The new SARS-CoV-2 outbreak has rapidly spread to many countries and has pushed health systems to radical changes in healthcare provision. This study aims to investigate the impact of the COVID-19 ...pandemic on the management of chronic patients in Primary Health Care (PHC). A narrative review of the literature was carried out in the PubMed and Google Scholar databases. It was found that since the pandemic’s onset, many regular medical visits have led to delays, postponements, and even cancellations. The reasons for this discontinuity of chronic care were individual (fear and reluctance, home isolation), but also collective (shortages of medical staff, weakening of PHC, and suspension of outpatient care). Therefore, postponements of scheduled medical visits, delayed seeking of help and lack of medication adherence could lead to deregulation of chronic diseases, posing a risk for catastrophic health consequences. In order to ensure the continuity of chronic care provision, health systems have adopted new practices such as telemedicine and self-monitoring. The inclusion of chronic care in national pandemic response plans, the strengthening of PHC and the improvement of communication between patients and public health officials are essential preconditions to mitigate the indirect effects of the pandemic on chronic care.
Improving the quality of and access to healthcare services in rural areas is fundamental to developing sustainable healthcare systems. This research aims to explore the motivations of healthcare ...professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary-care units that lack direct hospital or hospital-health centre access. The research was conducted specifically in the rural islands of the Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors, and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, an unstable working environment, educational and organisational aspects, and an insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.
During the recent COVID-19 pandemic, the clinical exposure of medical students has been hindered while the impact on medical education is under investigation. The potential negative impact of medical ...students on transmission rates, along with the shortages of Personal Protective Equipment (PPE), their lack of proper training, and their limited ability to work independently, give rise to reasonable concerns regarding their involvement in pandemic management. Nevertheless, the heavy workload could soon provoke severe deficiencies in the frontline medical workforce. Hence, the possibility of covering gaps in human resources by effectively deploying students should not be rejected in advance. Additionally, a pandemic poses a valuable learning opportunity for high-quality medical education. The aim of this commentary is to present a discussion with supporters and opponents of medical student engagement in the pandemic management and their involvement in placements requiring physical contact with patients. We also attempt to elucidate the necessary conditions for the students' possible involvement in clinical settings.
Introduction: Primary health care (PHC), the cornerstone of health systems, has an important role in infectious disease control. The SARS-CoV-2 (COVID-19) pandemic has put a burden on health systems ...worldwide and especially on healthcare workers at the first line delivering their services in remote areas of Greece. This study investigates preparedness and awareness level of primary healthcare workers (PHCWs) and their risk perception in managing the pandemic during its initial phase. Methods: A cross-sectional survey was conducted in public PHC units in Greece. A web-based 14-item questionnaire, tested in a pilot study, was administered by a pre-existing panel of the Education and Research Network in PHC of Aristotle University of Thessaloniki, Greece. Associations were assessed between epidemic response awareness, risk perception, participant demographics and work settings. Participants were grouped by profession in first-line physicians (general practitioners, internal medicine specialists, pediatricians), first-line non-physicians (nurses, health visitors, paramedics) and second-line PHCWs (dentists, microbiologists, administrators, midwifes, laboratory technicians, nutritionists and social workers). Univariate logistic regression and multivariable analysis were performed and linear regression was performed to examine the effect of participants' awareness of the preparedness plan to their working area characteristics. Results: A total of 441 PHCWs participated in the survey. Risks were perceived at a lower level by second-line PHCWs than by first-line PHCWs (B=-0.78, 95% confidence interval (CI) -1.49- -0.08; p=0.028). Older PHCWs had less concerns than younger PHCWs (B=-0.04, 95%CI -0.08- -0.01; p=0.025) and more experienced participants had more concerns than less experienced (B=0.04, 95%CI 0.00,0.07; p=0.050). PHCWs in rural settings presented with more preparedness awareness, compared to PHCWs in urban areas (B=1.10, 95%CI 0.28,1.92; p=0.008), while PHCWs living with high risk individuals showed less situation awareness (-0.55, 95%CI -0.95-0.16; p=0.006). Conclusion: PHCWs in rural areas revealed a relatively high awareness of the response measures and management protocol requirements that were in place, compared to their colleagues in urban areas. As expected, first-line PHCWs directly exposed to emergencies expressed more concerns than second-line PHCWs. Learning from the challenges occurring during the initial phase of the pandemic could help PHC facilities address COVID-19 effectively and PHCWs' sense of security and confidence could be augmented, even when working in remote areas of the country. When planning training, distributing equipment and proposing protocols, the characteristics of the area and the needs of PHCWs, and population should be cautiously considered.
This study aimed to assess the health profile of patient-attendees visiting primary healthcare (PHC) practice settings in the midst of the COVID-19 pandemic and to explore the relationships between ...multiple behavioral risk factors (MBRFs) and consultation-driven health information. Multiple behavioral risk factors involve a variety of unhealthy behaviors that are associated with an increased prevalence of non-communicable diseases (NCDs).
The study design was based on a dataset analysis, afterward exploring the feasibility and diagnostic capacity of respiratory morbidity aspects from a study previously conducted. The study dataset contained information regarding socio-demographic characteristics, health habits, clinical information, and reported comorbidities from 183 primary care patient-attendees. A categorical regression analysis was performed, using as a numeric variable the multiple MBRFs (clustering of 0 to four factors) in order to examine relationships with the basic and clinical characteristics of the patient-attendees.
Based on this secondary analysis, it was found that the prevalence of MBRFs is quite common among patient-attendees visiting urban PHC facilities. The prevalence of current smoking, sleep deprivation, increased body weight, and medium/high perceived stress levels were 33.9%, 52.5%, 83.1%, and 35.0%, respectively. An increased occurrence of MBRFs might be significantly predicted by the lower age of patient-attendees (b = -0.221, p = 0.05), by the absence of gray hair at an early age (b = -0.144, p = 0.042), by the physical discomfort during activities (b = 0.191, p = 0.017), or by the lower oxygen saturation (b = -0.184, p = 0.004). Diabetes mellitus (25.1%) was the most prevalent condition, followed by bronchial asthma (18.6%) and depression (15.8%).
Lower age, absence of premature hair whitening, physical discomfort during activities, and lower oxygen saturation are linked with an increased occurrence of MBRFs, leading to a neglected way of living. Those factors could be used to alert researchers, policymakers, and PHC professionals to act accordingly in order to prevent or early diagnose NCDs.
World health education should be an integral part of every medical school’s curriculum. Unfortunately, this is not always the truth. In an effort to bring medical students of our school closer to ...Health Education, we developed and implemented a Health Education Program. This Program featured the inclusion of medical students as coordinators, along with the experts of the Team. Herein we share our experience throughout this journey, the obstacles that we faced, and our advice for anyone who might be interested in developing such a program. Furthermore, we discuss what the impact of including medical students as team members and program coordinators can be.
The aim of this qualitative research, conducted in Spring 2021, was to identify the inconveniences and the psychological and social impact of 10 days of home isolation, required by law, in ...non-hospitalised COVID-19 patients in Greece and to improve management. Thirty-seven semi-structured telephone interviews were conducted, audio-recorded, and transcribed verbatim. Thematic analysis identified four key emergent themes, i.e., everyday life during self-isolation, psychological issues, social issues, and information and guidance. Food provisioning was of particular concern. Solidarity was expressed to individuals in need. Isolation was not always viable due to space constraints and the necessity to care for sick family members. Fear of transmission to vulnerable groups, hospitalisation, irreversible complications, and death as well as anxiety, insecurity, guilt, and alienation were articulated. COVID-19 disrupted the normal functioning of families and led to revision of interpersonal relationships. Patients avoided re-integration in society due to the transmitter stigma and to limit the risk of infection spread in the community. Over-information promoted fear. Mild illness raised doubts about information validity. Primary care provided monitoring and psychological support. Home isolation caused disruption in various aspects of participants’ life, ranging from logistic problems to dealing with the psychological burden of isolation and illness. Primary care could play a central role in supporting patients.
Multiple student initiatives were developed in the Medical School of the Aristotle University of Thessaloniki, under the guidance of the Laboratory of Primary Health Care, General Practice, and ...Health Services Research, as an answer to the increasing needs of the Greek National Health System during the pandemic. In one group, students were responsible for the phone call communication with patients of certain areas to book an appointment for a rapid test, announce the results of the test, monitor the symptoms and the health condition of patients with mild COVID-19 and inform the GPs of the health centers. At around the same time, in another group, senior medical students were enlisted as volunteers, and they were distributed to seven vaccination centers in two different Health Districts of Northern Greece. The vaccination process was significantly facilitated by the support of students in the initial data collection and recording of the personal medical history of the incoming citizens. Supporting the medical staff to accelerate the process, helping to raise public awareness about vaccination, keeping in touch with clinical life and patients, and further training in vaccination and communication skills were cited as critical expectations by the volunteer students, which were largely met. Other schools could implement similar strategies of including medical students in community health projects and promote initiatives that support primary health care.
Lung cancer is the leading cause of cancer death, with wide variations in national survival rates. This study compares primary care system factors and primary care practitioners' (PCPs') clinical ...decision-making for a vignette of a patient that could have lung cancer in five Balkan region countries (Slovenia, Croatia, Bulgaria, Greece, Romania).
PCPs participated in an online questionnaire that asked for demographic data, practice characteristics, and information on health system factors. Participants were also asked to make clinical decisions in a vignette of a patient with possible lung cancer.
The survey was completed by 475 PCPs. There were significant national differences in PCPs' direct access to investigations, particularly to advanced imaging. PCPs from Bulgaria, Greece, and Romania were more likely to organise relevant investigations. The highest specialist referral rates were in Bulgaria and Romania. PCPs in Bulgaria were less likely to have access to clinical guidelines, and PCPs from Slovenia and Croatia were more likely to have access to a cancer fast-track specialist appointment system. The PCPs' country had a significant effect on their likelihood of investigating or referring the patient.
There are large differences between Balkan region countries in PCPs' levels of direct access to investigations. When faced with a vignette of a patient with the possibility of having lung cancer, their investigation and referral rates vary considerably. To reduce diagnostic delay in lung cancer, direct PCP access to advanced imaging, availability of relevant clinical guidelines, and fast-track referral systems are needed.
PDF
