It’s not all Greek to me
An STSM experience from Cyprus to North Greece, Dimokrition University of Thrace
In October 2023, I visited Dimokrition University of Thrace, which is located in North Greece for a STSM with Dr Kontogriorgis Christos, Associate Professor of Hygiene, Department of Medicine, Democritus University of Thrace. The scope of the STSM was to explore best practices on adherence policies and cooperation potentials between Greece and Cyprus.
Who am I?
I am Dr Panagiotis Petrou, pharmacist and health economist. Currently, I am a senior officer in Health Insurance Organization and an adjunct researcher at the University of Nicosia, in the field of Pharmacoepidemiology and Pharmacovigilance.
The goal of this STSM was to pursue cooperation and exchange of expertise between Greece and Cyprus, regarding adherence to medicines. Cyprus has the newest health system in Europe, and as such, it can gain significant insights from more mature health systems. Greece’s health care system has evolved significantly through the years and can serve as a stepping stone. In particular, the consecutive MoU of Greece with a team of international lenders brought the entire health sector between a rock and a hard place. Currently, as the country has recovered from the profound and retracted fiscal uncertainty and stagnation, much focus has been put in the qualitative traits of Greece’s health system.
Greece was selected since it shares several similarities with Cyprus, with the most substantial being the common language. Moreover, Greece has always served as an educational hub for Cypriot physicians.
Another pillar of the STSM was to update existing projects, primarily studies that assess attitudes of pharmacists regarding this topic. To this direction, we agreed to jointly supervise 2 thesis at the Social Care Master of Demokritos Medical School, whose topic will be the aforementioned one. This will further enhance the dissemination of the context of adherence among students, and ultimately can provide us with valuable insights.
In addition, we performed several field visits, in order to engage with community pharmacists and one in a hospital pharmacy. The majority of the pharmacists concluded that while they try to assess adherence, major barriers is lack of time and the perception of patient that this should be overseen by the treating physician.
We explored several therapeutic categories and we agreed to focus on a highly volume one and a specialised one. The high volume will pertain to heart failure while the latter will focus on multiple sclerosis.
For heart failure, there was strong statements that patients, owing to hot summers as well, space out their treatment in summer and this becomes the norm in winter, which exerts a negative effect on their condition.
Regarding multiple sclerosis, we observed a similar pattern with Cyprus, in the sense that patients are worries, upon rumours primarily regarding safety of first line treatment, which perpetuates to suboptimal adherence and as a result, a deterioration of their conditions is more likely. This also leads to substantial costs.
Finally, we have extensively discussed the creation of apps, which will be highly facilitated by the common language. The Demokritos University has already cooperated with technology industries for their AI, therefore this target seems feasible, although a substantial time investment is imperative. A prerequisite is the interface between the prescribing systems of payers and the apps.
The way forward
This STSM has in principal achieved its goals and expected outcomes. The primary goal was to establish a cooperation network with countries with both the same language, and the same mentality as well, which will enable a common understanding of the attitudes of pharmacists regarding adherence, physicians and patients.
At this point, a systematic review pertaining to MS and adherence is under review. This was one of the outcomes of the STSM.
In addition, the co-supervision of 2 Master thesis on adherence related topics, which in combination will cover a substantial part of Greece, along with the existing ones in Cyprus, can forge a strong document with the ability to influence related health policies targeting adherence. This could include the introduction of the medical review, a pharmacists-oriented reimbursement tool, which will entail a one yearly assessment of adherence by a community or hospital pharmacist.
The development of the app, with the advantage of the use of common language qualifies as an important achievement of the STSM. The host University, due to its expertise and existing collaboration will explore the potentials to develop an app, targeting primarily illiterate adults.
In the immediate future, we will compare the adherence in heart failure treatments, since both countries and provide indirect measurements electronically (number of packs prescribed vs number of packs dispensed and percentage of patients who lower dose due to heat and remain on low dose). This will be an interesting study, given the prevalence and incidence of heart failure in both countries. To this direction, the host institute will provide the data for Greece and HIO and the corresponding ones for Cyprus. At a later stage, a similar project for multiple sclerosis will set-off. After we glean the data, we will be able to elaborate an evidence-based policy statement.
The joint activities are important since the majority of HCP in Cyprus studied in Greece and as a result Greece exerts a strong influential scientific effect on Cyprus HCP.
Overall, this STSM has laid the foundations for a close collaboration with Demokritos Medical School and we expect the first outcomes in the near future.
After all, it’s not all Greek to me.