Robustness of the EUROPEP questionnaire as regards data quality, reliability, and construct validity: The Greek experience before and after the economic crisis.

OBJECTIVES: To assess the data quality, reliability, and construct validity of the Greek EUROPEP and to examine the instrument's robustness in terms of its psychometric properties in a pre- and post-economic crisis period. METHODS: Taking into account the two key factors that affect the accuracy and quality of survey data, that is the representativeness of the sample selected from the population, and the response rate, four hundred ninety-two and five hundred thirty-two patients (492 and 532 patients) pre- and post-crisis, respectively, consulting GPs at 16 Primary Health Care Centers (PHCCs) in Greece were invited to complete the Greek EUROPEP. We assessed item missing, ceiling and floor effects, and used factor analysis to assess the structure of the 23 items of the EUROPEP. Scales were tested for reliability and construct validity. We further examined if the scales of EUROPEP need to be refined, taking into account the external validity across economic crises. RESULTS: Factor analysis identified three groups of questions that formed scales with satisfactory internal consistency reliability, and validity. The clinical behavior scale, the support, and services scale, and the organization of care scale, all met the criterion of 0.7 for Cronbach's alpha. All scales were found to have a significant correlation with the majority of the examined variables. Moreover, the EUROPEP was found to be robust in effectively detecting differences in patients' views over time in different economic contexts. CONCLUSIONS: The study identified three scales in the Greek EUROPEP-questionnaire with satisfactory psychometric properties, and its Greek version could be used in the recent primary health care (PHC) reform in this country.

Perceptions of primary care professionals on quality of services in rural Greece: a qualitative study.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.