Managing Alzheimerʼs Disease in Primary Care in Crete, Greece

Abstract

As Greece moves during the last two decades toward a national health care system, which gives emphasis to the development of a primary care system, many worry how to ensure that the quality of care is assessed. This is more apparent in the rural populations, in which health care is served to a large extent by physicians without formal training in general practice. This article explores the level of knowledge of primary care physicians in relation to Alzheimer's disease in geographically defined areas of Crete, Greece, in comparison with that of general practitioners in Ostergötland, Sweden, and in Iceland. It emphasizes the need for better education and training for primary care physicians in Crete in both the early diagnosis and management of Alzheimer's disease.

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

“…Coordinated care in the patient's own environment, through a comprehensive interplay of health and social care providers is regarded as the ideal pathway, safeguarding equity, patients' rights for care, cost-effectiveness and efficiency [38–42]. The need for establishment of efficient referral pathways and services involving community nurses, social workers, psychologists and other health professionals has been underlined [14, 25, 43].…”

“…Providing formally instituted incentives for primary care professionals towards life-long training, research capacity development and expertise building has also been emphasized in several publications [35, 44–48]. Service agreements between PHC providers and regional health authorities, establishment and operation of the PHC team and routine evaluation of quality of services based on internationally accepted, culturally adapted tools have all been debated or even pilot-tested by Greek investigators [13, 14, 38, 39, 49]. …”

The Cretan Aging Cohort: Cohort Description and Burden of Dementia and Mild Cognitive Impairment

“…35 There are many factors contributing to dementia underdiagnosis in ruraldwelling, low-educated populations such as the one targeted by the present study. [36][37][38][39] Impaired self-awareness of cognitive deficits is one such potential factor, especially for persons living alone or with a nonrelative caregiver who is not a trained professional. Both patients and relatives may be reluctant to seek medical assistance for declining cognitive abilities adhering to the cultural belief that their symptoms are part of normal aging.…”

“…43 Lack of formal training and of continuing expert support to PHC physicians in the detection of cognitive problems may further contribute to underdiagnosis in their patients. 37,38,44 In addition, due to the remoteness of the villages included in this study from specialist services, it is probable that this underdiagnosis reflects limited health-care access. It should also be noted that MCI diagnosis can be especially challenging, even for dementia experts, and often is confounded by comorbidities, such as depression.…”

Cultural Adaptation, Standardization and Clinical Validity of the Test Your Memory Dementia Screening Instrument in Greek

“…While literacy and formal schooling is known to affect performance on cognitive tests, cultural characteristics (regional, geographic and ethnic background) may operate either independently or as moderating factors to determine performance on dementia screening tools. At the population level, these factors are likely to affect the capacity for early detection of new dementia cases - to a greater extent in countries with limited resources in the primary health care sector, such as Greece, than in countries with well-organized national health care systems [10] . In these settings, the availability of standardized screening instruments for dementia is expected to enhance the diagnostic capacity of primary care.…”