The Cost and the Value of Stroke Care in Greece: Results from the SUN4P Study.

The aim of this study was to measure the one-year total cost of strokes and to investigate the value of stroke care, defined as cost per QALY. The study population included 892 patients with first-ever acute strokes, hemorrhagic strokes, and ischemic strokes, (ICD-10 codes: I61, I63, and I64) admitted within 48 h of symptoms onset to nine public hospitals located in six cities. We conducted a bottom-up cost analysis from the societal point of view. All cost components including direct medical costs, productivity losses due to morbidity and mortality, and informal care costs were considered. We used an annual time horizon, including all costs for 2021, irrespective of the time of disease onset. The average cost (direct and indirect) was extrapolated in order to estimate the national annual burden associated with stroke. We estimated the total cost of stroke in Greece at EUR 343.1 mil. a year in 2021, (EUR 10,722/patient or EUR 23,308 per QALY). Out of EUR 343.1 mil., 53.3% (EUR 182.9 mil.) consisted of direct healthcare costs, representing 1.1% of current health expenditure in 2021. Overall, productivity losses were calculated at EUR 160.2 mil. The mean productivity losses were estimated to be 116 work days with 55.1 days lost due to premature retirement and absenteeism from work, 18.5 days lost due to mortality, and 42.4 days lost due to informal caregiving by family members. This study highlights the burden of stroke and underlines the need for stakeholders and policymakers to re-organize stroke care and promote interventions that have been proven cost-effective.

Investigating the Impact of the Covid-19 Pandemic on the Economy and the Corresponding Entrepreneurship Support Measures in Europe.

Covid-19 pandemic continues to cause great losses in human lives and adverse consequences in many sectors of the EU economy. The aim of the paper is to evaluate the effects of the pandemic in small and medium-sized enterprises (SMEs), in culture - entertainment industry and to investigate the effectiveness of the corresponding entrepreneurship support measures have been taken. This review was conducted based on related articles that were published during the years 2020-2021, using the online databases of Google Scholar, Science Direct, Elsevier, PubMed, OECD, IOBE. A total of 16 eligible studies were included in this literature review. EU authorities have launched measures, setting up policy and funding instruments to mobilize the economy. The impact of these measures is of great significance for many EU countries and sectors. However, measures taken for small and medium-sized enterprises, tourism and culture were not evaluated effectively to get the sectors back on track. Those measures were effective in short term and were insufficient to boost the recovery of the EU economy in long term. Since Covid-19 still exists, the fear of a recurrence is fed back. Long-term support measures need to be re-evaluated and new strategies must be established, that will set, sustainability criteria for companies, according to future investment and development policies.

Cross-sectional assessment of predictors for COVID-19 vaccine uptake: an online survey in Greece.

Objective: To estimate the percentage of the general population vaccinated against the COVID-19 and to investigate the factors associated with COVID-19 vaccine uptake. Material and methods: We conducted an online cross-sectional study in Greece during August 2021. We included individuals over 18 years of age. Independent variables included socio-demographic data of the participants and attitudes towards COVID-19 vaccination and pandemic. Our outcome variable was COVID-19 vaccination status, measured through "yes/no" answers. Results: Most participants had been vaccinated against the COVID-19 (87.8%). Multivariate analysis identified that increased age and a higher level of education were associated with an increased likelihood of COVID-19 vaccination. Also, participants working in health services, participants without a previous COVID-19 diagnóstico, and those with previous seasonal influenza vaccination history had a greater probability to take a COVID-19 vaccine. Additionally, increased self-perceived severity of COVID-19, knowledge regarding COVID-19, and trust in COVID-19 vaccines and scientists were associated with COVID-19 vaccine uptake. On the other hand, the likelihood of vaccination was lower for participants who were more concerned about the side effects of COVID-19 vaccination. Conclusions: Understanding the factors affecting individuals' decision to take a COVID-19 vaccine is essential to improve the COVID-19 vaccination coverage rate. Policymakers and scientists should scale up their efforts to increase the COVID-19 vaccination rate among specific population groups such as young people, people with a low level of education, etc.

Objetivo: Calcular el porcentaje de población general vacunada contra la COVID-19 e investigar los factores asociados a la aceptación de dicha vacuna. Material y métodos: Realizamos un estudio transversal online en Grecia durante el mes de agosto de 2021, en el que incluimos a individuos mayores de 18 años de edad. Las variables independientes incluyeron los datos sociodemográficos de los participantes y las actitudes hacia la vacunación y la pandemia de COVID-19. Nuestra variable del resultado fue la situación de vacunación contra la COVID-19, medida mediante respuestas "sí/no". Resultados: La mayoría de los participantes habían sido vacunados contra la COVID-19 (87,8%). El análisis multivariante identificó que el incremento de la edad y el mayor nivel educativo estaban asociados a un aumento de la probabilidad de vacunarse contra la COVID-19. De igual modo, los participantes que trabajaban en servicios sociales, aquellos participantes sin un diagnóstico previo de COVID-19, y aquellos con historial previo de vacuna contra la gripe estacional tenían una mayor probabilidad de vacunarse contra la COVID-19. Además, el incremento de la gravedad autopercibida de la COVID-19, el conocimiento sobre la enfermedad, y la confianza en las vacunas contra la COVID-19 y en los científicos estuvieron asociados a la aceptación de la vacuna. Por otro lado, la probabilidad de vacunarse fue menor en los participantes más preocupados de los efectos secundarios de la vacuna contra la COVID-19. Conclusiones: Comprender los factores que afectan a la decisión de los individuos sobre la vacunación contra la COVID-19 es fundamental para mejorar la tasa de cobertura de dicha vacunación. Los responsables políticos y los científicos deberán redoblar sus esfuerzos para incrementar la tasa de vacunación contra la COVID-19 entre los grupos de población específicos tales como la gente joven, las personas con un bajo nivel educativo, etc.

Inpatient Cost of Stroke Care in Greece: Preliminary Results of the Web-Based "SUN4P" Registry.

The aim of this study was to calculate the average operational cost per sub-type of stroke patient and to investigate cost drivers (e.g. ALoS, NIHSS score, age) correlated to cost. METHODS: Direct medical costs (diagnostic imaging and clinical laboratory exams, overheads/bed cost, pharmaceuticals, ringers and other non-durables and inpatient rehabilitation) per patient were calculated from the providers' (hospitals') perspective. Resource use data derived from the "SUN4P" web-based registry and unit costs were retrieved from publically available sources and were assigned to resource use. RESULTS: The sample comprised 6,282 inpatient days of 750 patients (mean age: 75.5±13.3 years) admitted from July 2019 to July 2021, in nine public hospitals. Mean length of stay was 8.4±7.6 days and mean total operational cost was calculated to €1,239.4 (from which 45% and 35% related to diagnostic exams and overheads/bed cost respectively). Mean cost related to hemorrhagic stroke patients that were discharged alive was calculated significantly higher compared to mean cost related to ischemic stroke patients who didn't undertake thrombolysis and were also discharged alive from the hospital (€2,155.2 vs. €945.2, p<0.001). Linear regression analysis revealed that length of stay was significantly correlated with cost (coefficient beta=232, 95% CI confidence interval = 220-243, p<0.001). CONCLUSIONS: These findings are in accordance with current evidence and should be thoroughly assessed to rationalize inpatient reimbursement rates in order to achieve improved value of care.

Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges.

This paper conducts a comparative review of the (curative) health systems' response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the 'Health System Response Monitor' platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy "flexible" intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.

Development and validation of measurement tools for user experience evaluation surveys in the public primary healthcare facilities in Greece: a mixed methods study.

BACKGROUND: The public primary healthcare system in Greece has not been fully developed and is delivered by urban and rural health centers, outpatient departments in public hospitals and the recently established first-contact and decentralized local primary care units. The aim of this study was to develop a valid and reliable measurement tool for conducting periodic user experience evaluation surveys in public Primary HealthCare facilities in Greece such as outpatient clinics of public hospitals and health centers. METHODS: A mixed methods approach was applied. In particular, the methodology of developing and validating the tools included three steps: (a) establishment of the theoretical background/literature review, (b) qualitative study: development of the tools items and establishment of the face validity and (c) quantitative study: pilot testing and establishment of the structural validity and estimation of the internal consistency of the tools. Two patient focus groups participated in qualitative study: one visiting health centres and the other visiting the outpatient clinics of public hospitals. Quantitative study included 733 Primary Health Care services' users/patients and was conducted during August-October 2017. Exploratory and confirmatory factor analysis was performed to check for structural validity of the tools, while Cronbach's alpha coefficients were estimated to check for reliability. RESULTS: Confirmatory factor analysis confirmed almost perfectly the presumed theoretical model and the following six factors were identified through the tools: (a) accessibility (three items, e.g. opening hours), (b) continuity and coordination of care (three items, e.g. doctor asks for medical history), (c) comprehensiveness of care (three items, e.g. doctor provides advices for healthy life), (d) quality of medical care (four items, e.g. sufficient examination time), (e) facility (four items, e.g. comfortable waiting room) and (f) quality of care provided by nurses and other health professionals (four items, e.g. polite nurses). CONCLUSIONS: We have developed reliable and valid tools to measure users' experiences in public Primary HealthCare facilities in Greece. These tools could be very useful in examining differences between different types of public Primary Health Care facilities and different populations.