The Trials and Tribulations of the National Health System (ESY) in Greece: A Chronicle of Unfulfilled Promises

The creation of the National Health System (ESY) in the 1980s is a majorlandmark in the development of the welfare state in Greece during the metapolitefsi (regime change) period. An ambitious effort to reform the fragmented, ineffective health services of the post-World War II period, it achieved a major reorganisation of public hospitals and the establishment of rural health centres providing primary health care. Yet its promise of high-quality services for all was not fulfilled, since vested interests blocked its full implementation. While the fiscal crisis of the 2010s was the catalyst for theunification of the health insurance funds, the creation of integrated primary health care intowns failed once again. This article examines the achievements and failures of the reform in light of the political and social factors that shaped this era

Features of recording practices and communication during nursing handover: a cluster analysis

Objective: To record and identify the characteristics of nursing handovers in a tertiary hospital. Method: Observational study. Twenty-two nurses participated in 11 nursing handovers in 2015/16, using a recorded audio system and an unstructured observation form. Hierarchical cluster analysis was performed. Results: Thirty characteristics were identified. The nursing handovers were based on the clinical status of patients, and all nurses obtained specialized scientific knowledge specific to the clinical environment. The information used was not based on nursing diagnoses and not in accordance with best nursing clinical practice. The following four clusters emerged among the 30 characteristics: 1) the use of evidence-based nursing practice, 2) the nonuse of evidencebased nursing practice and its correlation with strained psychological environment, 3) patient management and the clinical skills/knowledge of nurses, and 4) handover content, quality of information transferred and specialization. Conclusion: Multiple characteristics were observed. The majority of characteristics were grouped based on common features, and 4 main clusters emerged. The investigation and understanding of structural relations between these characteristics and their respective clusters may lead to an improvement in the quality of nursing health care services

POKRETANJE ZDRAVSTVENIH REFORMI U MEĐURATNOM RAZDOBLJU: SLUČAJ GRČKE I ULOGA ZDRAVSTVENE ORGANIZACIJE LIGE NARODA

During the Interwar period (1918–1939), financial aid and technical assistance were given to countries worldwide by the League of Nations Health Organisation (LNHO) in an attempt to reform public health systems, address population health problems, and control infectious diseases. Greece was one of the countries that received this aid, and in 1928 cooperation with the LNHO was initiated. The aim of this alliance was an integrated health reform plan entitled “Collaboration with the Greek government for the sanitary reorganization of Greece” and had a dual purpose: a) the reorganisation of the health services and b) the establishment of a unified public health system that provided comprehensive healthcare for all citizens. The current article discusses the collaboration between Greece and the LNHO and their endeavour to reorganise the health system during the Interwar period. More specifically, it investigates the significant legislative and policy initiatives and their impact on the health system’s evolution. In addition, it aims to explore the factors that affected the outcome of LNHO’s reform plan. It is also argued that the proposed health reform plan was not fully implemented due to intense political and social conflicts that resulted from the institutional measures taken to address public health problems as well as financial and technical constraints.U međuratnom razdoblju (1918. – 1939.) Zdravstvena organizacija Lige naroda (ZOLN) pružala je financijsku pomoć i tehničku podršku zemljama širom svijeta u njihovu pokušaju reforme sustava javnog zdravstva, rješavanja zdravstvenih problema stanovništva i kontrole zaraznih bolesti. Grčka je bila jedna od zemalja koje su primile tu pomoć, a 1928. započela je suradnja sa ZOLN-om. Cilj je ovog saveza bio integrirani plan zdravstvene reforme pod nazivom „Suradnja s grčkom vladom za sanitarnu reorganizaciju Grčke“ i imao je dvostruku zadaću koja je pružala sveobuhvatnu zdravstvenu zaštitu za sve građane: a) reorganizaciju zdravstvenih usluga i b) uspostavu jedinstvenoga javnog zdravstvenog sustava. U članku se govori o suradnji između Grčke i ZOLN-a te njihovu nastojanju da reorganiziraju zdravstveni sustav u međuratnom razdoblju. Preciznije rečeno, istražuju se značajne zakonodavne i političke inicijative i njihov utjecaj na razvoj zdravstvenog sustava. Osim toga, cilj je istražiti čimbenike koji su utjecali na ishod plana reforme ZOLN-a. U članku se također tvrdi da predloženi plan reforme zdravstva nije u potpunosti proveden zbog intenzivnih političkih i društvenih sukoba koji su proizašli iz institucionalnih mjera poduzetih za rješavanje problema javnog zdravstva, kao i financijskih i tehničkih ograničenja

Clinical undergraduate training and assessment in primary health care: Experiences gained from Crete, Greece

BACKGROUND: Primary Health Care (PHC) is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed. METHODS: 284 students' case write-ups from the 6 primary care units (PCUs) where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8) primary qualitative criteria. RESULTS: Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p < 0.001) and more were reported in the write-ups that fulfilled criteria related to the biopsychosocial approach (p < 0.05). Nine quantitative criteria were fulfilled in more than 90% of case reports, but laboratory investigations were reported only in 69.0% of case reports. Statistically significant differences between the PCUs were observed in the fulfilment of criteria related to the community approach, patient assessment and information related to the patient's perception of the illness, but not to those related to aspects of clinical patient management. Differences in reporting laboratory investigations (p < 0.001) are explained by the lack of such facilities in some PCUs. Demographic characteristics of the patients or the students' do not affect the criteria. CONCLUSION: The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course

Attitudes to kidney donation among primary care patients in rural Crete, Greece

<p>Abstract</p> <p>Background</p> <p>In Greece, there is limited research on issues related to organ donation, and the low rate of registration as donors requires explanation. This study reports the findings of a survey of knowledge and attitudes to kidney donation among primary care patients in rural Crete, Greece.</p> <p>Methods</p> <p>Two rural primary care settings in the island of Crete, Anogia Health Centre and Vrachasi Practice, were involved in a questionnaire survey. This was conducted among primary care patients (aged 18 years and over) with routine appointments, to assess their knowledge and attitudes to kidney donation. General practitioners (GPs) recruited patients and questionnaires were completed following the patients' medical consultation. Pearson's chi square tests were used and crude odds ratios (OR) with 95% confidence intervals (95% CI) were calculated in order to investigate into the possible associations between the respondents' knowledge, attitudes and specific concerns in relation to their socio-demographic features. Logistic regression analyses were used to examine differences by geographical location.</p> <p>Results</p> <p>The 224 (92.5%) of the 242 primary care attenders who were approached agreed to participate. Only 2.2% (5/224) of the respondents carried a donor card. Most participants (84.4%, 189/224) did not feel well informed about registering as a kidney donor. More than half of the respondents (54.3%, 121/223) were unwilling to register as a kidney donor and donate kidneys for transplant after death. Over a third of respondents (35.4%, 79/223) were not confident that medical teams would try as hard as possible to save the life of a person who has agreed to donate organs. People with a higher level of education were more likely to be willing to register as kidney donors [(OR: 3.3; 95% CI: 1.8–6.0), p < 0.001)] and to be less worried about their kidneys being removed after death [(OR: 0.3; 95% CI: 0.1–0.5), p < 0.001)] than those having a lower level of education.</p> <p>Conclusion</p> <p>Lack of knowledge and information regarding organ donation and negative attitudes related to registration as donors were the main findings of this study. Efforts should be based on targeting the attitudes to organ donation of individuals and population groups.</p