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

Assessing Patient Organization Participation in Health Policy: A Comparative Study in France and Italy

Abstract Background: Even though there are many patient organizations across Europe, their role in impacting health policy decisions and reforms has not been well documented. In line with this, the present study endeavours to fill this gap in the international literature. To this end, it aims to validate further a previously developed instrument (the Health Democracy Index - HDI) measuring patient organization participation in health policy decision-making. In addition, by utilizing this tool, it aims to provide a snapshot of the degree and impact of cancer patient organization (CPO) participation in Italy and France. Methods: A convenient sample of 188 members of CPOs participated in the study (95 respondents from 10 CPOs in Italy and 93 from 12 CPOs in France). Participants completed online a self-reported questionnaire, encompassing the 9-item index and questions enquiring about the type and impact of participation in various facets of health policy decisionmaking. The psychometric properties of the scale were explored by performing factor analysis (construct validity) and by computing Cronbach α (internal consistency). Results: Findings indicate that the index has good internal consistency and the construct it taps is unidimensional. The degree and impact of CPO participation in health policy decision-making were found to be low in both countries; however in Italy they were comparatively lower than in France. Conclusion: In conclusion, the HDI can be effectively used in international policy and research contexts. CPOs participation is low in Italy and France and concerted efforts should be made on upgrading their role in health policy decision-making

Adrenal Aging and Its Implications on Stress Responsiveness in Humans

Normal aging results in subtle changes both in ACTH and cortisol secretion. Most notable is the general increase in mean daily serum cortisol levels in the elderly, without a noteworthy alteration in the normal circadian rhythm pattern. Glucocorticoid excess seen in the elderly population can have serious consequences in both the structural and functional integrity of various key areas in the brain, including the hippocampus, amygdala, prefrontal cortex, with consequent impairment in normal memory, cognitive function, and sleep cycles. The chronically elevated glucocorticoid levels also impinge on the normal stress response in the elderly, leading to an impaired ability to recover from stressful stimuli. In addition to the effects on the brain, glucocorticoid excess is associated with other age-related changes, including loss of muscle mass, hypertension, osteopenia, visceral obesity, and diabetes, among others. In contrast to the increase in glucocorticoid levels, other adrenocortical hormones, particularly serum aldosterone and DHEA (the precursor to androgens and estrogens) show significant decreases in the elderly. The underlying mechanisms for their decrease remain unclear. While the adrenomedullary hormone, norephinephrine, shows an increase in plasma levels, associated with a decrease in clearance, no notable changes observed in plasma epinephrine levels in the elderly. The multiplicity and complexity of the adrenal hormone changes observed throughout the normal aging process, suggests that age-related alterations in cellular growth, differentiation, and senescence specific to the adrenal gland must also be considered

Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension

Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold

Design, implementation and evaluation of a secondary prevention intervention to pediatricians in order to improve identification and management of maternal depression

Aim & objectives: Maternal depression is a common mood disorder that occurs in women, especially during child-bearing years with prevalence rates ranging from 10-20%. It affects both mother and child’s health and development. Although research evidence suggests the integration of mental health services into primary care, too little has yet been done. As a consequence, mothers demonstrating depressive symptoms do not have access to appropriate and adequate treatment. The role of the pediatrician in the early detection and management of maternal depression is well established. The aim of the present study was to implement an intervention for the secondary prevention of maternal depression in the pediatric primary care setting, Methods: The study was carried out in two phases: a) a qualitative exploration to assess pediatricians’ needs and perceptions regarding the detection and management of maternal depression, as well as, the pathways to treatment of mothers experiencing depressive symptoms and b) a randomized controlled trial to evaluate a theory-based intervention to pediatricians. The intervention was according to the Transtheoretical Model of Change and the Normalization Process Theory. For the purpose of the study, a random and representative sample of 377 pediatricians was selected. They were randomly assigned to intervention and control groups. Pediatricians in the intervention group participated in a web-based intervention. Evaluation measurements were carried out at baseline and post intervention, as well as, at 6 and 12 months. The following tools were employed to assess the impact of the intervention: i) Stage of Change Scale, ii) Processes of Change Scale, iii) Decisional Balance Scale, iv) Self-Efficacy Scale and v) the NoMad tool. To assess patient outcomes the PHQ-9 & SF-12 were used for depressive symptoms and quality of life related to health, respectively. Statistical analysis was performed using the SPSS 19 software and Pearson’s χ2 test, Student’s t-test, Analysis of Variance (ANOVA) and Multiple Logistic Regression Analysis. Results: The findings revealed that there were no statistical differences between the two groups prior to the intervention. Post and follow-up measurements indicated that differences at a statistical significance level between intervention and control groups. Pediatricians in the intervention group demonstrated higher scores in stages of change, processes of change, decisional balance and self-efficacy scales, as well as, screening rates and mothers identified with depressive symptoms. A strong and positive correlation was found between the processes of change scale and the NoMad instrument, indicating that the relationship between the pediatricians’ stage of change is directly proportional to the integration of detection and management practices in the pediatric setting. A proportion of 11% (1,102) of mothers was found to experience moderately severe and severe depression. A 20% of them evaluated for patient outcomes. Significant differences were found at 6 and 12 months follow-up measurements after referral. The severity of depressive symptoms was dramatically decreased while the quality of life related to health was significantly increased. Conclusion: The present study provides evidence for the benefits of integrating of mental health services into primary care. The pragmatic trial revealed that the intervention to pediatricians was effective and efficient for the secondary prevention of maternal depression. This suggests that the integration of maternal mental health into pediatric primary care may constitute an effective strategy to facilitate access to treatment for mothers suffering depressive symptoms and is recommended for countries of weak primary healthcare systems and limited resources.Σκοπός και στόχοι: Η κατάθλιψη που εμφανίζεται σε μητέρες με παιδιά ηλικίας 0-5 ετών έχει πολλαπλές επιπτώσεις τόσο στην υγεία της μητέρας, όσο και στην υγεία και την ανάπτυξη του παιδιού. Παρ’ όλο που τα σύγχρονα ερευνητικά δεδομένα συγκλίνουν στην ανάγκη ενσωμάτωσης μέρους των υπηρεσιών ψυχικής υγείας στην Πρωτοβάθμια Φροντίδα Υγείας (ΠΦΥ), ελάχιστα έχουν γίνει προς αυτήν την κατεύθυνση. Ο ρόλος του παιδιάτρου στην έγκαιρη ανίχνευση και παραπομπή αυτών των περιπτώσεων, αναδεικνύεται καθοριστικός. Στόχος της παρούσας εργασίας είναι η δευτερογενής πρόληψη της κατάθλιψης σε μητέρες παιδιών ηλικίας 0-5 ετών, μέσω της εφαρμογής μιας παρέμβασης στο παιδιατρικό πλαίσιο της ΠΦΥ. Μέθοδος: Η έρευνα πραγματοποιήθηκε σε δύο φάσεις: α) έγινε ποιοτική διερεύνηση τόσο των αναγκών των παιδιάτρων ως προς την εφαρμογή πρακτικών διαχείρισης της κατάθλιψης, όσο και των μητέρων σε σχέση με τους παράγοντες που επηρεάζουν την αναζήτηση βοήθειας (τα αποτελέσματα χρησιμοποιήθηκαν στην ανάπτυξη του θεωρητικού πλαισίου της παρέμβασης και το περιεχόμενό της) και β) ποσοτική έρευνα, η οποία περιελάμβανε τυχαιοποιημένη ελεγχόμενη μελέτη για την αξιολόγηση της παρέμβασης. Η παρέμβαση βασίστηκε στο Διαθεωρητικό Μοντέλο Αλλαγής και τη Θεωρία Κανονικοποίησης της Διαδικασίας. Για το σκοπό της έρευνας, επιλέχθηκε τυχαίο και αντιπροσωπευτικό δείγμα 377 παιδιάτρων από όλη την ελληνική επικράτεια, οι οποίοι εκχωρήθηκαν τυχαία στις ομάδες παρέμβασης και ελέγχου. Η ομάδα παρέμβασης συμμετείχε σε ένα πολυδιάστατο εκπαιδευτικό πρόγραμμα μέσω διαδικτύου, ενώ η ομάδα ελέγχου δεν έλαβε καμία παρέμβαση. Μετρήσεις πραγματοποιήθηκαν αμέσως μετά την παρέμβαση, 6 και 12 μήνες μετά. Για την αξιολόγηση της παρέμβασης χρησιμοποιήθηκαν τα ακόλουθα εργαλεία: i) ερωτηματολόγιο δημογραφικών στοιχείων, ii) Γενικές ερωτήσεις στάσεων, iii) κλίμακα σταδίου αλλαγής, iv) κλίμακα διαδικασιών αλλαγής, v) κλίμακα αυτοαποτελεσματικότητας, vi) κλίμακα ισοζυγίου απόφασης, αλλά και το ερωτηματολόγιο κανονικοποίησης της διαδικασίας. Για την αξιολόγηση των αποτελεσμάτων στην ψυχική υγεία και την ποιότητα ζωής της μητέρας χρησιμοποιήθηκαν: α) το εργαλείο ανίχνευσης καταθλιπτικών συμπτωμάτων PHQ-9 και το ερωτηματολόγιο για την Ποιότητα Ζωής που Σχετίζεται με την Υγεία (ΠΖΣΥ) SF-12. Για τη στατιστική ανάλυση χρησιμοποιήθηκε το Pearson’s χ2 test, το Student’s t-test, η ανάλυση διασποράς (ANOVA) και η πολλαπλή λογαριθμιστική παλινδρόμηση. Η ανάλυση έγινε με το στατιστικό πρόγραμμα SPSS 19.0. Αποτελέσματα: από τα ευρήματα φάνηκε ότι οι δύο ομάδες δεν είχαν στατιστικά σημαντικές διαφορές πριν από την παρέμβαση. Μετά την παρέμβαση, οι παιδίατροι της ομάδας παρέμβασης παρουσίασαν υψηλότερες επιδόσεις στο στάδιο και τις διαδικασίες αλλαγής, την αυτό-αποτελεσματικότητα και το ισοζύγιο απόφασης, ενώ αυξήθηκαν και τα ποσοστά των μητέρων που ανιχνεύθηκαν σε κάθε μέτρηση (αμέσως μετά την παρέμβαση, 6 μήνες, 12 μήνες). Ισχυρή θετική συσχέτιση παρουσίασε και το ερωτηματολόγιο κανονικοποίησης της διαδικασίας με την κλίμακα διαδικασιών αλλαγής – όσο δηλαδή οι παιδίατροι προχωρούσαν σε επόμενο στάδιο, αυξανόταν η ενσωμάτωση των πρακτικών διαχείρισης της κατάθλιψης στο πλαίσιο της καθημερινής τους κλινικής πρακτικής. Από τις μητέρες στις οποίες χορηγήθηκε το εργαλείο ανίχνευσης της κατάθλιψης, βρέθηκε να πάσχει από μέτρια σοβαρή και σοβαρή κατάθλιψη ποσοστό 11% (1102 μητέρες). Από αυτές επιλέχθηκε τυχαία ποσοστό 20% για να συμπληρώσει το PHQ-9 & το SF-12. Τα σκορ των μητέρων αμέσως μετά την παραπομπή και μετά από 6 και 12 μήνες, παρουσίασαν στατιστικά σημαντικές διαφορές τόσο ως προς τη σοβαρότητα της καταθλιπτικής συμπτωματολογίας, όσο και ως προς την ΠΖΣΥ. Τα επίπεδα κατάθλιψης μειώθηκαν δραστικά και η ΠΖΣΥ των μητέρων, μειώθηκε αισθητά στις μετρήσεις παρακολούθησης.Συμπέρασμα: Η παρέμβαση ήταν επιτυχημένη, καταδεικνύοντας ότι το παιδιατρικό πλαίσιο της ΠΦΥ είναι πλεονεκτικό πεδίο για τη δευτερογενή πρόληψη της κατάθλιψης σε μητέρες με μικρά παιδιά και αποτελεί ένα ενδεικτικό παράδειγμα, του πως είναι δυνατόν να ενσωματωθεί ένα μέρος των υπηρεσιών ψυχικής υγείας στην ΠΦΥ, δαπανώντας ελάχιστους πόρους και αυξάνοντας την πρόσβαση των μητέρων που αντιμετωπίζουν προβλήματα κατάθλιψης στη θεραπεία

Σχεδιασμός, υλοποίηση, αξιολόγηση παρέμβασης δευτερογενούς πρόληψης σε παιδιάτρους για τη βελτίωση της ανίχνευσης της κατάθλιψης στις μητέρες.

Σκοπός και στόχοι: Η κατάθλιψη που εμφανίζεται σε μητέρες με παιδιά ηλικίας 0-5 ετών έχει πολλαπλές επιπτώσεις τόσο στην υγεία της μητέρας, όσο και στην υγεία και την ανάπτυξη του παιδιού. Παρ’ όλο που τα σύγχρονα ερευνητικά δεδομένα συγκλίνουν στην ανάγκη ενσωμάτωσης μέρους των υπηρεσιών ψυχικής υγείας στην Πρωτοβάθμια Φροντίδα Υγείας (ΠΦΥ), ελάχιστα έχουν γίνει προς αυτήν την κατεύθυνση. Ο ρόλος του παιδιάτρου στην έγκαιρη ανίχνευση και παραπομπή αυτών των περιπτώσεων, αναδεικνύεται καθοριστικός. Στόχος της παρούσας εργασίας είναι η δευτερογενής πρόληψη της κατάθλιψης σε μητέρες παιδιών ηλικίας 0-5 ετών, μέσω της εφαρμογής μιας παρέμβασης στο παιδιατρικό πλαίσιο της ΠΦΥ. Μέθοδος: Η έρευνα πραγματοποιήθηκε σε δύο φάσεις: α) έγινε ποιοτική διερεύνηση τόσο των αναγκών των παιδιάτρων ως προς την εφαρμογή πρακτικών διαχείρισης της κατάθλιψης, όσο και των μητέρων σε σχέση με τους παράγοντες που επηρεάζουν την αναζήτηση βοήθειας (τα αποτελέσματα χρησιμοποιήθηκαν στην ανάπτυξη του θεωρητικού πλαισίου της παρέμβασης και το περιεχόμενό της) και β) ποσοτική έρευνα, η οποία περιελάμβανε τυχαιοποιημένη ελεγχόμενη μελέτη για την αξιολόγηση της παρέμβασης. Η παρέμβαση βασίστηκε στο Διαθεωρητικό Μοντέλο Αλλαγής και τη Θεωρία Κανονικοποίησης της Διαδικασίας. Για το σκοπό της έρευνας, επιλέχθηκε τυχαίο και αντιπροσωπευτικό δείγμα 377 παιδιάτρων από όλη την ελληνική επικράτεια, οι οποίοι εκχωρήθηκαν τυχαία στις ομάδες παρέμβασης και ελέγχου. Η ομάδα παρέμβασης συμμετείχε σε ένα πολυδιάστατο εκπαιδευτικό πρόγραμμα μέσω διαδικτύου, ενώ η ομάδα ελέγχου δεν έλαβε καμία παρέμβαση. Μετρήσεις πραγματοποιήθηκαν αμέσως μετά την παρέμβαση, 6 και 12 μήνες μετά. Για την αξιολόγηση της παρέμβασης χρησιμοποιήθηκαν τα ακόλουθα εργαλεία: i) ερωτηματολόγιο δημογραφικών στοιχείων, ii) Γενικές ερωτήσεις στάσεων, iii) κλίμακα σταδίου αλλαγής, iv) κλίμακα διαδικασιών αλλαγής, v) κλίμακα αυτοαποτελεσματικότητας, vi) κλίμακα ισοζυγίου απόφασης, αλλά και το ερωτηματολόγιο κανονικοποίησης της διαδικασίας. Για την αξιολόγηση των αποτελεσμάτων στην ψυχική υγεία και την ποιότητα ζωής της μητέρας χρησιμοποιήθηκαν: α) το εργαλείο ανίχνευσης καταθλιπτικών συμπτωμάτων PHQ-9 και το ερωτηματολόγιο για την Ποιότητα Ζωής που Σχετίζεται με την Υγεία (ΠΖΣΥ) SF-12. Για τη στατιστική ανάλυση χρησιμοποιήθηκε το Pearson’s χ2 test, το Student’s t-test, η ανάλυση διασποράς (ANOVA) και η πολλαπλή λογαριθμιστική παλινδρόμηση. Η ανάλυση έγινε με το στατιστικό πρόγραμμα SPSS 19.0. Αποτελέσματα: από τα ευρήματα φάνηκε ότι οι δύο ομάδες δεν είχαν στατιστικά σημαντικές διαφορές πριν από την παρέμβαση. Μετά την παρέμβαση, οι παιδίατροι της ομάδας παρέμβασης παρουσίασαν υψηλότερες επιδόσεις στο στάδιο και τις διαδικασίες αλλαγής, την αυτό-αποτελεσματικότητα και το ισοζύγιο απόφασης, ενώ αυξήθηκαν και τα ποσοστά των μητέρων που ανιχνεύθηκαν σε κάθε μέτρηση (αμέσως μετά την παρέμβαση, 6 μήνες, 12 μήνες). Ισχυρή θετική συσχέτιση παρουσίασε και το ερωτηματολόγιο κανονικοποίησης της διαδικασίας με την κλίμακα διαδικασιών αλλαγής – όσο δηλαδή οι παιδίατροι προχωρούσαν σε επόμενο στάδιο, αυξανόταν η ενσωμάτωση των πρακτικών διαχείρισης της κατάθλιψης στο πλαίσιο της καθημερινής τους κλινικής πρακτικής. Από τις μητέρες στις οποίες χορηγήθηκε το εργαλείο ανίχνευσης της κατάθλιψης, βρέθηκε να πάσχει από μέτρια σοβαρή και σοβαρή κατάθλιψη ποσοστό 11% (1102 μητέρες). Από αυτές επιλέχθηκε τυχαία ποσοστό 20% για να συμπληρώσει το PHQ-9 & το SF-12. Τα σκορ των μητέρων αμέσως μετά την παραπομπή και μετά από 6 και 12 μήνες, παρουσίασαν στατιστικά σημαντικές διαφορές τόσο ως προς τη σοβαρότητα της καταθλιπτικής συμπτωματολογίας, όσο και ως προς την ΠΖΣΥ. Τα επίπεδα κατάθλιψης μειώθηκαν 256 δραστικά και η ΠΖΣΥ των μητέρων, μειώθηκε αισθητά στις μετρήσεις παρακολούθησης. Συμπέρασμα: Η παρέμβαση ήταν επιτυχημένη, καταδεικνύοντας ότι το παιδιατρικό πλαίσιο της ΠΦΥ είναι πλεονεκτικό πεδίο για τη δευτερογενή πρόληψη της κατάθλιψης σε μητέρες με μικρά παιδιά και αποτελεί ένα ενδεικτικό παράδειγμα, του πως είναι δυνατόν να ενσωματωθεί ένα μέρος των υπηρεσιών ψυχικής υγείας στην ΠΦΥ, δαπανώντας ελάχιστους πόρους και αυξάνοντας την πρόσβαση των μητέρων που αντιμετωπίζουν προβλήματα κατάθλιψης στη θεραπεία.Aim & objectives: Maternal depression is a common mood disorder that occurs in women, especially during child-bearing years with prevalence rates ranging from 10-20%. It affects both mother and child’s health and development. Although research evidence suggests the integration of mental health services into primary care, too little has yet been done. As a consequence, mothers demonstrating depressive symptoms do not have access to appropriate and adequate treatment. The role of the pediatrician in the early detection and management of maternal depression is well established. The aim of the present study was to implement an intervention for the secondary prevention of maternal depression in the pediatric primary care setting, Methods: The study was carried out in two phases: a) a qualitative exploration to assess pediatricians’ needs and perceptions regarding the detection and management of maternal depression, as well as, the pathways to treatment of mothers experiencing depressive symptoms and b) a randomized controlled trial to evaluate a theory-based intervention to pediatricians. The intervention was according to the Transtheoretical Model of Change and the Normalization Process Theory. For the purpose of the study, a random and representative sample of 377 pediatricians was selected. They were randomly assigned to intervention and control groups. Pediatricians in the intervention group participated in a web-based intervention. Evaluation measurements were carried out at baseline and post intervention, as well as, at 6 and 12 months. The following tools were employed to assess the impact of the intervention: i) Stage of Change Scale, ii) Processes of Change Scale, iii) Decisional Balance Scale, iv) Self-Efficacy Scale and v) the NoMad tool. To assess patient outcomes the PHQ-9 & SF-12 were used for depressive symptoms and quality of life related to health, respectively. Statistical analysis was performed using the SPSS 19 software and Pearson’s χ2 test, Student’s t-test, Analysis of Variance (ANOVA) and Multiple Logistic Regression Analysis. Results: The findings revealed that there were no statistical differences between the two groups prior to the intervention. Post and follow-up measurements indicated that differences at a statistical significance level between intervention and control groups. Pediatricians in the intervention group demonstrated higher scores in stages of change, processes of change, decisional balance and self-efficacy scales, as well as, screening rates and mothers identified with depressive symptoms. A strong and positive correlation was found between the processes of change scale and the NoMad instrument, indicating that the relationship between the pediatricians’ stage of change is directly proportional to the integration of detection and management practices in the pediatric setting. A proportion of 11% (1,102) of mothers was found to experience moderately severe and severe depression. A 20% of them evaluated for patient outcomes. Significant differences were found at 6 and 12 months follow-up measurements after referral. The severity of depressive symptoms was dramatically decreased while the quality of life related to health was significantly increased. Conclusion: The present study provides evidence for the benefits of integrating of mental health services into primary care. The pragmatic trial revealed that the intervention to pediatricians was effective and efficient for the secondary prevention of maternal depression. This suggests that the integration of maternal mental health into pediatric primary care may constitute an effective strategy to facilitate access to treatment for mothers suffering depressive symptoms and is recommended for countries of weak primary healthcare systems and limited resources

Healthcare access for cancer patients in the era of economic crisis. Results from the HOPE III study

Background: Despite the documentation of addressing healthcare disparities in detection and treatment of cancer and health outcomes for cancer patients, the inequalities persist. Cancer patients of several vulnerable groups suffer disproportionally the effect of economic crisis on health and healthcare

Psychiatrists role in primary health care in Greece: findings from a quantitative study

Abstract Background Although the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population’ needs. Methods The present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies. Results The vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists’ participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners’ usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually fail to comply. Conclusions Respondents in the present study are receptive to participate in primary care. They believe that their inclusion to primary care will result to decreased social stigmatization for mental health problems, increased patient’ access and improved detection and management rates for common mental health conditions

Health Democracy Index: Development and Validation of a Self-Reported Instrument for Measuring Patient Participation in Health Policy

Introduction: Patient participation has emerged as a preponderant theme in contemporary health and healthcare; however there is a dearth of research on the degree and impact of collective patient participation on shaping health policy. In this frame, the current study endeavored to validate a scale for assessing patients' association (PA) participation in health policy processes. Furthermore, PAs' participation in health policy decision making in Greece was explored. Materials and Methods: The Health Democracy Index (HDI) is an eight-item scale enquiring about PAs' participation in important facets of health policy. To investigate its psychometric properties, 414 members of PAs in Greece were randomly recruited. By employing a self-reported questionnaire, construct validity was examined through exploratory and confirmatory factor analysis, while convergent validity was investigated through an additional question asking respondents to rate the degree of their association's participation in health policy processes. Moreover, the internal consistency of the scale and its test-retest reliability were explored. Results: The scale showed high internal consistency (Cronbach a = 0.85) and test-retest reliability (ICC = 0.89, p < 0,001). Exploratory factor analysis suggested a unidimensional construct; while confirmatory factor analysis indicated an adequate fit of the one-factor model (RMSEA = 0.079, CFI = 0.976, and GFI=0.972). Regarding convergent validity, the HDI composite score displayed strong and positive correlation with the item asking respondents to rate the degree of PA participation in health policy processes (rho = 0.73, p < 0.0001). Concerning the pattern of results in Greece, PAs' participation was found to be low. The lowest level was observed for the item enquiring about PA participation in the national parliament and the highest for panels at influential health-related organizations. Conclusion: The HDI is a valid and reliable tool that can be utilized to serve policy-related as well as research purposes. PAs' participation in Greece is weak and thus efforts should be made to enhance it