Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review
Identifieur interne : 000464 ( Pmc/Curation ); précédent : 000463; suivant : 000465Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review
Auteurs : Christos Lionis ; Emmanouil K. Symvoulakis ; Adelais Markaki ; Constantine Vardavas ; Maria Papadakaki ; Natasa Daniilidou ; Kyriakos Souliotis ; Ioannis KyriopoulosSource :
- International Journal of Integrated Care [ 1568-4156 ] ; 2009.
Abstract
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.
This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country.
A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care.
Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care.
Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.
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PubMed: 19777112
PubMed Central: 2748181
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review</title><author><name sortKey="Lionis, Christos" sort="Lionis, Christos" uniqKey="Lionis C" first="Christos" last="Lionis">Christos Lionis</name></author><author><name sortKey="Symvoulakis, Emmanouil K" sort="Symvoulakis, Emmanouil K" uniqKey="Symvoulakis E" first="Emmanouil K" last="Symvoulakis">Emmanouil K. Symvoulakis</name></author><author><name sortKey="Markaki, Adelais" sort="Markaki, Adelais" uniqKey="Markaki A" first="Adelais" last="Markaki">Adelais Markaki</name></author><author><name sortKey="Vardavas, Constantine" sort="Vardavas, Constantine" uniqKey="Vardavas C" first="Constantine" last="Vardavas">Constantine Vardavas</name></author><author><name sortKey="Papadakaki, Maria" sort="Papadakaki, Maria" uniqKey="Papadakaki M" first="Maria" last="Papadakaki">Maria Papadakaki</name></author><author><name sortKey="Daniilidou, Natasa" sort="Daniilidou, Natasa" uniqKey="Daniilidou N" first="Natasa" last="Daniilidou">Natasa Daniilidou</name></author><author><name sortKey="Souliotis, Kyriakos" sort="Souliotis, Kyriakos" uniqKey="Souliotis K" first="Kyriakos" last="Souliotis">Kyriakos Souliotis</name></author><author><name sortKey="Kyriopoulos, Ioannis" sort="Kyriopoulos, Ioannis" uniqKey="Kyriopoulos I" first="Ioannis" last="Kyriopoulos">Ioannis Kyriopoulos</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19777112</idno><idno type="pmc">2748181</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748181</idno><idno type="RBID">PMC:2748181</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000464</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000464</idno><idno type="wicri:Area/Pmc/Curation">000464</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000464</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review</title><author><name sortKey="Lionis, Christos" sort="Lionis, Christos" uniqKey="Lionis C" first="Christos" last="Lionis">Christos Lionis</name></author><author><name sortKey="Symvoulakis, Emmanouil K" sort="Symvoulakis, Emmanouil K" uniqKey="Symvoulakis E" first="Emmanouil K" last="Symvoulakis">Emmanouil K. Symvoulakis</name></author><author><name sortKey="Markaki, Adelais" sort="Markaki, Adelais" uniqKey="Markaki A" first="Adelais" last="Markaki">Adelais Markaki</name></author><author><name sortKey="Vardavas, Constantine" sort="Vardavas, Constantine" uniqKey="Vardavas C" first="Constantine" last="Vardavas">Constantine Vardavas</name></author><author><name sortKey="Papadakaki, Maria" sort="Papadakaki, Maria" uniqKey="Papadakaki M" first="Maria" last="Papadakaki">Maria Papadakaki</name></author><author><name sortKey="Daniilidou, Natasa" sort="Daniilidou, Natasa" uniqKey="Daniilidou N" first="Natasa" last="Daniilidou">Natasa Daniilidou</name></author><author><name sortKey="Souliotis, Kyriakos" sort="Souliotis, Kyriakos" uniqKey="Souliotis K" first="Kyriakos" last="Souliotis">Kyriakos Souliotis</name></author><author><name sortKey="Kyriopoulos, Ioannis" sort="Kyriopoulos, Ioannis" uniqKey="Kyriopoulos I" first="Ioannis" last="Kyriopoulos">Ioannis Kyriopoulos</name></author></analytic><series><title level="j">International Journal of Integrated Care</title><idno type="eISSN">1568-4156</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>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.</p></sec><sec id="st2"><title>Purpose</title><p>This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country.</p></sec><sec id="st3"><title>Methods</title><p>A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care.</p></sec><sec id="st4"><title>Results</title><p>Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care.</p></sec><sec id="st5"><title>Conclusion</title><p>Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Integr Care</journal-id><journal-id journal-id-type="publisher-id">IJIC</journal-id><journal-title-group><journal-title>International Journal of Integrated Care</journal-title></journal-title-group><issn pub-type="epub">1568-4156</issn><publisher><publisher-name>Igitur, Utrecht Publishing & Archiving</publisher-name><publisher-loc>Utrecht, The Netherlands</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19777112</article-id><article-id pub-id-type="pmc">2748181</article-id><article-id pub-id-type="publisher-id">ijic200988</article-id><article-categories><subj-group subj-group-type="heading"><subject>Policy</subject></subj-group><series-title>Special series: Integrated primary health care</series-title></article-categories><title-group><article-title>Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lionis</surname><given-names>Christos</given-names></name><degrees>MD, PhD, HonFRCGP</degrees><role>Associate Professor, Head of the Clinic of Social and Family Medicine</role><aff>School of Medicine, University of Crete, 71003 Heraklion, Crete, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Symvoulakis</surname><given-names>Emmanouil K</given-names></name><degrees>MD, PhD</degrees><aff>Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Crete, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Markaki</surname><given-names>Adelais</given-names></name><degrees>RN, PhD</degrees><role>Clinical Specialist Community Health Nursing</role><aff>Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Crete, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Vardavas</surname><given-names>Constantine</given-names></name><degrees>RN, MPH</degrees><aff>Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Crete, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Papadakaki</surname><given-names>Maria</given-names></name><role>Social Worker, MPH</role><aff>Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Crete, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Daniilidou</surname><given-names>Natasa</given-names></name><role>Scientific Collaborator</role><aff>Health Economics Division, National School of Public Health, 196 Alexandras Avenue, 11521 Athens, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Souliotis</surname><given-names>Kyriakos</given-names></name><role>Scientific Collaborator</role><aff>Health Economics Division, National School of Public Health, 196 Alexandras Avenue, 11521 Athens, Greece</aff></contrib><contrib contrib-type="author"><name><surname>Kyriopoulos</surname><given-names>Ioannis</given-names></name><role>Professor of Health Economics</role><aff>National School of Public Health, 196 Alexandras Avenue, 11521 Athens, Greece</aff></contrib></contrib-group><author-notes><corresp id="cor1">Correspondence to: Christos Lionis, Head of the Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Crete, Greece, Phone: +30-2810-394621, Fax: +30-2810-394606, E-mail: <email>lionis@galinos.med.uoc.gr</email></corresp></author-notes><pub-date pub-type="collection"><season>Jul-Sep</season><year>2009</year></pub-date><pub-date pub-type="epub"><day>30</day><month>7</month><year>2009</year></pub-date><volume>9</volume><elocation-id>e88</elocation-id><history><date date-type="received"><day>10</day><month>10</month><year>2008</year></date><date date-type="rev-recd"><day>25</day><month>4</month><year>2009</year></date><date date-type="accepted"><day>18</day><month>5</month><year>2009</year></date></history><permissions><copyright-statement>Copyright 2009, International Journal of Integrated Care (IJIC)</copyright-statement><copyright-year>2009</copyright-year></permissions><abstract><sec id="st1"><title>Background</title><p>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.</p></sec><sec id="st2"><title>Purpose</title><p>This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country.</p></sec><sec id="st3"><title>Methods</title><p>A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care.</p></sec><sec id="st4"><title>Results</title><p>Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care.</p></sec><sec id="st5"><title>Conclusion</title><p>Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>integrated care</kwd><kwd>continuity</kwd><kwd>primary health care</kwd><kwd>policy</kwd><kwd>Greece</kwd></kwd-group></article-meta></front><floats-group><fig id="fg001" position="float"><label>Figure 1</label><caption><p>Literature search and strategy outcomes.</p></caption><graphic xlink:href="ijic2009-200988-001"></graphic></fig><table-wrap id="tb001" position="float"><label>Table 1</label><caption><p>Electronic search literature review results (PUBMED and SCOPUS)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Authors</th><th valign="top" align="left" rowspan="1" colspan="1">Publication year</th><th valign="top" align="left" rowspan="1" colspan="1">Journal origin</th><th valign="top" align="left" rowspan="1" colspan="1">Level of integration (according to Delnoj et al., 2001)</th><th valign="top" align="left" rowspan="1" colspan="1">Level of outcome change (according to Grol and Grimshaw, 2003)</th><th valign="top" align="left" rowspan="1" colspan="1">Study topic</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Chatziarsenis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">1999</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Specific actions should be undertaken at a local level, including implementation of promotional and educational programs, and actions to assess population's perceptions and expectations.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Grammatikou et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2000</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Discusses a pilot technological implementation in progress towards a PHC workflow model.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lionis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2001</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Reports on the need for better education and training of primary care physicians in Crete regarding early diagnosis and management of Alzheimer's disease.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lappas</td><td valign="top" align="left" rowspan="1" colspan="1">2002</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">How to ensure that the information management process provides a mechanism to measure and manage any health enterprise through the use of e-technology and telemedicine.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Tountas et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2002</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Reports on reform priorities including decentralization, improvement of social insurance financing system, development of urban primary care units and changes to hospital management.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Zavras et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2002</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Development of a national health care chart, matching available resources to the population health care needs.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Anogiianakis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2003</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Reports on a prison telemedicine pilot project and its potential to improve and streamline the quality of care available to prisoners.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Malamateniou et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2003</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Presents a virtual patient record framework that allows integrating geographically—dispersed medical information.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Souliotis and Lionis</td><td valign="top" align="left" rowspan="1" colspan="1">2003</td><td valign="top" align="left" rowspan="1" colspan="1">National</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Proposes certain structural reforms for better functioning of primary care services.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lionis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2004</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Promoting actions for implementing clinical governance and quality programs in a rural PHC setting in Crete.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Orphanoudakis</td><td valign="top" align="left" rowspan="1" colspan="1">2004</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Discusses challenges encountered in developing a regional health information network in Crete.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Souliotis and Lionis</td><td valign="top" align="left" rowspan="1" colspan="1">2005</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">A proposal for an integrated PHC system in Greece.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Belos et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2005</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Presents gained teaching experiences of practice-based primary care in rural Crete.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Vivilaki et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2005</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Describes educational pathways and midwives' role in increasing women's compliance rate in cervical screening programs.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Bellali and Kalafati</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Explores needs and the role of mental health nursing specialty in Greece towards mental health reform.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Maglavera et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Describes pathways to support a continuous home monitoring service aiming at reduction of hospitalization rates and improvement of healthcare delivery.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Markaki et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Educational background of PHC nursing staff has little effect in practice role variations and professional needs.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mitropoulos et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Describes the necessity of national strategic planning to ensure better use of available resources through the use of applied scientific approaches for resource allocation.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Panagopoulou et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">A project illustrating integration of communication, clinical and research skills in medical education.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pappa and Niakas</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Describes potential implications towards proper allocation of scarce health resources.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Chronaki et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Underlines the need for continuous training, incentives, and awareness initiatives to increase the use of electronic health records.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Eustathiou et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Describes the need to employ nurses to assist primary care, home care, day care and palliative care services.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Katechakis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Supports implementation of evidence-based medicine through the use of e-health records.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Markaki et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Assesses professional development needs of nursing staff in Greek primary care settings.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pierrakos and Yfantopoulos</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">National</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Reports on patients' dissatisfaction with rural primary care services.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kastania</td><td valign="top" align="left" rowspan="1" colspan="1">2008</td><td valign="top" align="left" rowspan="1" colspan="1">International</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Explores pathways to build integrated PHC telemedicine services.</td></tr></tbody></table></table-wrap><table-wrap id="tb002" position="float"><label>Table 2</label><caption><p>Hand search literature review results (4 Greek journals)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Authors</th><th valign="top" align="left" rowspan="1" colspan="1">Publication year</th><th valign="top" align="left" rowspan="1" colspan="1">Journal origin</th><th valign="top" align="left" rowspan="1" colspan="1">Level of integration (according to Delnoj et al., 2001)</th><th valign="top" align="left" rowspan="1" colspan="1">Level of outcome change (according to Grol and Grimshaw, 2003)</th><th valign="top" align="left" rowspan="1" colspan="1">Study topic</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Kalokerinou and Lamprou</td><td valign="top" align="left" rowspan="1" colspan="1">2000</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Need for establishment of family nursing—definition, implementation, implications for PHC in Greece.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kyriopoulos and Lionis</td><td valign="top" align="left" rowspan="1" colspan="1">2000</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">The role and impact of GPs in high quality PHC—the use of open care networks.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kyriopoulos et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2000</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Analysis of shortcomings of Greek NHS and recommendations for restructuring with emphasis on PHC and establishment of open care networks.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lionis and Merkouris</td><td valign="top" align="left" rowspan="1" colspan="1">2001</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Recommendations for the establishment of GP/Family Medicine in order to increase effectiveness and comprehensiveness of PHC.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Priami</td><td valign="top" align="left" rowspan="1" colspan="1">2001</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Community mental health nurse—definition, role, implications for PHC.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Zafiropoulou</td><td valign="top" align="left" rowspan="1" colspan="1">2001</td><td valign="top" align="left" rowspan="1" colspan="1">Koinoniki Ergasia</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">The use of a jigsaw model for inter-professional teamwork within a home care program for cancer sufferers.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Douka</td><td valign="top" align="left" rowspan="1" colspan="1">2002</td><td valign="top" align="left" rowspan="1" colspan="1">Koinoniki Ergasia</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Weaknesses and problems faced by Greek PHC and the need for introducing family physicians, developing collaboration with community services and promoting inter-professional dialogue and health care teams.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Koutis and Fiolitakis</td><td valign="top" align="left" rowspan="1" colspan="1">2002</td><td valign="top" align="left" rowspan="1" colspan="1">Iatriki</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Development of a social demography database and a database of unmet health/social care needs for a Cretan population. Community as an ideal environment for primary prevention and social care programs.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kritsotakis</td><td valign="top" align="left" rowspan="1" colspan="1">2002</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">The concept of community participation in relation to PHC and its use in models of health promotion.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kavoura et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2003</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Identification of quantitative and qualitative needs for nursing personnel to achieve optimal coverage in PHC.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Thireos et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2003</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Cooperation and interrelation of staff in PHC centers in Attika.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Tsirintani and Binioris</td><td valign="top" align="left" rowspan="1" colspan="1">2003</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Development of contemporary strategic planning in Greece—nurses' new roles within regional health systems.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kotzabassaki</td><td valign="top" align="left" rowspan="1" colspan="1">2004</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Nursing education in Greece—current developments, future changes, perspectives (orientation in PHC, autonomy in nursing practice, culturally diverse populations, multi-professional teams, research involvement).</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pournaras et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2004</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Educational needs of student nurses in regards to transcultural care. Greek nursing education lacks cultural sensitivity and exposure.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pilli et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2005</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Exploration of interdisciplinary collaboration in PHC centers in Greece.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Stilianidis and Zisi</td><td valign="top" align="left" rowspan="1" colspan="1">2005</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">A pilot project providing training of PHC practitioners on psychiatry—experiences from a Mobile Unit in NE Cyclades.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kolovos and Sourtzi</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Priority setting in planning health care services—allocation based on priorities.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pierrakos et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Training needs and vocational training of human resources in the health sector.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Sarris et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Evaluation of training centers within the health sector.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Vivilaki et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Community postnatal care led and delivered by midwives enhances quality of services offered at a community level.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lonis and Markaki</td><td valign="top" align="left" rowspan="1" colspan="1">2006</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">The new role of nurses in PHC mandated by international developments—Greek realities.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kolovos and Sourtzi</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">Nosileftiki</td><td valign="top" align="left" rowspan="1" colspan="1">Organizational</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Impact of citizen participation in decision-making process, planning, delivery of care is still minimal.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kounalakis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="left" rowspan="1" colspan="1">Creation, application, evaluation of an electronic pt. records system suitable for PHC in Greece—experiences from a study in Crete.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mariolis et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Health needs assessment in special areas—the paradigm of Mani. An extended PHC network is recommended to improve services.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Tsiantou et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2007</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Description and role of open maintenance networks operating in the UK and Canada. Potential for implementation of such networks in Greece with the contribution of local authorities.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Markaki et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2008</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Clinical</td><td valign="top" align="left" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="left" rowspan="1" colspan="1">Job description and professional development needs assessment of nursing staff in rural PHC Centers.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kommatas et al.</td><td valign="top" align="left" rowspan="1" colspan="1">2008</td><td valign="top" align="left" rowspan="1" colspan="1">PFY</td><td valign="top" align="left" rowspan="1" colspan="1">Functional</td><td valign="top" align="left" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="left" rowspan="1" colspan="1">Need for modernization of NHS to respond to consumer demands—response from Ministry of Health through a public consultation process to formulate legislation integrating PHC services.</td></tr></tbody></table></table-wrap><table-wrap id="tb003" position="float"><label>Table 3</label><caption><p>Classification of articles by level and type of integration (n=53)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="center" rowspan="1" colspan="1">Level of integration (according to Delnoj et al., 2001)</th><th valign="top" align="center" rowspan="1" colspan="1">Number of studies/ literature reviews</th><th valign="top" align="center" rowspan="1" colspan="1">Type of integration (vertical vs. horizontal)</th><th valign="top" align="center" rowspan="1" colspan="1">Conclusions</th></tr></thead><tbody><tr><td valign="top" align="center" rowspan="1" colspan="1">Functional</td><td valign="top" align="center" rowspan="1" colspan="1"> 8</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (1) Horizontal (7)</td><td valign="top" align="center" rowspan="4" colspan="1">Primary emphasis of interventions at a micro level, followed by interventions at a meso level. A total of 36 studies/reviews on vertical (targeted) integration and 17 on horizontal (comprehensive) integration.</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Organizational</td><td valign="top" align="center" rowspan="1" colspan="1">16</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (11)<break></break> Horizontal (5)</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Professional</td><td valign="top" align="center" rowspan="1" colspan="1"> 9</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (6)<break></break> Horizontal (3)</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Clinical</td><td valign="top" align="center" rowspan="1" colspan="1">20</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (18)<break></break> Horizontal (2)</td></tr></tbody></table></table-wrap><table-wrap id="tb004" position="float"><label>Table 4</label><caption><p>Classification of articles by level of outcome change (n=53)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="center" rowspan="1" colspan="1">Level of outcome change (according to Grol and Grimshaw, 2003)</th><th valign="top" align="center" rowspan="1" colspan="1">Number of studies/ literature reviews</th><th valign="top" align="center" rowspan="1" colspan="1">Type of integration (vertical vs. horizontal)</th><th valign="top" align="center" rowspan="1" colspan="1">Conclusions</th></tr></thead><tbody><tr><td valign="top" align="center" rowspan="1" colspan="1">Hospital/Health Center</td><td valign="top" align="center" rowspan="1" colspan="1">22</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (8)<break></break> Horizontal (14)</td><td valign="top" align="center" rowspan="1" colspan="1">Focus of implementation on resources/organization.</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Team/Unit</td><td valign="top" align="center" rowspan="1" colspan="1">17</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (15)<break></break> Horizontal (2)</td><td valign="top" align="center" rowspan="1" colspan="1">Focus of implementation on social influence and leadership.</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">Individual/Professional</td><td valign="top" align="center" rowspan="1" colspan="1">14</td><td valign="top" align="center" rowspan="1" colspan="1">Vertical (12)<break></break> Horizontal (2)</td><td valign="top" align="center" rowspan="1" colspan="1">Focus of implementation on attitudes, motivation, routines and cognition.</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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