Sbarouni V, Tsimtsiou Z, Symvoulakis E, Kamekis A, Petelos E, Saridaki A, Papadakis N, Lionis C
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece.
Rural Remote Health. 2012;12:2156. Epub 2012 Oct 22.
Greece is striving to limit its health expenditure to essential needs. General practice and the provision of Primary Health Care (PHC) mainly take place in rural settings, where approximately 200 Primary Health Care Centres (PHCCs) have been established. In order to determine how to optimize the effectiveness and efficiency of PHC services, it is important to first gain insights into the providers' perspectives. The aim of the study was to assess the perceptions of General Practitioners (GPs) and the directors of PHCCs regarding the effectiveness of available PHC services, and to elicit suggestions on how current services could be improved.
This qualitative study was based on semi-structured interviews. The setting was 21 PHCCs in the Epirus and Crete regions of Greece. Twenty-nine physicians were interviewed on aspects of capacity, resources, performance and quality of PHC services. Discussions were digitally recorded and transcribed verbatim. The transcriptions were then analysed using thematic content analysis.
The main identified barriers to providing high-quality PHC services were: PHC service shortages in workforce and equipment; inadequate GP and paramedic training; the absence of position/job descriptions or duty statements for GPs and other PHC personnel; and limited public awareness about the role of GPs. Suggestions for remodelling the current PHC system included: the introduction of new technologies; GP empowerment; leadership reforms; and mechanisms for evaluating of the quality of services. Finally, areas of concern regarding future development and utilisation of private PHC infrastructure and services were highlighted.
The methodology of this study and the results regarding remodelling the current PHC system could be used to inform policy-making in Greece, particularly in the current period of severe economic crisis; they may also be of relevance to other European countries facing similar challenges in allocating resources and reforming PHC.
希腊正努力将其医疗支出限制在基本需求范围内。全科医疗和初级卫生保健服务主要在农村地区开展，当地已设立了约200个初级卫生保健中心（PHCCs）。为了确定如何优化初级卫生保健服务的有效性和效率，首先了解提供者的观点很重要。本研究的目的是评估全科医生（GPs）和初级卫生保健中心主任对现有初级卫生保健服务有效性的看法，并就如何改进当前服务征求建议。
本定性研究基于半结构化访谈。研究地点为希腊伊庇鲁斯和克里特地区的21个初级卫生保健中心。对29名医生就初级卫生保健服务的能力、资源、绩效和质量等方面进行了访谈。讨论内容进行了数字录音并逐字转录。然后使用主题内容分析法对转录内容进行分析。
确定的提供高质量初级卫生保健服务的主要障碍包括：初级卫生保健服务在劳动力和设备方面短缺；全科医生和护理人员培训不足；缺乏全科医生和其他初级卫生保健人员的职位/工作描述或职责说明；以及公众对全科医生作用的认识有限。重塑当前初级卫生保健系统的建议包括：引入新技术；赋予全科医生权力；领导力改革；以及服务质量评估机制。最后，强调了对私人初级卫生保健基础设施和服务未来发展及利用的关注领域。
本研究的方法以及关于重塑当前初级卫生保健系统的结果可用于为希腊的政策制定提供信息，特别是在当前严重经济危机时期；它们可能也与其他在资源分配和初级卫生保健改革方面面临类似挑战的欧洲国家相关。
