Measuring patient satisfaction in oncology units: interview-based psychometric validation of the 'Comprehensive Assessment of Satisfaction with Care' in Greece.

The aim of this study is to validate the 'Comprehensive Assessment of Satisfaction with Care' (CASC) in Greece. A total of 84 cancer inpatients met the inclusion criteria. Of them, 32 (38%) refused to participate, leading to a 62% response rate. For the translation of the scale, we followed the European Social Survey procedures encompassing four stages. Interview-based administration was chosen in order to obtain more reliable results in terms of time of assessment, response rate and data omission. Multitrait scaling analyses along with construct, scale-discriminant validity and reliability tests were carried out to establish the Greek version of CASC. Scales on doctors' technical skills, care organization and general satisfaction were in support of the European structure. In general, Doctors' scales had the anticipated structures. Most variations were noticed in the Nurses' scales, leading to a revised item-scale formation, and may reflect different importance patients attribute to various aspects of health care in different countries. Greek version of CASC may be a practical, valid and reliable tool for assessing patient satisfaction in oncology settings. Cross-cultural validation of the existing tools is necessary to enable comparison between various countries and settings. Interview-based administration should be considered when validating patient satisfaction instruments.

Measuring the prevalence of diabetes mellitus in a Greek primary health care district.

BACKGROUND: Diabetes mellitus is a common disease in developed countries, but in Greece national figures on its prevalence are lacking. OBJECTIVES: The aim of this study was to identify the burden of known diabetes mellitus through its estimation in the area of responsibility of the Spili Health Centre, based on the health information system that had been established in Primary Health Care in rural Crete. METHOD: The diagnosis of diabetes was retrospectively documented by reviewing all medical records (n = 47151) at the Spili Health Centre and its five regional outposts during the period 1/6/1988-1/7/1993. The diagnostic criteria of WHO were used to establish the diagnosis. RESULTS: After excluding the patients who had died, we found 210 patients with diabetes mellitus. Thirty cases were evaluated with OGTT because of mild but not diagnostic elevations of fasting plasma glucose, on more than one occasion. The prevalence of diabetes after age and sex standardization of that for the European population was estimated at 1.52% (1.31% in males and 1.68 in females). CONCLUSIONS: Our study shows that: 1) the role of the GPs and one appropriate information system in measuring the prevalence of known diabetes mellitus are now considered important within the Greek context; 2) diabetes mellitus seems not to be a rare disease in rural Crete. The estimated prevalence appears to be similar to the prevalence rates reported in other areas of rural Greece.

Mortality rates in a cardiovascular 'low-risk' population in rural Crete.

A research project in primary health care has been in progress since 1988 in an agricultural area of Crete, with the aim of surveying the cardiovascular risk profile and following the incidence of cardiovascular disease in the population over time. In the present paper we have investigated the mortality rates and the causes of death in 1989 and 1990 of the population of the Agios Vassilios county (n = 7758). Furthermore, whenever possible, we have checked the accuracy of the certified causes of death against the case record system introduced in 1988 in the health centre. During 1989 and 1990, 267 subjects died in the research area, 234 of whom were > 65 years old. Diseases of the circulatory system (mostly congestive heart failure) accounted for 46% of all deaths. The corresponding figure for neoplasms was 18%. The standardized mortality from ischaemic heart disease was found to be very low in both men and women, 37.9 and 41.9 per 100,000 per year, respectively, in comparison with that of Greece as a whole in 1989, 140.0 and 59.5, respectively. These figures were considerably lower than those reported in 1988 from for example Sweden, 303.6 and 153.3, respectively. The standardized mortality from cerebrovascular disease in Agios Vassilios county was found to be somewhat lower than the national figures in 1989, 118.1 and 107.0 in males and females versus 135.7 and 142.1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiographic signs of coronary heart disease in a "low risk" population in rural Crete.

BACKGROUND: Ischemic heart disease (IHD) has been shown to be very uncommon in the population of Crete. Therefore, we established a research project in a rural part of Crete to survey the cardiovascular risk profile and follow the incidence of cardiovascular disease over time. This study investigated the prevalence of ECG abnormalities in the population of five villages and compared the prevalence of hypertension, obesity, diabetes, and hypercholesterolemia in those with and without ECG signs of IHD. METHODS: A cross-sectional study was conducted in a group from 15 to 79 years of age (n = 1218); overall attendance was 926 (76%). Studies included case history, clinical status, laboratory variables, and 12-lead ECG. Technically acceptable ECGs were read and coded blindly for 895 subjects (97%). RESULTS: Minnesota codes suggesting "Probable IHD" were recorded in 3.3% of the women and 3.5% of the men from 45 to 79 years of age. Hypertension was more common in subjects with than in those without "Probable IHD." This also tended to be the case for diabetes. Cholesterol and body mass index were relatively high in both groups. CONCLUSIONS: The present prevalence of "Probable IHD" in Cretans appears to be very similar to that observed in other population surveys. Also, the contemporary cardiovascular risk factor profile in the population was quite unfavorable, with a relatively high prevalence of smoking, dyslipidemia, hypertension, and diabetes. The prevalence of "Probable IHD" was lowest in the village where the health center was situated (1% vs 4.5%), and this difference was also reflected in differences among the villages of some important risk factors for IHD as well as in the way patients with hypertension and other diseases were cared for. Thus, it seems IHD is becoming more prevalent in the "low risk" population of Crete. This may very well be a result of a more unfavorable lifestyle and a higher rate of risk factors than before.

Differences in the diagnose panorama in primary health care in Dalby, Sweden and Spili, Crete.

We have compared the use of primary health care and the diagnoses at visits to doctors in the Spili Health Centre (SHC) in Crete and the Dalby Health Centre (DHC) in Sweden. In DHC more patients per 1000 population visited the doctors than in SHC. This was so regardless of age-group and sex, in fact more or less regardless of diagnosis. Other differences between the populations were: The diagnosis acute otitis media was more frequent in the Dalby children than in the Spili ones. The opposite was true of "head injuries" which were more frequent in the Spili boys. Visits to doctors for bronchitis was more frequent in the Spili men, maybe because of the extensive smoking habits of Cretan men. Visits for diseases of the musculoskeletal system were more frequent in DHC than in SHC. A hypothesis worth testing is that this was influenced by differences in the health insurance and sick benefit systems. Angina pectoris was fairly frequent in both areas but cardiosclerosis (including healed myocardial infarction) was more common in DHC than in SHC. Use of primary health care may be influenced by the need for health care in the population, the accessibility of the health care facilities, the costs for the patients, the quality of care as perceived by the patients and by other sociocultural factors. Comparative studies, even though fairly uncommon today, may be of use in generating hypotheses about the impact of different factors on the use of health care.

Characteristics of the 'metabolic syndrome X' in a cardiovascular low risk population in Crete.

We have studied hypertension, obesity, diabetes and hypercholesterolaemia in those aged 45-79 years in the Cretan low risk population of Spili (n = 249; attendance 82%) to see if these conditions interacted in the same way as previously described for high risk populations. Hypertension, diabetes, obesity, and hypercholesterolaemia were found to be at least as prevalent in Spili as in Sweden. Furthermore, the previously described 'Metabolic Syndrome X', with insulin resistance and hyperinsulinaemia as a common denominator also seemed to exist in the Spili population where patients with these conditions had higher insulin and C-peptide levels than normals. Our finding should be viewed against the low prevalence of past myocardial infarction in Cretan men from Spili reported by us and confirming the results of the Seven Countries Study.

Risk factors for ischaemic heart disease in a Greek population. A cross-sectional study of men and women living in the village of Spili in Crete.

We have established a research project in primary health care in Crete with the aim of surveying the cardiovascular risk profile of a defined 'low-risk' population. The study population comprised all men and women aged 15-79 years in the village of Spili (n = 445); the overall attendance rate was 77% (greater than or equal to 82% in those aged 45 years and above). In this cross-sectional study we found a high (44%) prevalence of smoking in men aged 45-64 years as well as a high alcohol intake (48% drank greater than or equal to 210 g of pure alcohol every week). Furthermore, there was a high cholesterol level (6.2 mmol.l-1), and a high prevalence of hypertension and diabetes. Against this background it is somewhat surprising that we did not find any signs of post-myocardial infarction in Spili men aged 63 and under. It is possible that positive factors, i.e. the closely knit social networks, the low unemployment rate, the hard water, and some of the dietary habits, e.g. the high consumption of olive oil, may counter-balance the negative factors mentioned above. It is also possible that the low risk factors in the past explain the low incidence of myocardial infarction today, and that this will change in the years to come.

Patient-number-based computerized medical records in Crete. A tool for planning and assessment of primary health care.

Primary Health Care (PHC) in Crete is in a state of rapid development. The strategy for introducing PHC involves an orientation towards the population and the creation of possibilities for evaluation. A case records system, "Egino", was installed in the University of Heraklion and at the Health Centre in Spili in 1988, and was further developed according to local needs during 1989, when also a Greek version of the statistical system, "DoIt", was installed. The main reasons for establishing a computerized medical information system were (i) to assess the health needs in Crete, (ii) to monitor activities of the primary health care organizations, and (iii) to introduce epidemiological research into primary health care in Greece. The information system was based on specially assigned patient numbers containing several pieces of information about the individual; the system was developed at the Dalby Health Sciences Centre in Sweden. Each month, data were extracted in Spili Health Centre, and these data were regularly used to present incidence and prevalence indices. Some of the data extracted were reported to the health authorities in Greece. "EginO" and "DoIt" gave possibilities to evaluate health services by following the morbidity, while also making it possible to describe and analyse health needs in the population of Spili and other primary health care catchment areas in Greece.

PIP: The Lund University Health Sciences Centre in Dalby, Sweden and the Department of Family and Social Medicine at the Crete University in Heraklion entered a collaborative agreement in December 1987 which involved the development of a computerized patient information system for primary health care (PHC) in Crete. In 1988, computer programmers installed the case record system "Egin0" on a personal computer at the University of Heraklion and at the health center in Spili, Crete. Based on local needs, this system was improved upon in 1989 which included installation of the Greek statistical System "DoIt". Purposes of the system included assessment of the health needs of the island, monitoring activities of PHC organizations, and introduction of epidemiologic research into PHC in Greece. The Crete and Swedish team successfully established a computer based information system in Spili in only 1 year and was able to analyze data on health care use and cardiovascular risk. The Greek version was more inclusive than the Swedish version because it included dental and preventive. The installed patient information system should allow comparison of date to evaluate new PHC settings in Greece in the future. Further, it should permit analyses of the effect of sociocultural factors on the use of PHC and attitudes and behavior of patients. Health center workers in Spili have continuously assessed the system. Immediate feedback has resulted in identifying needs for training and modifications of procedures. The "Egin0" and "DoIt" systems have also allowed researchers to analyze aggregate data. The success of these systems have resulted in their implementation in other health centers in Crete and other parts of Greece.

Use of primary health care in Spili, Crete, and in Dalby, Sweden.

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC). In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%) but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%). There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.

PIP: In 1989, researchers from Crete University in Crete and Lund University in Dalby, Sweden examined similarities and differences in the health care use pattern at the Spili Health Center (SHC) in Crete and at the Dalby Health Center (DHC) in Sweden. They also needed to establish a computerized medical record system in Greek primary health care. Essentially the same proportion of the population visited the 2 health centers (56% for SHC and 57% for DHC), but DHC patients made more frequent visits than did SHC patients (3.33 vs. 2.3). Yet there were more physicians per person in Spili than in Dalby (10.1 vs. 5.2/10,000 population). The mountainous terrain in an near Spili may have made it more difficult for people to go to the health center. Another possible explanation for the differences in number of visits for each patient in 1989 was that Swedes are perhaps more willing to go the health center for medical advice than the Cretes. 36% of visits to DHC were appointments compared with only 12.6% at SHC. In Crete, males were just as likely to visit the health center as females (55% vs. 57%), but females were more likely to visit the health center than males in Sweden (64% vs. 50%). People 65 years of age or older were more common in Spili than in Dalby (28% vs. 11%). Acute upper respiratory infections were the most common diagnoses in the 0-14 and 15-44 age groups. Head injuries were more common among 0-14 year old patients at SHC than their DHC counterparts (5% vs. 1.3%). Ear inflammation was the 2nd most common diagnosis at DHC but it was not 1 of the 10 most common diagnoses at SHC. This may have been due to better diagnostic abilities and modern equipment at DHC. Hypertension and diabetes mellitus predominated among 45 year old people.