Arch Hellen Med, 34(3), May-June 2017, 343-362
Operational integration of primary health care units in Greece:
M. Karagianni, D. Sifaki-Pistolla, V.E. Chatzea, M. Trigoni, A. Ko utis, E. Petelos, C. Lionis
OBJECTIVE Description of the degree of integration across primary health care (PHC) services in Greece, in the context of providing integrated care through the implementation of unified processes and quality standards.
METHOD The study was conducted in the framework of a national program funded under the National Strategic Reference Framework (NSRF) in the operational program "Administrative reform 2007–2013", with the title "Operational integration of PHC units") and the Monitoring Information System (MIS) code no 337424. The study design was embedded in a theoretical framework covering three levels and 10 dimensions of PHC. The study sample consisted of 124 PHC units throughout Greece, selected by stratified random sampling. Two evaluation instruments were used to assess the degree of integration and the quality of the healthcare services provided: The validated questionnaire Primary Care Assessment Tool (PCAT) – short Version of the Primary Care Policy Center for Underserved Populations, Johns Hopkins University, and a questionnaire developed for this study by the project research team, based on synthesis and selection of domains from other standard questionnaires. The data were collected and analyzed using a five point Likert scale (1: minimal, 2: poor, 3: basic, 4: partial, 5: maximum) and a multi-criteria decision algorithm.
RESULTS The overall rating of integration for the majority of the PHC units ranged between 3 and 4 (i.e., basic to partial), while a small percentage (5%) were rated as 2 (poorly integrated). Regarding specific PHC dimensions, "Continuity of Health Care" was reported to have a higher degree of integration, with 80% of the PHC units being rated as 4 or 5 (i.e., partial to maximum integration levels). Conversely, the dimensions that were identified as requiring significant improvement were "Economic Conditions of the PHC system" and the "Service Quality of PHC". In the majority of the units, the rating regarding economic conditions was evaluated below the basic level, with 73% rated as having poor integration in terms of the "remuneration system of PHC workforce".
CONCLUSIONS In terms of the degree of integration of care, a high degree of heterogeneity was identified across PHC services in Greece. The implementation of targeted actions could effect improvement in the quality of services provided and in the degree of operational integration, thus enhancing their effectiveness.
Key words: Continuity of patient care, Coordination, Operational integration, Primary health care, Quality of health care.