Faculty of Social and Political Sciences

Seasonal influenza has become a serious public health problem worldwide, and vaccination is recognized as the most effective preventative measure. However, data suggest that influenza vaccination rates are generally low among health care workers. The present study showed that the vaccination rates for influenza among nurses are 21.2%.

Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active rheumatoid arthritis (RA). In Greece, it is mandatory that all infusions are administered in a hospital setting; therefore, they are strongly correlated with the system’s capacity in terms of resources. The objective of this paper was to assess the capacity of the Greek National Health System (NHS) hospitals to meet current/projected demand for iv treatment of RA patients. Semi-qualitative interviews on the basis of a strictly structured questionnaire were conducted with the Heads of all NHS RA infusion sites to record available resources, service utilization and ability to meet current/projected demand. Out of 31 NHS infusion sites, 28 responded (90.3%). On average, 41.6% of Greek NHS RA patients are treated with a biologic agent and 61.5% of respondents stated that available resources are insufficient to meet current demand. The most important constraints in selection order were as follows: space (93%), staff (89.5%), equipment (61.5%) and working hours (57%). Fifty-six percent of respondents stated that they may decline treatment to patients due to constraints. Overall, respondents estimated that the number of iv patients could be increased by 104%, were there no capacity constraints. An important proportion of the estimated 40.000 RA patients in Greece, for whom iv biologic treatment in the hospital setting is essential for disease control, may be declined treatment due to constraints in RA-specific resources. Rationalization and reallocation of NHS resources is required to ensure equity in access to effective treatment for all RA patients.

This paper examines the economic, political and legal characteristics of the Greek pharmaceutical market, which is largely affected by the paradox of state intervention: while pharmaceutical regulation is mainly directed towards a rationalisation of total pharmaceutical expenditure, all measures taken to date aim at exhaustive pricing controls, i.e. interventions on the supply side alone, disregarding the "balloon" effect of shrinking prices on the expanding volume of consumption.

compared eight oral antineoplastics (capecitabine, imatinib, lenalidomide, thalidomide, sunitinib, erlotinib, temozolomide, dasatinib) to a market basket of eight commonly utilized oral drugs (celecoxib, sitagliptin, rosuvastatin, fenofibrate, ramipril, simvastatin, atorvastatin, amlodipine). We calculated the correlation coefficient (r 2 ) for the relationships between a drug's average OPC and its TRx. RESULTS: Two of the eight cancer drugs (erlotinib and dasatinib) showed any remarkable correlations (r 2 0.17 and 0.29, respectively) while the other six all had correlation coefficients less than 0.10. Five of the market basket drugs had a correlation coefficient greater than 0.10. Four of those had negative correlations between OPC and TRx: simvastatin (r 2 0.71), sitagliptin (r 2 0.64), amlodipine (r 2 0.59), atorvastatin (r 2 0.14). Interestingly, ramipril had a significant positive correlation between OPC and TRx (r 2 0.51). CONCLUSIONS: Antineoplastic utilization appears to be inelastic with respect to OPC fluctuations vis-à-vis the chosen market basket. This observation may be a function of the severity of disease, the lack of treatment options or both. In contrast, changes in OPC for products in the general market basket, notably simvastin and sitagliptin, precipitated significant changes in drug utilization. Broader treatment options and specifically generic competition may contribute to this finding. Further research is warranted to track these relationships in a prospective, multi-factorial manner in order to better infer a cause-effect relationship. Greece OBJECTIVES: As an extension of our 2008 study, which demonstrated that clustering of oncology specific resources exceeded the spatial concentration pattern of health care services observed in Greece, we analyzed nation-wide data, in order to identify and highlight the cross-regional flows of cancer patients to access adequate treatment. METHODS: Patient admission and discharge data from public hospitals for the period 1999-2005 were collected on a regional basis from the National Statistical Service of Greece (NSS). Patients with a cancer diagnosis were grouped according to a) place of residence and b) place of treatment for the 11 regions of Greece. RESULTS: A significant flow of patients was observed towards Attika, the largest urban center and capital of Greece, where the number of cancer patients treated exceeded the number of cancer patients residing in the region by 48.9%, per year, on average. The reverse pattern (negative flow) was observed in Sterea, Ionian Islands, Aegean Islands, Thessaly and Thrace, the corresponding percentages being 76.2%, 63.3%, 45.2%, 37.3% and 27.9%, respectively. For the remaining 5 regions the flows did not exceed 10%. A further analysis based on type of cancer for the Attika region revealed that the highest flows, proportionally, according to diagnoses, were observed for melanoma, malignant and benign neoplasms of the uterus and Hodgkin's disease, whereas the lowest for benign neoplasms of the skin, the urinary organs and the thyroid. CON-CLUSIONS: Cross-regional flows of cancer patients to access adequate cancer treatment is in line with the geographical misdistribution of oncology-specific resources in favor of larger urban areas, especially Attika. A fair allocation of resources according to population distribution and cancer prevalence, as well as ongoing disease management programs at the place of residence, could greatly contribute to improved access to oncology services and minimize the socioeconomic burden to patients and their carers.

Over the past few years Greece has undergone several endeavors, aimed at modernizing and improving the national health care services. A Health Care Reform Act seeking quality improvement and coordination of outpatient and hospital services at the Regional level, through the enhancement of primary care, has been recently approved. This paper reports a proposal for integrated health system in the primary care system in Greece with a major focus on equity, quality, and outcomes. The equity and quality framework of this proposal will possess the main components focusing on the provision of essential services, and clinical and organizational standards.

Over the past few years Greece has undergone several endeavors, aimed at modernizing and improving the national health care services. A Health Care Reform Act seeking quality improvement and coordination of outpatient and hospital services at the Regional level, through the enhancement of primary care, has been recently approved. This paper reports a proposal for integrated health system in the primary care system in Greece with a major focus on equity, quality, and outcomes. The equity and quality framework of this proposal will possess the main components focusing on the provision of essential services, clinical, and organizational standards.

Over the past few years Greece has undergone several endeavors, aimed at modernizing and improving the national health care services. A Health Care Reform Act seeking quality improvement and coordination of outpatient and hospital services at the Regional level, through the enhancement of primary care, has been recently approved. This paper reports a proposal for integrated health system in the primary care system in Greece with a major focus on equity, quality, and outcomes. The equity and quality framework of this proposal will possess the main components focusing on the provision of essential services, clinical, and organizational standards.

Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned.

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. 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 ...

Chronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients. This is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees' age, gender, percentage of co-payment and social security unique number. Statistical analysis included descriptive statistics and logistic regression. 174,357 patients received medicines for COPD during the study period. Patients were ...

Background: While there is currently no cure for multiple sclerosis (MS), treatment with biologic diseasemodifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients' experiences. Methods: A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socioeconomic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. Results: During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. Conclusion: Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry.

Aim: Clarity on health expenditures is essential for the timely identification of risks that jeopardize the democratic provision of health services and the credibility of health insurance systems. Furthermore, observing health outcomes with geographical scope is essential for making multilateral associations. This study aimed at conveying information on the variability of important economic parameters of the health sector of Serbia and Greece from 2007 to 2012, when the most serious financial crisis in the postwar economic history hit the global economy. Methods: Exchange rates, purchase-power-parities (PPP) and price indices were used for the bilateral review of health and pharmaceutical expenditure dynamics during 2007-2012. Prescription and dispensing changes were also studied taking into account the anatomical therapeutic chemical (ATC) structure of drugs consumed. Results: Greece was forced to cut down its total health care and pharmaceutical expenditure and mainly its out-of-p...

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.