Addressing Barriers to Health Services in Greece
ENSA Working group Older Adults and Disability
PANDA Conference
ENSA Working Group Youth, Child, and Family/Youth Care Platform
27, 28 & 29 June 2023
- Brussels
Efkarpidis
Apostolos, R. Nurse,
MSc Health Management, MSc
Public Health, PhD(c) Public Health Policies,
Deputy Director in General Hospital of Syros, Partner of Altera Vita
1
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TEAM OF AUTHORS
Politis Antonios, Professor
of Psychiatry, University of Athens
Efkarpidis
Apostolos, R. Nurse, MSc
Public Health, PhD
(c) Public Health Policies, General
Hospital of Syros, Partner of Altera Vita
Petrou
Anna, R. Nurse, General Hospital of Syros, MSc.
Aggeletaki
Eleftheria , R. Nurse, Physical and Medical Rehabilitation Center
,
General Hospital of
Syros
Sakellariou
Miltos, Biologist, MSc Counseling Psychology, Director of Altera Vita, Syros
Daskou Miranta, Biologist, Member of Altera Vita
,
Syros
2
Purpose of the
presentation
To describe the problems of the
National Health System in Greece that
create barriers to citizens' access to
health care services, especially for
people suffering from dementia, and to
mention the good practices applied for
these patients in Greece.
3
The agenda
of the
presentation
includes
1)
Some dementia-oriented national
health data to understand the big picture
2) Information about Day Care Centers
for patients with dementia and
3) Some information about the INTRINSIC
program
(
1
)
P
r
o
b
l
e
m
s
o
f
t
h
e
N
a
t
i
o
n
a
l
H
e
a
l
t
h
S
y
s
t
e
m
t
h
a
t
p
o
s
e
b
a
r
r
i
e
r
s
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o
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e
n
s
'
a
c
c
e
s
s
t
o
h
e
a
l
t
h
s
e
r
v
i
c
e
s
•
The public underfunding of health
•
The increased burden of out-of-pocket payments (due to the decrease in
household income)
•
Staff shortages
•
The poor quality of services in the public health sector
•
The geomorphology of the country and the
unequal
geographical distribution
of health care facilities
•
The unequal geographical distribution of medical and nursing staff
4
Total health care expenditure. Expenditure on long-term care
services. Out of pocket expenditure in indicative countries of the
European Union
.
Percentage of GDP.
Eurostat, 202
2
5
What is happening globally specifically for dementia
6
Prevalence of dementia in Europe
•
In Europe it is estimated that 9.78 million people are living with
dementia today.
•
In the European Union 7.85 million people
.
Alzheimer Europe Dementia Yearbook 2019.
7
(2)
Dementia in Greece
•
In Greece it is estimated that
around 240 thousand people
are living with dementia
.
•
Greece has the highest
prevalence in the European
Union for dementia
(2.37%
of
the population) right after Italy
(2
.
44% of the population).
Alzheimer Europe Dementia Yearbook 2019.
8
9
The existence of public Day Care Centers for patients with
dementia is an existential need for both patients and their
caregivers.
•
The time spent by caregivers at home, in the dependent stage of the patient,
has been estimated to be
168 hours per month
by a family member and an
additional
72 hours per month
by a domestic helper.
•
Totally 240 hours/month or 8 hours/day.
(
National Dementia Action Plan, 2015-2020)
•
This creates a great physical, mental, social and also financial burden for
caregivers.
•
In Syros, it is estimated that 250 people
are living with dementia, of which
96% are cared for at home, while the remaining percentage reside in nursing
homes until death
(
Bowen, et al, 2016).
10
What do Dementia Day Care Centers offer?
Dementia Day Care Centers are open approximately 8 hours a day. During these
hours, patients are offered:
a)
Neuropsychological and functional assessment – Memory Test
b)
Non-pharmacological therapeutic interventions for people with dementia
c)
Creative occupation, creative play and exercise
d)
Education, information and psychosocial support for caregivers
e)
Free time for caregivers
11
(3)
Τ
he INTRINSIC
program
INTEGRATED INTERVENTION PSYCHOGERIATRIC CARE (INTRINSIC) services are collaborative mental
health telehealth services in primary and secondary health care centers in low-resource areas of
Greece.
These are services supported by the country's Ministry of Health and its implementation began in the
spring of 2022.
Uses a digital platform, called HERMES to register the psychogeriatric health data of the beneficiary
citizen
s
.
The goals are twofold
: (
a
)
To offer modern care services facilitating early detection, monitoring and
symptom management of people over 65 with memory problems, depression and other
psychogeriatric syndromes, who live in remote or inaccessible areas.
(b) To provide training, support and service development opportunities for primary and secondary
health care professionals serving in hard-to-reach areas of Greece.
12
13
14
Results from INTRINSIC services
So far more than 500 people have received INTRINSIC services in the places
where they are offered.
•
These people have had a psychogeriatric evaluation,
•
Their medication has been adjusted where necessary
,
and
•
They are being systematically monitored.
•
The use of INTRINSIC services reduced barriers to old-age mental healthcare,
since
it contributed to the reduction of time and costs for seeking old-age
cognitive-and
mental healthcare. It resulted in a significant reduction in the
distance (in km) older
adults annually travelled to visit health care services and
in
time (hours) annually spent for travelling and accessing healthcare services
due to
their old-age mental or neurocognitive disorder and returning home
.
15
The services also include:
•
Memory booster groups
•
Caregiver training in the neuropsychiatric symptoms of dementia
•
Counseling for caregivers
•
PATH (Problem Adaptation Therapy) a non-pharmacological
intervention for citizens suffering from depression.
16
In conclusion
•
Greece seems to be finding ways for people with psychogeriatric problems to access health
care services.
•
These services are still at a very early stage and in no way cover the needs of the population.
•
The Day Care Centers for Dementia and the INTRINSIC program it is necessary to extend in
all country because can
really improve the access to care for these special category of
citizens
•
Strengthening this effort, both through national resources and through programs of
European organizations and networks, is vital and very useful for facilitating the access of
people with psychogeriatric problems who
are living
in remote and inaccessible areas of
Greece.
The heads of the Universities,
The teamwork of our
General Hospital
of Syros,
and
τ
he Health Centers of Andros and Tinos,
and Altera Vita
we
are working intensively on this
.
.
17
Thank you again for your kind invitation
Thank you again for your kind invitation
And for your attention
And for your attention
18
This content discusses the challenges faced by Greece's National Health System in providing access to health services, particularly for patients with dementia. It highlights problems such as underfunding, out-of-pocket payments, staff shortages, and geographical disparities. The presentation also covers the good practices of Day Care Centers for dementia patients in Greece.
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ENSA Working group Older Adults and Disability ENSA Working group Older Adults and Disability PANDA Conference PANDA Conference ENSA Working Group Youth, Child, and Family/Youth Care Platform ENSA Working Group Youth, Child, and Family/Youth Care Platform 27, 28 & 29 June 2023 27, 28 & 29 June 2023 - - Brussels Brussels Efkarpidis EfkarpidisApostolos, R. Nurse, Apostolos, R. Nurse, MSc Health Management, MSc MSc Health Management, MScPublic Health, PhD(c) Public Health Policies, Public Health, PhD(c) Public Health Policies, Deputy Director in General Hospital of Syros, Partner of Altera Vita Deputy Director in General Hospital of Syros, Partner of Altera Vita 1
Day Care Centers for patients with dementia and Integrated Day Care Centers for patients with dementia and Integrated Psychogeriatric Care (INTRINSIC), as good practices of health care Psychogeriatric Care (INTRINSIC), as good practices of health care services in Greece services in Greece TEAM OF AUTHORS PolitisAntonios, Professor of Psychiatry, University of Athens Efkarpidis Apostolos, R. Nurse, MSc Public Health, PhD (c) Public Health Policies, General Hospital of Syros, Partner of Altera Vita Petrou Anna, R. Nurse, General Hospital of Syros, MSc. Aggeletaki Eleftheria , R. Nurse, Physical and Medical Rehabilitation Center, General Hospital of Syros Sakellariou Miltos, Biologist, MSc Counseling Psychology, Director of Altera Vita, Syros Daskou Miranta, Biologist, Member of Altera Vita, Syros 2
The agenda of the presentation includes Purpose of the presentation 1) Some dementia-oriented national To describe the problems of the health data to understand the big picture National Health System in Greece that create barriers to citizens' access to 2) Information about Day Care Centers health care services, especially for for patients with dementia and people suffering from dementia, and to 3) Some information about the INTRINSIC mention the good practices applied for program these patients in Greece. 3
(1) Problems of the National Health System that pose barriers to Problems of the National Health System that pose barriers to citizens' access to health services citizens' access to health services The public underfunding of health The increased burden of out-of-pocket payments (due to the decrease in household income) Staff shortages The poor quality of services in the public health sector The geomorphology of the country and the unequal geographical distribution of health care facilities The unequal geographical distribution of medical and nursing staff 4
Total health care expenditure. Expenditure on long-term care services. Out of pocket expenditure in indicative countries of the European Union. Percentage of GDP. Eurostat, 2022 40 33.44 35 30 25 21.28 20 16.8 16.04 14.44 13.03 15 9.63 9.51 10 11.39 11.33 11.2 10.87 5 2.98 2.45 1.8 1.67 0.98 0.14 0 Grecce Italy European Union (27) Belgium Sweden Austria 5 Total health care expenditure. Long-term care (health) expenditure. Out-of-pocket expenditure (% of current health expenditure)
Prevalence of dementia in Europe In Europe it is estimated that 9.78 million people are living with dementia today. In the European Union 7.85 million people. 7 Alzheimer Europe Dementia Yearbook 2019.
(2) Dementia in Greece In Greece it is estimated that around 240 thousand people are living with dementia. Greece has the highest prevalence in the European Union for dementia (2.37% of the population) right after Italy (2.44% of the population). 8 Alzheimer Europe Dementia Yearbook 2019.
2 9
The existence of public Day Care Centers for patients with dementia is an existential need for both patients and their caregivers. The time spent by caregivers at home, in the dependent stage of the patient, has been estimated to be 168 hours per month by a family member and an additional 72 hours per month by a domestic helper. Totally 240 hours/month or 8 hours/day. (National Dementia Action Plan, 2015-2020) This creates a great physical, mental, social and also financial burden for caregivers. In Syros, it is estimated that 250 people are living with dementia, of which 96% are cared for at home, while the remaining percentage reside in nursing homes until death (Bowen, et al, 2016). 10
What do Dementia Day Care Centers offer? Dementia Day Care Centers are open approximately 8 hours a day. During these hours, patients are offered: a) Neuropsychological and functional assessment Memory Test b) Non-pharmacological therapeutic interventions for people with dementia c) Creative occupation, creative play and exercise d) Education, information and psychosocial support for caregivers e) Free time for caregivers 11
(3) he INTRINSIC program INTEGRATED INTERVENTION PSYCHOGERIATRIC CARE (INTRINSIC) services are collaborative mental health telehealth services in primary and secondary health care centers in low-resource areas of Greece. These are services supported by the country's Ministry of Health and its implementation began in the spring of 2022. Uses a digital platform, called HERMES to register the psychogeriatric health data of the beneficiary citizens. The goals are twofold: (a) To offer modern care services facilitating early detection, monitoring and symptom management of people over 65 with memory problems, depression and other psychogeriatric syndromes, who live in remote or inaccessible areas. (b) To provide training, support and service development opportunities for primary and secondary health care professionals serving in hard-to-reach areas of Greece. 12
Results from INTRINSIC services So far more than 500 people have received INTRINSIC services in the places where they are offered. These people have had a psychogeriatric evaluation, Their medication has been adjusted where necessary, and They are being systematically monitored. The use of INTRINSIC services reduced barriers to old-age mental healthcare, since it contributed to the reduction of time and costs for seeking old-age cognitive-and mental healthcare. It resulted in a significant reduction in the distance (in km) older adults annually travelled to visit health care services and in time (hours) annually spent for travelling and accessing healthcare services due to their old-age mental or neurocognitive disorder and returning home. 15
The services also include: Memory booster groups Caregiver training in the neuropsychiatric symptoms of dementia Counseling for caregivers PATH (Problem Adaptation Therapy) a non-pharmacological intervention for citizens suffering from depression. 16
. In conclusion Greece seems to be finding ways for people with psychogeriatric problems to access health care services. These services are still at a very early stage and in no way cover the needs of the population. The Day Care Centers for Dementia and the INTRINSIC program it is necessary to extend in all country because can really improve the access to care for these special category of citizens Strengthening this effort, both through national resources and through programs of European organizations and networks, is vital and very useful for facilitating the access of people with psychogeriatric problems who are living in remote and inaccessible areas of Greece. The heads of the Universities, The teamwork of our General Hospital of Syros, and he Health Centers of Andros and Tinos, and Altera Vita we are working intensively on this. 17
Thank you again for your kind invitation And for your attention 18
