The Linneaus implementation in Greece Yannis Skalkidis MD, PhD, MPH, FACS Athens University Medical School ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Linneaus Collaboration Recruit methods for assessing PS culture in primary care Recruit methods for assessing PS culture in primary care Development of a suitable reporting system Development of a suitable reporting system Getting consensus on identifying prescribing errors and type of clinical data for reporting Getting consensus on identifying prescribing errors and type of clinical data for reporting Develop a framework for involving new countries and primary care organisations to “assess/accredit” primary care services Develop a framework for involving new countries and primary care organisations to “assess/accredit” primary care services ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

WP10 Main Objective Identification of clinical indicators and methodologies –based on Linneaus results- that can be used in preparing an accreditation framework for clinical services in the delivery of primary healthcare services ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Action Plan Analysis of the current system of delivering primary health services in the specific health centers Analysis of the current system of delivering primary health services in the specific health centers Identification of 6-8 primary health centres, where piloting will take place Identification of 6-8 primary health centres, where piloting will take place Preparation of the technical platform and the organisational microenvironment in the pilot sites to run the proposed systems and indicators Preparation of the technical platform and the organisational microenvironment in the pilot sites to run the proposed systems and indicators ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Action Plan (cont.) Piloting of the Linneaus systems and indicators at the Greek health centres Piloting of the Linneaus systems and indicators at the Greek health centres Monitoring and analysis of results and ad hoc meetings among all involved GPs along with key experts for interpreting results and finalising conclusions Monitoring and analysis of results and ad hoc meetings among all involved GPs along with key experts for interpreting results and finalising conclusions ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Action Plan (cont.) Report on next steps related to sustainability of the Linneaus system at regional level Report on next steps related to sustainability of the Linneaus system at regional level Development of a “road map’ for expansion of the system at national level as well as in similar primary healthcare settings at European level Development of a “road map’ for expansion of the system at national level as well as in similar primary healthcare settings at European level ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

WP 10 Key outputs Building regional network and extending to a wider level Building regional network and extending to a wider level Getting consistency on data gathering, taxonomy, culture measurement, developing indicators, disseminating PS concepts and techniques Getting consistency on data gathering, taxonomy, culture measurement, developing indicators, disseminating PS concepts and techniques Identifying key improvement strategies Identifying key improvement strategies ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

What is expected Identify how the implementation of these indicators will be addressed by each health centre, Identify how the implementation of these indicators will be addressed by each health centre, Assess the barriers and the facilitators for the use of the proposed indicators and methodologies to other primary care settings Assess the barriers and the facilitators for the use of the proposed indicators and methodologies to other primary care settings ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

A final workshop with all the participants in the Project and other experts will take place to interpret results and produce a consensus report on the feasibility, utility and sustainability of the piloted system regarding monitoring patient safety indicators ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Road map to accreditation of clinical services A road map describing the key steps to launch the use of patient safety indicators in primary healthcare (addressing health professionals, health policy makers and relevant health authorities) A road map describing the key steps to launch the use of patient safety indicators in primary healthcare (addressing health professionals, health policy makers and relevant health authorities) The road map will offer key details (scientific, organisational, technical, cultural etc) to sustain and expand the piloted Linneaus system The road map will offer key details (scientific, organisational, technical, cultural etc) to sustain and expand the piloted Linneaus system ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Road map to accreditation of clinical services It will include crucial parameters to meet accreditation requirements for clinical services in primary healthcare It will include crucial parameters to meet accreditation requirements for clinical services in primary healthcare It is anticipated that it will be especially useful, appropriate and cost-effective for similar healthcare systems, as for example in a number of Eastern European countries It is anticipated that it will be especially useful, appropriate and cost-effective for similar healthcare systems, as for example in a number of Eastern European countries ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

LINNEAUS INDICATORS LINNEAUS INDICATORS No Warfarin prescribing without a documented INR result within the last 12 weeks (all health centers) All people over 50 who are prescribed an anti-inflammatory should be also prescribed a PPI (all health centers) A fail safe mechanism to ensure that Methotrexate is only prescribed once weekly ( description of this system) (one health center) Documented U&E results in any patients prescribed ACE inhibitors (at initiation of treatment and 4 weeks later) (two health centers) Methotrexate without a documented FBC result within the previous 3 months ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

ADDITIONAL INDICATORS PROPOSED Long acting β-2 agonist inhaler for patients with asthma (not prescribed an inhaler corticosteroid) (A) Metoclopramide or prochlorperazine for Parkinson’s patients (A) Initiation of benzodiazepine for >21 days in patients >65 yrs with depression (A) Clarithromycin or erythrocin to patients receiveing simvastatin with no evidence that s/he has been advised to stop simvastatin while taking antibiotics ( A) ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

ADDITIONAL INDICATORS PROPOSED HbA1c every three months for all diabetic patients (B) Transaminases for all patients receiving statins (B) FRAX tool for postmenopausal women for presymptomatic assessment of fracture risk (B) Mammography over 50 yrs (C) Test pap over 20 yrs (C) Quit smoking consultation (C, D) Weight loss consultation (C) ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Identification of indicators and methodology A project initiation workshop has already been held at the beginning of the process with input from Linneaus experts and local key stakeholders in order to: A project initiation workshop has already been held at the beginning of the process with input from Linneaus experts and local key stakeholders in order to: – get international support for the process – emphasise the importance of the project for the local health professionals, – underline its potential beneficial impact for other EU Member States ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Identification of indicators and methodology Analysis of the current situation in the delivery of primary healthcare services Analysis of the current situation in the delivery of primary healthcare services Focus on the microenvironment of the selected health centres Focus on the microenvironment of the selected health centres Discussion ending up to a workshop to reach consensus among GPs to agree on a minimum common set of patient safety indicators, in addition to specific indicators reporting for each health center Discussion ending up to a workshop to reach consensus among GPs to agree on a minimum common set of patient safety indicators, in addition to specific indicators reporting for each health center ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Identification of indicators and methodology Established indicators, which have been developed as part of the Linneaus Collaboration, will be tested for use Established indicators, which have been developed as part of the Linneaus Collaboration, will be tested for use It is expected 4-6 indicators covering areas such as prescribing, adverse event reporting and safety culture to be used in pilot health centers It is expected 4-6 indicators covering areas such as prescribing, adverse event reporting and safety culture to be used in pilot health centers ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS

Piloting patient safety indicators The use of the selected patient safety indicators will be implemented in the selected health centres for a period of 4-6 months The use of the selected patient safety indicators will be implemented in the selected health centres for a period of 4-6 months Relevant data will be collected and analysed and through a series of practice visits Relevant data will be collected and analysed and through a series of practice visits ΕΘΝΙΚΟ & ΚΑΠΟΔΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS