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Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Informing primary care reform in Greece: patient expectations and experiences (the QUALICOPC study)

Authors: Christos Lionis, Sophia Papadakis, Chrysanthi Tatsi, Antonis Bertsias, George Duijker, Prodromos-Bodosakis Mekouris, Wienke Boerma, Willemijn Schäfer, on behalf of the Greek QUALICOPC team

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients.

Methods

This study was conducted as part of the Quality and Costs of Primary Care in Europe (QUALICOPC) study. A cross-sectional sample of patients were recruited from general practitioner’s offices in Greece and surveyed. Patients rated five features of person-focused primary care: accessibility; continuity and coordination; comprehensiveness; patient activation; and doctor–patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. Comparisons were made between patients with and without chronic disease.

Results

The sample included 220 general practitioners from both public and private sector. A total of 1964 patients that completed the experience questionnaire and 219 patients that completed the patient values questionnaire were analyzed. Patients overall report a positive experiences with the general practice they visited. Several gaps were identified in particular in terms of wait times for appointments, general practitioner access to patient medical history, delivery of preventative services, patient involvement in decision-making. Patients with chronic disease report better experience than respondents without a chronic condition, however these patient groups report the same values in terms of qualities of the primary care system that are important to them.

Conclusions

Data gathered may be used to improve the quality of primary health care services in Greece through an increased focus on patient-centered approaches. Our study has identified several gaps as well as factors within the primary care health system that patient’s perceive as most important which can be used to prioritize quality improvement activities, especially within the austerity period. Study findings may also have application to other countries with similar context and infrastructure.
Literature
1.
go back to reference Schafer WL, Boerma WG, Kringos DS, De Maeseneer J, Gress S, Heinemann S, Rotar-Pavlic D, Seghieri C, Svab I, Van den Berg MJ, Vainieri M, Westert GP, Willems S, Groenewegen PP. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care. BMC Fam Pract. 2011;12:115-2296-12-115. Schafer WL, Boerma WG, Kringos DS, De Maeseneer J, Gress S, Heinemann S, Rotar-Pavlic D, Seghieri C, Svab I, Van den Berg MJ, Vainieri M, Westert GP, Willems S, Groenewegen PP. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care. BMC Fam Pract. 2011;12:115-2296-12-115.
2.
go back to reference Pullicino G, Sciortino P, Calleja N, Schafer W, Boerma W, Groenewegen P. Comparison of patients’ experiences in public and private primary care clinics in Malta. Eur J Public Health. 2015;25(3):399–401.CrossRefPubMed Pullicino G, Sciortino P, Calleja N, Schafer W, Boerma W, Groenewegen P. Comparison of patients’ experiences in public and private primary care clinics in Malta. Eur J Public Health. 2015;25(3):399–401.CrossRefPubMed
3.
go back to reference Delnoij D, Van Merode G, Paulus A, Groenewegen P. Does general practitioner gatekeeping curb health care expenditure? J Health Serv Res Policy. 2000;5(1):22–6.CrossRefPubMed Delnoij D, Van Merode G, Paulus A, Groenewegen P. Does general practitioner gatekeeping curb health care expenditure? J Health Serv Res Policy. 2000;5(1):22–6.CrossRefPubMed
4.
go back to reference Groenewegen PP, Jurgutis A. A future for primary care for the Greek population. Qual Prim Care. 2013;21(6):369–78.PubMed Groenewegen PP, Jurgutis A. A future for primary care for the Greek population. Qual Prim Care. 2013;21(6):369–78.PubMed
5.
go back to reference Bleich SN, Ozaltin E, Murray CK. How does satisfaction with the health-care system relate to patient experience? Bull World Health Organ. 2009;87(4):271–8.CrossRefPubMedPubMedCentral Bleich SN, Ozaltin E, Murray CK. How does satisfaction with the health-care system relate to patient experience? Bull World Health Organ. 2009;87(4):271–8.CrossRefPubMedPubMedCentral
8.
go back to reference Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff (Millwood). 2010;29(5):766–72.CrossRef Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff (Millwood). 2010;29(5):766–72.CrossRef
10.
go back to reference Helitzer DL, Lanoue M, Wilson B, de Hernandez BU, Warner T, Roter D. A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Educ Couns. 2011;82(1):21–9.CrossRefPubMed Helitzer DL, Lanoue M, Wilson B, de Hernandez BU, Warner T, Roter D. A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Educ Couns. 2011;82(1):21–9.CrossRefPubMed
11.
go back to reference Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–75.CrossRefPubMed Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–75.CrossRefPubMed
12.
go back to reference Taylor K. Paternalism, participation and partnership - the evolution of patient centeredness in the consultation. Patient Educ Couns. 2009;74(2):150–5.CrossRefPubMed Taylor K. Paternalism, participation and partnership - the evolution of patient centeredness in the consultation. Patient Educ Couns. 2009;74(2):150–5.CrossRefPubMed
13.
go back to reference Smith RC, Lyles JS, Mettler JA, Marshall AA, Van Egeren LF, Stoffelmayr BE, Osborn GG, Shebroe V. A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995;70(8):729–32.CrossRefPubMed Smith RC, Lyles JS, Mettler JA, Marshall AA, Van Egeren LF, Stoffelmayr BE, Osborn GG, Shebroe V. A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995;70(8):729–32.CrossRefPubMed
14.
go back to reference Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18.CrossRefPubMed Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18.CrossRefPubMed
15.
go back to reference Souliotis K, Golna C, Tountas Y, Siskou O, Kaitelidou D, Liaropoulos L. Informal payments in the Greek health sector amid the financial crisis: old habits die last...Eur J Health Econ. 2016;17(2):159–70. doi:10.1007/s10198-015-0666-0. Souliotis K, Golna C, Tountas Y, Siskou O, Kaitelidou D, Liaropoulos L. Informal payments in the Greek health sector amid the financial crisis: old habits die last...Eur J Health Econ. 2016;17(2):159–70. doi:10.​1007/​s10198-015-0666-0.
16.
go back to reference Kringos DS, Boerma W, van der Zee J, Groenewegen P. Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health Aff (Millwood). 2013;32(4):686–94.CrossRef Kringos DS, Boerma W, van der Zee J, Groenewegen P. Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health Aff (Millwood). 2013;32(4):686–94.CrossRef
17.
go back to reference Schafer WL, Boerma WG, Murante AM, Sixma HJ, Schellevis FG, Groenewegen PP. Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey. Bull World Health Organ. 2015;93(3):161–8.CrossRefPubMedPubMedCentral Schafer WL, Boerma WG, Murante AM, Sixma HJ, Schellevis FG, Groenewegen PP. Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey. Bull World Health Organ. 2015;93(3):161–8.CrossRefPubMedPubMedCentral
18.
go back to reference Schafer WL, Boerma WG, Kringos DS, De Ryck E, Gress S, Heinemann S, Murante AM, Rotar-Pavlic D, Schellevis FG, Seghieri C, Van den Berg MJ, Westert GP, Willems S, Groenewegen PP. Measures of quality, costs and equity in primary health care instruments developed to analyse and compare primary care in 35 countries. Qual Prim Care. 2013;21(2):67–79.PubMed Schafer WL, Boerma WG, Kringos DS, De Ryck E, Gress S, Heinemann S, Murante AM, Rotar-Pavlic D, Schellevis FG, Seghieri C, Van den Berg MJ, Westert GP, Willems S, Groenewegen PP. Measures of quality, costs and equity in primary health care instruments developed to analyse and compare primary care in 35 countries. Qual Prim Care. 2013;21(2):67–79.PubMed
19.
go back to reference Karakolias S.E. PNM. The newly established Unified Healthcare Fund (EOPYY): Current situation and proposed structural changes, towards an upgraded,odel of primary health care, in Greece. Health. 2014;6:809–821. Karakolias S.E. PNM. The newly established Unified Healthcare Fund (EOPYY): Current situation and proposed structural changes, towards an upgraded,odel of primary health care, in Greece. Health. 2014;6:809–821.
20.
go back to reference Polyzos N, Karakolias S, Dikeos C, Theodorou M, Kastanioti C, Mama K, Polizoidis P, Skamnakis C, Tsairidis C, Thireos E. The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? BMC Health Serv Res. 2014;14:583-014-0583-4. Polyzos N, Karakolias S, Dikeos C, Theodorou M, Kastanioti C, Mama K, Polizoidis P, Skamnakis C, Tsairidis C, Thireos E. The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed? BMC Health Serv Res. 2014;14:583-014-0583-4.
21.
go back to reference Kringos D, Boerma W, Hutchinson A, Saltman R. Building Primary Care in a Changing Europe. 2015. Kringos D, Boerma W, Hutchinson A, Saltman R. Building Primary Care in a Changing Europe. 2015.
22.
go back to reference Lionis C, Petelos E. The impact of the financial crisis on the quality of care in primary care: an issue that requires prompt attention. Qual Prim Care. 2013;21(5):269–73.PubMed Lionis C, Petelos E. The impact of the financial crisis on the quality of care in primary care: an issue that requires prompt attention. Qual Prim Care. 2013;21(5):269–73.PubMed
23.
go back to reference Brotons C. Control of cardiovascular risk factors in primary healthcare: do we control the factors or the risk? Med Clin (Barc). 2005;124(11):415–6.CrossRef Brotons C. Control of cardiovascular risk factors in primary healthcare: do we control the factors or the risk? Med Clin (Barc). 2005;124(11):415–6.CrossRef
24.
go back to reference Tsiligianni I, Anastasiou F, Antonopoulou M, Chliveros K, Dimitrakopoulos S, Duijker G, Kounalakis D, Makri K, Petraki C, Prokopiadou D, Stefanaki I, Symvoulakis E, Tsakountakis N, Vasilopoulos T, Vittorakis C, Lionis C, Cretan Practice based Primary Care Research Network ‘G. Lambrakis’, Clinic of Social and Family Medicine, School of Medicine, University of Crete. Greek rural GPs’ opinions on how financial crisis influences health, quality of care and health equity. Rural Remote Health. 2013;13(2):2528.PubMed Tsiligianni I, Anastasiou F, Antonopoulou M, Chliveros K, Dimitrakopoulos S, Duijker G, Kounalakis D, Makri K, Petraki C, Prokopiadou D, Stefanaki I, Symvoulakis E, Tsakountakis N, Vasilopoulos T, Vittorakis C, Lionis C, Cretan Practice based Primary Care Research Network ‘G. Lambrakis’, Clinic of Social and Family Medicine, School of Medicine, University of Crete. Greek rural GPs’ opinions on how financial crisis influences health, quality of care and health equity. Rural Remote Health. 2013;13(2):2528.PubMed
25.
go back to reference Lionis C. Is there any room for General Practice in Greece? A proposal to scientific and academic stakeholders. Hippokratia. 2014;18(4):383.PubMedPubMedCentral Lionis C. Is there any room for General Practice in Greece? A proposal to scientific and academic stakeholders. Hippokratia. 2014;18(4):383.PubMedPubMedCentral
26.
go back to reference Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, Dolor RJ, Irvine RJ, Heidenfelder BL, Kendrick AS, Gray R, Williams JW. Improving patient care. The patient centered medical home. A Systematic Review. Ann Intern Med. 2013;158(3):169–78.CrossRefPubMed Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, Dolor RJ, Irvine RJ, Heidenfelder BL, Kendrick AS, Gray R, Williams JW. Improving patient care. The patient centered medical home. A Systematic Review. Ann Intern Med. 2013;158(3):169–78.CrossRefPubMed
27.
go back to reference Brown L, Oliver-Baxte J, Bywood P. International trends and initiatives in primary health care… 2013;RESEARCH ROUNDup Issue 32. Brown L, Oliver-Baxte J, Bywood P. International trends and initiatives in primary health care… 2013;RESEARCH ROUNDup Issue 32.
28.
go back to reference World Health Organization. Facts and figures: Trends in Primary Care..Retrieved 4 July 2013. World Health Organization. Facts and figures: Trends in Primary Care..Retrieved 4 July 2013.
30.
go back to reference Lionis C, Symvoulakis EK, Vardavas CI. Implementing family practice research in countries with limited resources: a stepwise model experienced in Crete. Greece Fam Pract. 2010;27(1):48–54.CrossRefPubMed Lionis C, Symvoulakis EK, Vardavas CI. Implementing family practice research in countries with limited resources: a stepwise model experienced in Crete. Greece Fam Pract. 2010;27(1):48–54.CrossRefPubMed
31.
go back to reference Frederikson LG. Exploring information-exchange in consultation: the patients’ view of performance and outcomes. Patient Educ Couns. 1995;25(3):237–46.CrossRefPubMed Frederikson LG. Exploring information-exchange in consultation: the patients’ view of performance and outcomes. Patient Educ Couns. 1995;25(3):237–46.CrossRefPubMed
32.
go back to reference Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ. 2001;322(7284):468–72.CrossRefPubMedPubMedCentral Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ. 2001;322(7284):468–72.CrossRefPubMedPubMedCentral
33.
go back to reference Lionis C. Financial crisis and primary health care in Greece; is it time for family medicine? Fam Med & Prim Care Rev. 2015;17(3):225–7. Lionis C. Financial crisis and primary health care in Greece; is it time for family medicine? Fam Med & Prim Care Rev. 2015;17(3):225–7.
34.
go back to reference Kringos D, Boerma W, Bourgueil Y, Cartier T, Dedeu T, Hasvold T, Hutchinson A, Lember M, Oleszczyk M, Rotar Pavlic D, Svab I, Tedeschi P, Wilm S, Wilson A, Windak A, Van der Zee J, Groenewegen P. The strength of primary care in Europe: an international comparative study. Br J Gen Pract. 2013;63(616):e742–50.CrossRefPubMedPubMedCentral Kringos D, Boerma W, Bourgueil Y, Cartier T, Dedeu T, Hasvold T, Hutchinson A, Lember M, Oleszczyk M, Rotar Pavlic D, Svab I, Tedeschi P, Wilm S, Wilson A, Windak A, Van der Zee J, Groenewegen P. The strength of primary care in Europe: an international comparative study. Br J Gen Pract. 2013;63(616):e742–50.CrossRefPubMedPubMedCentral
35.
go back to reference Fleming NS, Herrin J, Roberts W, Couch C, Ballard DJ. Patient-centeredness and timeliness in a primary care network: baseline analysis and power assessment for detection of the effects of an electronic health record. Proc (Bayl Univ Med Cent). 2006;19(4):314–9. Fleming NS, Herrin J, Roberts W, Couch C, Ballard DJ. Patient-centeredness and timeliness in a primary care network: baseline analysis and power assessment for detection of the effects of an electronic health record. Proc (Bayl Univ Med Cent). 2006;19(4):314–9.
36.
go back to reference Kounalakis DK, Lionis C, Okkes I, Lamberts H. Developing an appropriate EPR system for the Greek primary care setting. J Med Syst. 2003;27(3):239–46.CrossRefPubMed Kounalakis DK, Lionis C, Okkes I, Lamberts H. Developing an appropriate EPR system for the Greek primary care setting. J Med Syst. 2003;27(3):239–46.CrossRefPubMed
37.
go back to reference Minas M, Koukosias N, Zintzaras E, Kostikas K, Gourgoulianis KI. Prevalence of chronic diseases and morbidity in primary health care in central Greece: an epidemiological study. BMC Health Serv Res. 2010;10:252-6963-10-252. Minas M, Koukosias N, Zintzaras E, Kostikas K, Gourgoulianis KI. Prevalence of chronic diseases and morbidity in primary health care in central Greece: an epidemiological study. BMC Health Serv Res. 2010;10:252-6963-10-252.
38.
go back to reference Brotons C, Bjorkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, Kloppe P, Lionis C, Mierzecki A, Pineiro R, Pullerits L, Sammut MR, Sheehan M, Tataradze R, Thireos EA, Vuchak J. EUROPREV network. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med. 2005;40(5):595–601.CrossRefPubMed Brotons C, Bjorkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, Kloppe P, Lionis C, Mierzecki A, Pineiro R, Pullerits L, Sammut MR, Sheehan M, Tataradze R, Thireos EA, Vuchak J. EUROPREV network. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med. 2005;40(5):595–601.CrossRefPubMed
39.
go back to reference Busse R, Blumel M, Scheller-Kreinsen D, Zentner A. Tackling chronic disease in Europe, observatory study, vol. 20. 2010. Busse R, Blumel M, Scheller-Kreinsen D, Zentner A. Tackling chronic disease in Europe, observatory study, vol. 20. 2010.
40.
go back to reference Franco OH, der Kinderen AJ, De Laet C, Peeters A, Bonneux L. Primary prevention of cardiovascular disease: cost-effectiveness comparison. Int J Technol Assess Health Care. 2007;23(1):71–9.CrossRefPubMed Franco OH, der Kinderen AJ, De Laet C, Peeters A, Bonneux L. Primary prevention of cardiovascular disease: cost-effectiveness comparison. Int J Technol Assess Health Care. 2007;23(1):71–9.CrossRefPubMed
41.
go back to reference Markaki A, Alegakis A, Antonakis N. Kalokerinou-Anagnostopoulou A, Lionis C. Exploring training needs of nursing staff in rural Cretan primary care settings. Appl Nurs Res. 2009;22(2):138–43. discussion 144–5.CrossRefPubMed Markaki A, Alegakis A, Antonakis N. Kalokerinou-Anagnostopoulou A, Lionis C. Exploring training needs of nursing staff in rural Cretan primary care settings. Appl Nurs Res. 2009;22(2):138–43. discussion 144–5.CrossRefPubMed
42.
go back to reference Lionis C, Symvoulakis EK, Markaki A, Vardavas C, Papadakaki M, Daniilidou N, Souliotis K, Kyriopoulos I. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review. Int J Integr Care. 2009;9:e88.CrossRefPubMedPubMedCentral Lionis C, Symvoulakis EK, Markaki A, Vardavas C, Papadakaki M, Daniilidou N, Souliotis K, Kyriopoulos I. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review. Int J Integr Care. 2009;9:e88.CrossRefPubMedPubMedCentral
43.
go back to reference Markaki A, Antonakis N, Philalithis A, Lionis C. Primary health care nursing staff in Crete: an emerging profile. Int Nurs Rev. 2006;53(1):16–8.CrossRefPubMed Markaki A, Antonakis N, Philalithis A, Lionis C. Primary health care nursing staff in Crete: an emerging profile. Int Nurs Rev. 2006;53(1):16–8.CrossRefPubMed
Metadata
Title
Informing primary care reform in Greece: patient expectations and experiences (the QUALICOPC study)
Authors
Christos Lionis
Sophia Papadakis
Chrysanthi Tatsi
Antonis Bertsias
George Duijker
Prodromos-Bodosakis Mekouris
Wienke Boerma
Willemijn Schäfer
on behalf of the Greek QUALICOPC team
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2189-0

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