Dimitris Kounalakis - Academia.edu (original) (raw)

Papers by Dimitris Kounalakis

Journal of innovation in health informatics, 2008

Background The computer-based electronic medical record (EMR) is an essential new technology in h... more Background The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computernaïve public primary care centres in Cyprus. Methods One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters. Results Two public primary care centres participated, and a total of ten health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. Conclusion The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population.

Εισαγωγή: Ο ηλεκτρονικός φάκελος ασθενή είναι ένα σημαντικό εργαλείο για την συνέχεια στη παροχή ... more Εισαγωγή: Ο ηλεκτρονικός φάκελος ασθενή είναι ένα σημαντικό εργαλείο για την συνέχεια στη παροχή φροντίδας στην πρωτοβάθμια. Στην Ελλάδα έχουν γίνει σημαντικές προσπάθειες στο παρελθόν χωρίς όμως να γίνει γενίκευση κάποιου λογισμικού. Σκοπός: Ο σχεδιασμός, η κατασκευή και η εφαρμογή ενός λογισμικού βασισμένο σε αποδεκτές κωδικοποιήσεις κατάλληλου για χρήση στην πρωτοβάθμια φροντίδα υγείας. Μέθοδος: Έγινε αναζήτηση των υπαρχόντων λογισμικών ΗΦΑ για την ΠΦΥ, στο Medline, στο Internet και σε συνεργαζόμενα πανεπιστήμια και επιλέχθηκε ένα εξ αυτών ως πρότυπο. Καταγράφηκαν οι απόψεις και οι αντιλήψεις γενικών ιατρών με την χρήση ερωτηματολογίου Ένα νέο λογισμικό αναπτύχθηκε στο οποίο χρησιμοποιήθηκαν οι ταξινομήσεις ICD10, ATC και η ICPC-2, η οποία μεταφράστηκε στην Ελληνική γλώσσα. Το νέο λογισμικό εγκαταστάθηκε και έγινε εφαρμογή του σε μονάδες ΠΦΥ σε Ελλάδα και Κύπρο. Η αξιολόγησή του έγινε με καταγραφή της διαδικασίας, συνεντεύξεις με τους χρήστες και συμπλήρωση ερωτηματολόγιων. Αποτε...

Primary Care Respiratory Journal, 2002

International Journal of Otolaryngology, 2011

Venous aneurysms are rare causes of neck mass. Among neck veins, aneurysms of the external jugula... more Venous aneurysms are rare causes of neck mass. Among neck veins, aneurysms of the external jugular vein are extremely uncommon. We present a case of a woman with a history of prior internal jugular vein catheterization who presented at a rural primary health care unit with a nontender progressively enlarging swelling in the right supraclavicular region. B-mode and Doppler ultrasound examination revealed a saccular dilatation of the external jugular vein, suggesting a posttraumatic venous aneurysm. Saccular aneurysms of the external jugular vein are uncommon and only rarely lead to serious complications. Access to ultrasound examination can allow early detection of this entity.

Journal of Medical Case Reports, 2008

Introduction: Popliteal venous aneurysms are uncommon but potentially fatal vascular disorders. T... more Introduction: Popliteal venous aneurysms are uncommon but potentially fatal vascular disorders. They can be symptomatic or asymptomatic, mimicking different conditions. Popliteal venous aneurysms are possible sources of embolism. Case presentation: A 68-year-old woman presented at a rural primary health care unit in Crete, Greece, reporting local symptoms of discomfort in the right popliteal fossa with pain during palpation. Colour Doppler ultrasonography revealed local widening and saccular dilatation in the right distal popliteal vein. The diagnosis of a popliteal venous aneurysm was formulated. Conclusion: Popliteal venous aneurysms are rare conditions, but are potentially more common than usually thought in daily practice. Physician awareness and access to ultrasound examination may allow for early diagnosis, before the occurrence of any thromboembolic or other major complication.

International Journal of Medical Sciences, 2012

The objective of this brief communication was to tabulate common reasons for encounter in a Greek... more The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented.

BMC Family Practice, 2011

Background: Research has indicated that general practitioners (GPs) have good clinical judgment i... more Background: Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods: The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results: The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions: The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

Annals of General Psychiatry, 2010

Background: The aim of the current study was to assess the reliability and validity of the Greek ... more Background: The aim of the current study was to assess the reliability and validity of the Greek translation of the Short Anxiety Screening Test (SAST), for use in primary care settings. The scale consists of 10 items and is a brief clinician rating scale for the detection of anxiety disorder in older people, particularly, in the presence of depression. Methods: The study was performed in two rural primary care settings in Crete. The sample consisted of 99 older (76 ± 6.3 years old) people, who fulfilled the participating criteria. The translation and cultural adaptation of the questionnaire was performed according to international standards. Internal consistency using the Cronbach α coefficient and test-retest reliability using the intraclass correlation coefficient (ICC) was used to assess the reliability of the tool. An exploratory factor analysis using Varimax with Kaiser normalisation (rotation method) was used to examine the structure of the instrument, and for the correlation of the items interitem correlation matrix was applied and assessed with Cronbach α. Results: Translation and backtranslation did not reveal any specific problems. The psychometric properties of the Greek version of the SAST scale in primary care were good. Internal consistency of the instrument was good, the Cronbach α was found to be 0.763 (P < 0.001) and ICC (95% CI) for reproducibility was found to be 0.763 (0.686 to 0.827). Factor analysis revealed three factors with eigenvalues >1.0 accounting for 60% of variance, while the Cronbach α was >0.7 for every item. Conclusions: The Greek translation of the SAST questionnaire is comparable with that of the original version in terms of reliability, and can be used in primary healthcare research. Its use in clinical practice should be primarily as a screening tool only at this stage, with a follow-up consisting of a detailed interview with the patient, in order to confirm the diagnosis.

Rural and remote health, 2013

© I Tsiligianni, F Anastasiou, M Antonopoulou, K Chliveros, S Dimitrakopoulos, G Duijker, D Kouna... more © I Tsiligianni, F Anastasiou, M Antonopoulou, K Chliveros, S Dimitrakopoulos, G Duijker, D Kounalakis, K Makri, C Petraki, D Prokopiadou, I Stefanaki, E Symvoulakis, N Tsakountakis, T Vasilopoulos, C Vittorakis, C Lionis, on behalf of the Cretan Practice based Primary Care Research Network ‘G. Lambrakis’ and Clinic of Social and Family Medicine, School of Medicine, University of Crete, 2013. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 1

Annals of General …, Jan 1, 2010

BACKGROUND: Research has indicated that general practitioners (GPs) have good clinical judgment i... more BACKGROUND:
Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece.

METHODS:
The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GPs from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25,000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST).

RESULTS:
The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 +/- 3.9 vs. 21.1 +/- 5.7; p=0.029).

CONCLUSIONS:
The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

The management capabilities and performance of primary health care (PHC) can be improved by stren... more The management capabilities and performance of primary health care (PHC) can be improved by strengthening the information system. This study focuses on the Palestinian Health Management Information System (HMIS), used in PHC and reports on the achievements and shortcomings. A retrospective review and content analysis of the HMIS documentation was carried out and a Strengths, Weaknesses, Opportunities, and Threats (SWOT)

Journal of medical systems, 2003

The creation of an electronic patient record (EPR) system with a user-friendly interface based on... more The creation of an electronic patient record (EPR) system with a user-friendly interface based on the concept of the episode of care was considered an urgent priority in the present Greek context, where a Health Care Reform program is in progress. This paper reports the procedures of developing an EPR system, and outlines some of its essentials and key issues. We performed a systematic review and analyzed the perceptions and patterns of use of existing EPR systems among Greek general practitioners. On the basis of this analysis, Transhis was selected using defined criteria for appropriateness, efficiency, and feasibility for general practice as a prototype, for creating a Windows-based EPR system using the International Classification of Primary Care (ICPC-2) and International Classification of Diseases (ICD-10) as classifications. The new EPR system seems appropriate for use within the current Greek primary care setting. Further studies are required for its evaluation.

International Journal of Medical Informatics, 2000

The design, implementation, and utilization of an electronic medical record system (EMRS) in a pe... more The design, implementation, and utilization of an electronic medical record system (EMRS) in a pediatric psychopharmacology clinic is described. The EMRS is a relational database with information entered directly by the clinician during a patient visit. It has been used during more than 2590 patient visits with 805 patients. Complete clinical documentation and simultaneous data entry as well as computer generated prescriptions for the patient were accomplished 75% of the time within a 20-min medication management session. One hundred consecutive parents of patients were asked to fill out a five-question survey to begin to assess the impact of the application. Of the 87 parents who responded, all (100%) noted that the doctor paid attention to their concerns. Between 88 and 90% of the parents reported that the use of the computer is a 'good' thing, made it easier to work with the doctor, and that they understood why the computer was being used. The findings support that the development and implementation of an EMRS with direct clinician information entry within pediatric psychopharmacology clinic, is feasible.