the emotional intelligence-job satisfaction relationship. Hierarchical multiple regression analysis revealed that surface acting could predict job satisfaction over and above emotional intelligence dimensions. CONCLUSIONS: The results of the present study may contribute to the better understanding of emotion-related parameters that affect the work process with a view to increasing the quality of service in the health sector

Assessment of Knowledge and Associated Factors towards Palliative Care among Greek Nurses

Introduction: Nurses can have a prominent role in end-of-life care. They should however have the appropriate knowledge and practice about Palliative Care (PC) in order to provide high quality of care at the end of life of for chronically sick patients.Methods: A cross sectional quantitative study and analysis was carried through a validated questionnaire tool based on the Palliative Care Quiz for Nursing (PCQN). The study included 150 nurses working in a major public hospital in Greece. Results: The majority of nurses in Greece had poor knowledge about PC reaching a 8.9 PCQN overall score out of 20. The findings from this study confirmed the association of gender, age, work experience and level of education on nurses’ knowledge about PC. Conclusions: There is a lack of proper training and there are very few healthcare units specializing in PC provision in Greece. Special programs for PC are required in order to enhance nurses’ knowledge and attitude towards good PC practices

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

The participatory medicine attidutes of general practitioners in Greece: an information behaviour perspective.

In shared health decision-making, cooperation in the patient-doctor relationship is fundamental. However, lack of health literacy may act as a significant barrier in this process. Patients are expected to make decisions even though they are in an uneven position in terms of knowledge (Bernabeo & Holmboe, 2013; McMullan, 2006). In our research we examined the information seeking behaviour of doctors, their views on cooperation with their patients, and the role that information consultations play in shared decision-making. Our study involved a survey of 162 private general practitioners and private pathologists in Greece. We collected demographic characteristics and self-assessments of doctors using a five point Likert scale. We used the Kruskall-Wallis non-parametric test for the analysis of the relationship between demographics and the importance assigned to information consultations. Doctors reported that they used both electronic and interpersonal sources for diagnoses, treatment, and updating their knowledge. The barriers they experienced included lack of time, the cost of access, and the difficulty of finding information, confirming previous research in this area (Davies, 2011). Most doctors considered the cooperation of their patients as important for decision making (mean=3.69) and improving the overall clinical outcome (mean =4.19). Most agreed that they relied on patients to further developing their own information literacy (IL). Doctors expected their patients to consult health related publications they directed them to in the form of print materials (mean=3.59), medical Internet websites (mean=3.81), or the website/Facebook page of their general practice (mean=3.20). However, there was a statistically significant difference when age was factored in. More than half of the more experienced doctors (above 60 years old, 55,1%) did not share the same positive views on cooperation and did not direct their patients to different information sources. It was mostly the younger doctors who took advantage of the Internet as a health consultation tool. Doctors between 40-55 years (97%) directed their patients to articles published on medical websites, while using the website/Facebook page of the general practice was more prevalent in doctors younger than 40 years old (90%). This paper argues that doctors form the main information literacy (IL) pillar for patients as they are their first port of call for their healthcare decisions. But not all doctors are ready and willing to offer information prescriptions that will help advance their patients' IL empowerment to be able to identify and use quality health information independently for their evidence-based and informed decision-making. Title listed on conference website as The Value of Information Related Practices in Patient-Doctor Relationships

Linking physicians' medical practice information needs, resources and barriers to job satisfaction: a moderated mediation model.

Purpose: Medical doctors seek information in order to satisfy their demanding everyday work practices and professional development endeavours. Information seeking is a continuous goal-related process that has impact on how they perceive and experience their job. The purpose of this paper is to explore the association of doctors’ awareness of medical practice information needs (MPIN), their frequency of using online information resources and the barriers they encountered during information seeking with their overall job satisfaction. More specifically, the research examined the mediating role of these information seeking related variables (information needs, online scholarly resources and information barriers) on doctors’ overall job satisfaction. Design/methodology/approach: The study employed a questionnaire survey of 138 medical doctors working within the context of a University Hospital in Greece. The survey took place between February and March 2014. To test the hypotheses the authors conducted regression analysis, hierarchical moderated analysis and bootstrapping using SPSS macro developed by Preacher and colleagues. Findings: The statistical analysis found that higher awareness of MPIN had an indirect effect on doctors’ overall job satisfaction when they used online information scholar resources. In addition, this indirect effect was contingent on information-related barriers. Originality/value: This study provides evidence for supporting the pivotal role of doctors’ information seeking preferences in fostering job satisfaction. This is an understudied research area that deserves a unique focus particularly with the constantly expanding medical information space that has impact on doctors’ medical practices and professional activities

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