New policies at Nosokomio Neapolis : introducing small areas research and development in a Cretan primary/hospital care setting

Sammanfattning: The present thesis gives an account of the scheduled transformation of a combined Hospital and Primary Health Care institution, Nosokomio Neapolis, in a semi-rural community on Crete to an integrated population health research and development (R&D) centre by relatively minor organisational updatings and focused scientific studies with academic and political support and supervision. This process has engaged the whole local team, and the thesis is concerned with some of its bearing "Ariadne threads". First, the health systems perspective and framework of the Nosokomio Neapolis are described, including opportunities and scope of the directed, needs-and-outcome-oriented R&D undertaken also outside the focus of the present thesis, e.g. osteoporosis, cardiovascular diseases and accidents (I).Then, and new to Greece, three different and complementary lines are drawn concerning primary health care (PHC) quality assurance research in the three ages and with an epidemiological, risk factor and staff emphasis, respectively. The first of them is the primary prevention sector of immunisation in Cretan schoolchildren, where insufficient levels were found and measures of improvement implemented (II). The second concerns the determination of hepatitis A, B, and C markers and assessment of immunisation status in the Neapolis prison inmates and staff, and showing that both are high risk groups, where secondary and tertiary preventive measures are highly warranted (III). In the third age, research focused upon staff capacity regarding PHC physicians' level of knowledge and patterns of practices related to dementia in two European Regions; Crete, Greece and OstergOtland, Sweden. This is predominantly a tertiary preventive sector, where the care organisation is instrumentaL The study showed in the younger Greek PHC physicians a need for quality improvement, in particular in relation to Alzheimer's disease (IV).The final, fifth and sixth papers give an overview of the decisive step out to society, by a specially designed questionnaire, in order to achieve community involvement: a vital requirement for population participation and shar-ingjn the decentralised work towards Health For All by year 2000 and beyond (V - VI). The general conclusion of the thesis is that the new policies of small-areas action R&D in the community are both needed and relevant in the primary health care of Cretan and other Mediterranean areas.