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| Identifier |
000350425 |
| Title |
Πρωτοβάθμια φροντίδα υγείας και γενική ιατρική στην Κύπρο : ανάλυση της υφιστάμενης κατάστασης και σχεδιασμός μίας πιλοτικής παρέμβασης σε αγροτικές και αστικές περιοχές στην ευρύτερη περιοχή της Λευκωσίας |
| Alternative Title |
Primary health care and general practice in Cyprus : describing the current situation and designing a pilot intervention in urban and rural areas in the district of Nicosia |
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Author
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Ζαχαριάδου, Θεοδώρα
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Thesis advisor
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Λιονής, Χρήστος
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Reviewer
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Φιλαλήθης, Αναστάσιος
Καφάτος, Αντώνιος
Βάρδας, Παναγιώτης
Τσιφτσής, Δημήτριος
Σιαφάκας, Νικόλαος
Κογεβίνας, Εμμανουήλ
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| Abstract |
Background: The role and effectiveness of General Practise/
Family Medicine has been under a lot of discussion in the
literature. In Cyprus, a new National Health System will soon
be introduced. In the context of this reform a collaboration
agreement was signed between the Ministry of Health of Cyprus
and the Clinic of Social and Family Medicine of the University
of Crete. This dissertation was part of the aforementioned
collaboration.
Aim: The aim of this thesis is to describe the current situation
in the primary healthcare of Cyprus and to design a pilot
intervention in rural and urban areas in the district of Nicosia.
The objectives were the following:
1) To determine the most common chronic conditions that
General Practitioners (GPs) manage in the primary health care
of Cyprus.
2) To examine whether the management of patients with
selected chronic conditions follows international guidelines.
3) To examine whether the use of European standardised tools
(SCORE risk model) can be implemented in the primary
healthcare of Cyprus in order to identify high risk patients.
4) To describe the contents of a pilot intervention that can be
implemented in the primary healthcare setting of Cyprus in
order to improve the quality of the delivered health services.
Subjects and methods: The thesis was performed in four
Primary Care Health Centres (PCHCs), [two urban and two
rural] in Nicosia area using specific selection criteria. At first, a
pilot study was performed in 2,754 patients in order to
determine the most common chronic conditions that GPs
manage in the primary healthcare. The ten GPs filled in a
questionnaire for every patient who visited the four PCHCs for
eleven consecutive working days which included the
demographic characteristics of the patients, the reason for
encounter, diagnosis, and treatment. From a total of 4,633 of
patients with one or more of from the three most common
conditions identified in the pilot study, we randomly selected
1,140 medical files using specific selection criteria. We
examined the management of those patients during one year
according to international guidelines using the most recent
values of Blood Pressure (BP) and lipids recorded in the medical
files. In order to collect unregistered information in the medical
records (smoking habits) a telephone survey was performed by
the ten trained nurses in the four PCHCs. The SCORE risk
function for high-risk regions was used to calculate 10-year risk
of cardiovascular fatal event. The results of the above studies
were used for the design of a pilot intervention in the primary
healthcare setting of Cyprus.
Results: The three most common chronic conditions identified
from the pilot study were: Hypertension (40.6%), Type 2
Diabetes Mellitus [DM2] (14.8%) and Hyperlipidemia (10.5%).
Chart review of the selected patients identified 26.8% of the
patients with DM2, 79.5% with hypertension and 38.8% with
hyperlipidemia. The goal of glycated Hemoglobin (HbA1c) <
7% was achieved in 38.7% of patients with DM2, whereas total
cholesterol (TC) target < 200 mg/dl and LDL-C goal < 100
mg/dl were achieved in 36.1% and 20.7% of diabetic patients
respectively. The target of LDL-C < 100 mg/dl was achieved in
28.6% of patients with cardiovascular disease. BP goal of <
130/80 mmHg and < 140/90 mmHg was reached in 7.5% and
54.0% of patients with DM2 and without diabetes respectively.
The use of SCORE risk chart labelled overall 39.9% of the study
population as high risk individuals (10 year risk ≥ 5%) for fatal
cardiovascular event.
Diabetic patients had statistically significant lower mean values
of ΤC και LDL-C as compared to non diabetic patients (TC 214
vs 225 mg/dl, p= 0.009, LDL-C 127 vs 137 mg/dl, p= 0.026)
whereas mean systolic blood pressure (SBP) and mean
triglyceride (TG) values were significantly higher (SBP 137 vs
134 mmHg, p= 0.006, TG 205 vs 173 mg/dl, p= 0.003).
Conclusion: This thesis described morbidity and co morbidity
patterns in the primary health care setting of Cyprus as well as
the management of patients with chronic conditions by GPs. It
also revealed failures in recording of clinical information in the
medical files with regard to personal and family history as well
as documentation of blood tests results. Our study demonstrated
suboptimal control and under-treatment of cardiovascular risk
factors in the primary healthcare in Cyprus. Prior to the
introduction of a new national health system we propose the
implementation of a pilot intervention in an urban and rural
population of 18 months duration including guideline use for the
management of patients with selected chronic diseases and
introduction of an electronic patient record system.
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| Physical description |
134 σ. : πιν. ; 30 εκ. |
| Language |
Greek, English |
| Subject |
Cyprus |
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Delivery of Health Care |
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Helath Services |
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Primary Health Care |
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Public Health |
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Quality of Health Care |
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Δημόσια υγεία |
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Κύπρος |
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Παροχή υπηρεσιών υγείας |
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Ποιότητα φροντίδας υγείας |
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Πρωτοβάθμια φροντίδα υγείας |
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Υπηρεσίες υγείας |
| Issue date |
2008-04-03 |
| Collection
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School/Department--School of Medicine--Department of Medicine--Doctoral theses
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Type of Work--Doctoral theses
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| Views |
498 |
Πρωτοβάθμια φροντίδα υγείας και γενική ιατρική στην Κύπρο : ανάλυση της υφιστάμενης κατάστασης και σχεδιασμός μίας πιλοτικής παρέμβασης σε αγροτικές και αστικές περιοχές στην ευρύτερη περιοχή της Λευκωσίας
