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      Integrated people-centred primary health care in Greece: unravelling Ariadne’s thread

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          Abstract

          The 40th anniversary of the World Health Organization Alma-Ata Declaration in Astana offered the impetus to discuss the extent to which integrated primary health care (PHC) has been successfully implemented and its impact on research and practice. This paper focuses on the experiences from Greece in implementing primary health care reform and lessons learned from the conduct of evidence-based research. It critically examines what appears to be impeding the effective implementation of integrated PHC in a country affected by the financial and refugee crisis. The key challenges for establishing integrated people-centred primary care include availability of family physicians, information and communication technology, the prevention and management of chronic disease and migrant and refugees’ health. Policy recommendations are formulated to guide the primary health care reform in Greece, while attempting to inform efforts in other countries with similar conditions.

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          The breadth of primary care: a systematic literature review of its core dimensions

          Dionne S. Kringos, Wienke Boerma, Allen Hutchinson … (2010)
          Background Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health.
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            The strength of primary care in Europe: an international comparative study.

            Dionne Sofia Kringos, Wienke Boerma, Yann Bourgueil … (2013)
            A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.
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              Making sense of big data in health research: Towards an EU action plan

              Charles Auffray, Rudi Balling, Inês Barroso … (2016)
              Medicine and healthcare are undergoing profound changes. Whole-genome sequencing and high-resolution imaging technologies are key drivers of this rapid and crucial transformation. Technological innovation combined with automation and miniaturization has triggered an explosion in data production that will soon reach exabyte proportions. How are we going to deal with this exponential increase in data production? The potential of “big data” for improving health is enormous but, at the same time, we face a wide range of challenges to overcome urgently. Europe is very proud of its cultural diversity; however, exploitation of the data made available through advances in genomic medicine, imaging, and a wide range of mobile health applications or connected devices is hampered by numerous historical, technical, legal, and political barriers. European health systems and databases are diverse and fragmented. There is a lack of harmonization of data formats, processing, analysis, and data transfer, which leads to incompatibilities and lost opportunities. Legal frameworks for data sharing are evolving. Clinicians, researchers, and citizens need improved methods, tools, and training to generate, analyze, and query data effectively. Addressing these barriers will contribute to creating the European Single Market for health, which will improve health and healthcare for all Europeans.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Prim Health Care Res Dev
                Journal ID (iso-abbrev): Prim Health Care Res Dev
                Journal ID (publisher-id): PHC
                Title: Primary Health Care Research & Development
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 1463-4236
                ISSN (Electronic): 1477-1128
                Publication date Collection: 2019
                Publication date (Electronic): 25 July 2019
                Volume: 20
                Electronic Location Identifier: e113
                Affiliations
                [1 ]Department of Social Medicine, Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete , Heraklion, Greece
                [2 ]Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden
                [3 ]Department of Family, Community and Health Systems, WHO Collaborating Center for International Nursing, School of Nursing, University of Alabama at Birmingham , Birmingham, AL, USA
                [4 ]Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, University of Maastricht , Maastricht, Netherlands
                [5 ]Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, ON, Canada
                [6 ]Faculty of Medicine, University of Ottawa , Ottawa, ON, Canada
                [7 ]Department of Social Work, Technological Educational Institute of Crete , Heraklion, Greece
                [8 ]Faculty of Social and Political Sciences, University of Peloponnese , Corinth, Greece
                [9 ]Reseach Institute, Melabev and Hebrew University , Jerusalem, Israel
                Author notes
                Author for correspondence: Christos Lionis, Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Heraklion, Crete, Greece. Email: lionis@ 123456galinos.med.uoc.gr
                Author information
                https://orcid.org/0000-0002-9324-2839
                https://orcid.org/0000-0002-2038-3139
                Article
                Publisher ID: 00044 Publisher Item ID: S1463423619000446
                DOI: 10.1017/S1463423619000446
                PMC ID: 6683235
                PubMed ID: 31668150
                SO-VID: 78fc1b5b-ab45-4f63-9e53-bacec980ae5d
                Copyright © © The Author(s) 2019
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 September 2018
                Date revision received : 22 January 2019
                Date accepted : 08 May 2019
                Page count
                References: 46, Pages: 7
                Categories
                Subject: Development

                Keywords: greece,integrated,multidisciplinary,people-centred care,primary care,primary health care
                Data availability:
                Keywords: greece, integrated, multidisciplinary, people-centred care, primary care, primary health care

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