| Abstract |
INTRODUCTION: Primary health care (PHC) is a key component of all health systems. The absence of operational integration of PHC units is a major issue in the case of Greece. Particularly during austerity times, there is a clear need for structural changes that will lead to reduction of health costs and effectiveness of the health system. This project aims to assess the current status of integration levels of PHC units in Greece, as they are provided in the 3rd and 4th Local Health Unit (TO.M.Y) of Heraklion, Crete, in the context of comprehensive care with the use of common processes and quality standards.
METHODS: A literature review were conducted in three scientific databases (Pub Med, Cochrane Library, Google Scholar) jointly with desk research to find Greek programmes or studies aiming to operational integration of PHC units. No studies were found apart from two projects: one nationally funded (NSRF, MIS 337 424 OP "Administrative Reform 2007-2013", Social Medicine Clinic of the University of Crete) and a European FP7 project entitled QUALICOPC (Quality and costs of Primary Care in Europe). A synthesis of QUALICOPC project outcomes into the main results of the NSRF project was attempted. The identified theoretical framework from the literature review was the one by Kringos et al. (2010), which combines the fundamental PHC principles of B. Starfield and the Chronic Disease Management model. The main evaluation tool was the «Primary Care Assessment Tool (PCAT) - Short Version». Τhe 3rd and 4th Local Health Units (TO.M.Y - Primary Health Care structure) of Heraklion, Crete participated in the study. In each unit, a PCAT questionnaire, along with additional questionnaires for services rendered by reason for encounter across the four most frequent categories were completed: chronic diseases, emergencies, prevention, and home services. The sample was collected via purposive sampling method in both cases (coordinators and TOMY’s beneficiaries). Regarding the coordinators, the sample consists of one representative of each TOMY. The number of beneficiaries required was 160 individuals in total. More specifically, there were participated 20 patients for each case type (in total: four case types) for each TOMY. Therefore, 80 individuals participated at TOMY A and 80 at TOMY B. Collected data were analyzed with the help of an algorithm that gave different mathematical weights and integrated the Kringos et al. (2010) dimensions with their characteristics and each item of the questionnaire. A 5-point Likert-scale reflected the final assessment, grouping the PHC units based on their integration levels, as follows: absent, poor, basic, medium and maximum integration.
RESULTS: The overall assessment of the operational integration levels of To.M.Y. in Heraklion, Crete reveals that no unit showed a maximum or minimum operational integration. Instead, levels range between basic (48%) and partial (47%) integration. Only (5%) of the units were valued with poor integration. From the results for the ten PHC elements according to the selected theoretical model, it became clear that "economic conditions" and "quality of services" can be further improved. On the contrary, a higher score was observed for "continuity in the provision of health care", as well as "access to PHC services". Evaluation of integration in regards to reason for encounter and specifically, to chronic diseases was basic (86%) and poor (14%). Respectively, integration level for urgent or acute cases was poor (78%) and basic (22%). Finally, for home care and prevention, integration was basic (50%) and partial (50%). CONCLUSIONS: Evaluation of PHC levels and characteristics can significantly contribute to improvement of the PHC in Greece and specifically in the newly established structures, such as TOMY. Planning of a new PHC system with high quality and efficiency that focuses on person-centered care is considered necessary. This will be achieved through motivation of health care users and an interdisciplinary approach to care. Finally, targeted actions can improve the level of operational integration in terms of the quality of provided services, as well as enhance the effectiveness of PHC structures.
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