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Korompoki E, Ntaios G, Tountopoulou A, Mavraganis G, Tsampalas E, Kalliontzakis I, Vassilopoulou S, Manios E, Savopoulos C, Milionis H, Protogerou A, Kakaletsis N, Galanis P, Kaitelidou D, Siskou O, Vemmos K. Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P). J Clin Med 2024; 13:917. [PMID: 38337611 PMCID: PMC10856279 DOI: 10.3390/jcm13030917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
AIM The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. METHODS This prospective multicenter study included consecutive patients admitted to nine hospitals across Greece in 2019-2021. Descriptive statistics were used to present patients' characteristics, key performance measures and stroke outcomes. RESULTS Among 892 patients, 755 had ischemic stroke (IS) (mean age 75.6 ± 13.6, 48.7% males) and 137 had hemorrhagic stroke (HS) (mean age 75.8 ± 13.2, 57.7% males). Of those, 15.4% of IS and 8% of HS patients were treated in the acute stroke unit (ASU) and 20.7% and 33.8% were admitted to the intensive care unit (ICU) or high-dependency unit (HDU), respectively. A total of 35 (4.6%) out of 125 eligible patients received intravenous alteplase with a door-to needle time of 60 min (21-90). The time to first scan for IS patients was 60 min (31-105) with 53.2% undergoing a CT scan within 60 min post presentation. Furthermore, 94.4% were discharged on antiplatelets, 69.8% on lipid-lowering therapy and 61.6% on antihypertensives. Oral anticoagulants (OAC) were initiated in 73.2% of the 153 IS patients with atrial fibrillation (AF). Among the 687 IS patients who survived, 85.4% were discharged home, 12% were transferred to rehabilitation centers, 1.2% to nursing homes and 1.3% to another hospital. CONCLUSIONS The SUN4P Registry is the first study to provide data from a prospectively collected cohort of consecutive patients from nine representative national hospitals. It represents an important step in the evaluation and improvement of the quality of acute stroke care in Greece.
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Affiliation(s)
- Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;
| | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.T.); (S.V.)
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | | | | | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.T.); (S.V.)
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Athanasios Protogerou
- Clinic-Laboratory of Pathophysiology, First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikolaos Kakaletsis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, 54643 Thessaloniki, Greece;
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
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Siskou O, Galanis P, Konstantakopoulou O, Stafylas P, Karagkouni I, Tsampalas E, Garefou D, Alexopoulou H, Gamvroula A, Lypiridou M, Kalliontzakis I, Fragkoulaki A, Kouridaki A, Tountopoulou A, Kouzi I, Vassilopoulou S, Manios E, Mavraganis G, Vemmou A, Karagkiozi E, Savopoulos C, Dimas G, Myrou A, Milionis H, Siopis G, Evaggelou H, Protogerou A, Samara S, Karapiperi A, Kakaletsis N, Papastefanatos G, Papastefanatos S, Sourtzi P, Ntaios G, Vemmos K, Korompoki E, Kaitelidou D. The Cost and the Value of Stroke Care in Greece: Results from the SUN4P Study. Healthcare (Basel) 2023; 11:2545. [PMID: 37761742 PMCID: PMC10530928 DOI: 10.3390/healthcare11182545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this study was to measure the one-year total cost of strokes and to investigate the value of stroke care, defined as cost per QALY. The study population included 892 patients with first-ever acute strokes, hemorrhagic strokes, and ischemic strokes, (ICD-10 codes: I61, I63, and I64) admitted within 48 h of symptoms onset to nine public hospitals located in six cities. We conducted a bottom-up cost analysis from the societal point of view. All cost components including direct medical costs, productivity losses due to morbidity and mortality, and informal care costs were considered. We used an annual time horizon, including all costs for 2021, irrespective of the time of disease onset. The average cost (direct and indirect) was extrapolated in order to estimate the national annual burden associated with stroke. We estimated the total cost of stroke in Greece at EUR 343.1 mil. a year in 2021, (EUR 10,722/patient or EUR 23,308 per QALY). Out of EUR 343.1 mil., 53.3% (EUR 182.9 mil.) consisted of direct healthcare costs, representing 1.1% of current health expenditure in 2021. Overall, productivity losses were calculated at EUR 160.2 mil. The mean productivity losses were estimated to be 116 work days with 55.1 days lost due to premature retirement and absenteeism from work, 18.5 days lost due to mortality, and 42.4 days lost due to informal caregiving by family members. This study highlights the burden of stroke and underlines the need for stakeholders and policymakers to re-organize stroke care and promote interventions that have been proven cost-effective.
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Affiliation(s)
- Olga Siskou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
- Department of Tourism Studies University of Piraeus, 185 34 Piraeus, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
| | | | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
| | - Evangelos Tsampalas
- Department of Neurology, Panarkadikon General Hospital, 221 00 Tripoli, Greece
| | - Dafni Garefou
- Department of Neurology, Panarkadikon General Hospital, 221 00 Tripoli, Greece
| | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, 221 00 Tripoli, Greece
| | - Anastasia Gamvroula
- Department of Neurology, Panarkadikon General Hospital, 221 00 Tripoli, Greece
| | - Maria Lypiridou
- Department of Neurology, Panarkadikon General Hospital, 221 00 Tripoli, Greece
| | | | | | - Aspasia Kouridaki
- Department of Neurology, General Hospital of Chania, 733 00 Creta, Greece
| | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (A.T.)
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (A.T.)
| | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (A.T.)
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece (E.K.)
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece (E.K.)
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece (E.K.)
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 413 34 Larissa, Greece (G.N.)
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, 546 36 Thessaloniki, Greece
| | - Gregorios Dimas
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, 546 36 Thessaloniki, Greece
| | - Athina Myrou
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, 546 36 Thessaloniki, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Georgios Siopis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Hara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Athanasios Protogerou
- Cardiovascular Prevention & Research Unit, Laiko General Hospital of Athens at the Medical School, National & Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Stamatina Samara
- Cardiovascular Prevention & Research Unit, Laiko General Hospital of Athens at the Medical School, National & Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Asteria Karapiperi
- Cardiovascular Prevention & Research Unit, Laiko General Hospital of Athens at the Medical School, National & Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Nikolaos Kakaletsis
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece
| | - George Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
- Information Management Systems Institute, ATHENA Research Center, 151 25 Athens, Greece
| | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
| | - Panayota Sourtzi
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 413 34 Larissa, Greece (G.N.)
- Hellenic Stroke Organization, 115 28 Athens, Greece;
| | | | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece (E.K.)
- Hellenic Stroke Organization, 115 28 Athens, Greece;
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian, University of Athens, 115 27 Athens, Greece (D.K.)
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Korompoki E, Ntaios G, Milionis H, Manios E, Mavraganis G, Sagris D, Savopoulos C, Tsampalas E, Kalliotzakis I, Tountopoulou A, Vassilopoulou S, Kouzi I, Galanis P, Konstantakopoulou O, Karagouni I, Papastefanatos S, Kaitelidou D, Vemmos K, Siskou O. Stroke Patients' Management During COVID-19 Pandemic: Results from the Sun4Patients Web-Based Registry. Stud Health Technol Inform 2023; 305:464-468. [PMID: 37387066 DOI: 10.3233/shti230532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Covid-19 pandemic has influenced stroke care in different ways. Recent reports demonstrated a sharp decline in acute stroke admissions worldwide. Even for patients presented to dedicated healthcare services, management at the acute phase may be sub-optimal. On the other hand, Greece has been praised for the early initiation of restriction measures which were associated with a 'milder' surge of SARS-CoV-2 infection. Methods Data derived from a prospective cohort multicenter registry. The study population consisted of first-ever acute stroke patients, hemorrhagic or ischemic, admitted within 48 hours of symptom onset in seven national healthcare system (NHS) and University hospitals in Greece. Two different time periods have been considered, defined as "before Covid-19" (15/12/2019-15/02/2020) and "during Covid-19" (16/02/2020-15/04-2020) era. Statistical comparisons on acute stroke admission characteristics between the two different time periods have been performed. Results This exploratory analysis of 112 consecutive patients showed a reduction of acute stroke admissions by 40during Covid-19 period. No significant differences were observed regarding stroke severity, risk factor profile and baseline characteristics for patients admitted before and during Covid-19 pandemic period. There is a significant delay between symptom onset to CT scan during Covid-19 era compared to the period before pandemic reached Greece (p=0.03). Conclusions The rate of acute stroke admissions has been reduced by 40% during Covid-19 pandemic. Further research is needed to clarify whether the reduction in stroke volume is actual or not and identifying the reasons underlying the paradox.
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Affiliation(s)
- Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Giorgos Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | | | - Argyro Tountopoulou
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vassilopoulou
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Iliana Karagouni
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Vemmos
- Hellenic Stroke Organization, Hellenic Cardiovascular Research Society, Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Galanis P, Konstantakopoulou O, Karagkouni I, Gallos P, Tsampalas E, Lypiridou M, Gamvroula A, Mavraganis G, Manios E, Ntaios G, Karagkiozi E, Milionis H, Evangelou C, Tountopoulou A, Kouzi I, Vassilopoulou S, Protogerou A, Samara S, Karapiperi A, Savopoulos C, Hatzitolios AI, Myrou A, Kalliontzakis I, Kouridaki A, Papastefanatos S, Papastefanatos G, Vemmos K, Sourtzi P, Bellali T, Korompoki E, Kaitelidou D, Siskou O. Assessing Staff's and Stroke Patients' Experiences in 8 Hospitals in Greece: Results from a Prospective Multi-Center Study ("SUN4Patients"). Stud Health Technol Inform 2022; 289:392-396. [PMID: 35062174 DOI: 10.3233/shti210941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED To assess stroke patient-reported experiences and hospital staff experiences, during hospital stay. METHODS Stroke patient-reported experiences (n=387) were recorded using the translated and culturally adapted NHS-Stroke Questionnaire into Greek and staff experiences (n=236) were investigated using the Compassion Satisfaction and Burnout subscales of the ProQOL questionnaire. RESULTS Staff's mean compassion satisfaction score was 39.2 (SD=6.3) and mean burnout score was 24.3 (SD=5.6). Only 38.5% of the staff stated that there is smooth cooperation with healthcare professionals of other specialties/disciplines. Personnel working in an NHS Hospital was more satisfied and less burned-out when compared to personnel working at a University Hospital (p=0.02 and p<0.001, respectively). Mean total patient-reported experiences score was 81.9 (SD=9.5). Bivariate analysis revealed statistically significant differences for total patient-reported experiences among the eight study hospitals (p>0.001). CONCLUSIONS Health policy planners and decision-makers must take into consideration the results of such self-reported measures to establish innovative techniques to accomplish goals such as staff-specialization, continuous training and applying formal frameworks for efficient cooperation amongst different disciplines.
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Affiliation(s)
- Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | | | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | - Paris Gallos
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | | | - Maria Lypiridou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, NKUA, Athens, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, NKUA, Athens, Greece
| | - George Ntaios
- Hellenic Stroke Organization, Athens, Greece
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | - Chara Evangelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | | | - Ioanna Kouzi
- Department of Neurology, Eginition Hospital, NKUA, Athens, Greece
| | | | - Athanasios Protogerou
- Cardiovascular Prevention & Research Unit, Laiko General Hospital, Medical School NKUA, Athens, Greece
| | - Stamatina Samara
- Cardiovascular Prevention & Research Unit, Laiko General Hospital, Medical School NKUA, Athens, Greece
| | - Asteria Karapiperi
- Cardiovascular Prevention & Research Unit, Laiko General Hospital, Medical School NKUA, Athens, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | | | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | | | | | - Panayiota Sourtzi
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | - Thalia Bellali
- Department of Nursing, International Hellenic University, Thessaloniki, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, NKUA, Athens, Greece
- Hellenic Stroke Organization, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
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Siskou O, Galanis P, Konstantakopoulou O, Karagkouni I, Tsampalas E, Garefou D, Alexopoulou H, Gamvroula A, Kalliontzakis I, Fragkoulaki A, Kouridaki A, Tountopoulou A, Kouzi I, Vassilopoulou S, Manios E, Mavraganis G, Ntaios G, Karagkiozi E, Louka AM, Savopoulos C, Dimas G, Myrou A, Milionis H, Siopis G, Evaggelou H, Protogerou A, Samara S, Karapiperi A, Kakaletsis N, Gallos P, Papastefanatos S, Sourtzi P, Vemmos K, Korompoki E, Kaitelidou D. Inpatient Cost of Stroke Care in Greece: Preliminary Results of the Web-Based "SUN4P" Registry. Stud Health Technol Inform 2022; 289:439-442. [PMID: 35062185 DOI: 10.3233/shti210952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED The aim of this study was to calculate the average operational cost per sub-type of stroke patient and to investigate cost drivers (e.g. ALoS, NIHSS score, age) correlated to cost. METHODS Direct medical costs (diagnostic imaging and clinical laboratory exams, overheads/bed cost, pharmaceuticals, ringers and other non-durables and inpatient rehabilitation) per patient were calculated from the providers' (hospitals') perspective. Resource use data derived from the "SUN4P" web-based registry and unit costs were retrieved from publically available sources and were assigned to resource use. RESULTS The sample comprised 6,282 inpatient days of 750 patients (mean age: 75.5±13.3 years) admitted from July 2019 to July 2021, in nine public hospitals. Mean length of stay was 8.4±7.6 days and mean total operational cost was calculated to €1,239.4 (from which 45% and 35% related to diagnostic exams and overheads/bed cost respectively). Mean cost related to hemorrhagic stroke patients that were discharged alive was calculated significantly higher compared to mean cost related to ischemic stroke patients who didn't undertake thrombolysis and were also discharged alive from the hospital (€2,155.2 vs. €945.2, p<0.001). Linear regression analysis revealed that length of stay was significantly correlated with cost (coefficient beta=232, 95% CI confidence interval = 220-243, p<0.001). CONCLUSIONS These findings are in accordance with current evidence and should be thoroughly assessed to rationalize inpatient reimbursement rates in order to achieve improved value of care.
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Affiliation(s)
- Olga Siskou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dafni Garefou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Ntaios
- Hellenic Stroke Organization, Greece
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anna Maria Louka
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Gregorios Dimas
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Siopis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Hara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Athanasios Protogerou
- Cardiovascular Prevention & Research Unit in Laiko General Hospital of Athens at the Medical School of the National & Kapodistrian University of Athens, Greece
| | - Stamatina Samara
- Cardiovascular Prevention & Research Unit in Laiko General Hospital of Athens at the Medical School of the National & Kapodistrian University of Athens, Greece
| | - Asteria Karapiperi
- Cardiovascular Prevention & Research Unit in Laiko General Hospital of Athens at the Medical School of the National & Kapodistrian University of Athens, Greece
| | - Nikolaos Kakaletsis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, Greece
| | - Paris Gallos
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayota Sourtzi
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Stroke Organization, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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6
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Mavraganis G, Korompoki E, Tsampalas E, Garefou D, Alexopoulou H, Lypiridou M, Kalliontzakis I, Fragkoulaki A, Kouridaki A, Tountopoulou A, Kouzi I, Vassilopoulou S, Karagkiozi E, Louka AM, Manios E, Vemmou A, Savopoulos C, Dimas G, Myrou A, Milionis H, Siopis G, Evaggelou H, Protogerou A, Samara S, Karapiperi A, Kakaletsis N, Karagkouni I, Konstantakopoulou O, Galanis P, Kaitelidou D, Papastefanatos S, Vemmos K, Ntaios G, Siskou O. Stroke Units Necessity for Patients, Web-Based "SUN4P" Registry: Descriptive Characteristics of the Population. Stud Health Technol Inform 2022; 289:325-328. [PMID: 35062158 DOI: 10.3233/shti210925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to present the descriptive characteristics of the Stroke Units Necessity for Patients (SUN4P) registry. METHODS The study population derived from the web-based SUN4P registry included 823 patients with first-ever acute stroke. Descriptive statistics were used to present patients' characteristics. RESULTS The vast majority of patients (80.4%) had an ischemic stroke, whereas 15.4% had a hemorrhagic stroke. Hypertension was the leading risk factor in both patients. The patients with ischemic stroke had higher prevalence of traditional cardiovascular risk factors such as diabetes mellitus, dyslipidemia and smoking and most commonly cryptogenic stroke (39%). National Institutes of Health Stroke Scale (NIHSS) was higher among patients with hemorrhagic in comparison to those with ischemic stroke (10.5 vs 6 respectively). Moreover, all patients had similar rate of disability prior to stroke, as shown by Modified Rankin Scale (mRS=0). CONCLUSIONS These data are in accordance with current evidence and should be thoroughly assessed in order to ensure optimal therapeutic management of stroke patients.
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Affiliation(s)
- Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Stroke Organization, Greece
| | | | - Dafni Garefou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | - Maria Lypiridou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anna-Maria Louka
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Gregorios Dimas
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Siopis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Hara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Athanasios Protogerou
- Cardiovascular Prevention & Research Unit in Laiko General Hospital of Athens at the Medical School of the National & Kapodistrian University of Athens, Greece
| | - Stamatina Samara
- Cardiovascular Prevention & Research Unit in Laiko General Hospital of Athens at the Medical School of the National & Kapodistrian University of Athens, Greece
| | - Asteria Karapiperi
- Cardiovascular Prevention & Research Unit in Laiko General Hospital of Athens at the Medical School of the National & Kapodistrian University of Athens, Greece
| | - Nikolaos Kakaletsis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, Greece
| | - Iliana Karagkouni
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Ntaios
- Hellenic Stroke Organization, Greece.,Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
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7
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Karantali E, Vemmos K, Tsampalas E, Xynos K, Karachalia P, Lambrou D, Angeloglou S, Kazakou M, Karagianni A, Aravantinou-Fatorou K, Karakatsani E, Bots ML, Karamatzianni G, Bellos S, Ntiloudis R, Lypiridou M, Gamvoula A, Georgiopoulos G, Ajdini E, Gatselis N, Makaritsis K, Korompoki E, Ntaios G. Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study. Int J Stroke 2021; 17:37-47. [PMID: 33527879 DOI: 10.1177/1747493021995594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stroke incidence and case-fatality are reported to decline in high-income countries during the last decades. Epidemiological studies are important for health services to organize prevention and treatment strategies. AIMS The aim of this population-based study was to determine temporal trends of stroke incidence and case-fatality rates of first-ever stroke in Arcadia, a prefecture in southern Greece. METHODS All first-ever stroke cases in the Arcadia prefecture were ascertained using the same standard criteria and multiple overlapping sources in three study periods: from November 1993 to October 1995; 2004; and 2015-2016. Crude and age-adjusted to European population incidence rates were compared using Poisson regression. Twenty-eight days case fatality rates were estimated and compared using the same method. RESULTS In total, 1315 patients with first-ever stroke were identified. The age-standardized incidence to the European population was 252 per 100,000 person-years (95% CI 231-239) in 1993/1995, 252 (95% CI 223-286) in 2004, and 211 (192-232) in 2015/2016. The overall age- and sex-adjusted incidence rates fell by 16% (incidence rates ratio 0.84, 95% CI: 0.72-0.97). Similarly, 28-day case-fatality rate decreased by 28% (case fatality rate ratio = 0.72, 95% CI: 0.58-0.90). CONCLUSIONS This population-based study reports a significant decline in stroke incidence and mortality rates in southern Greece between 1993 and 2016.
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Affiliation(s)
- Eleni Karantali
- Neurological Department, Arcadia General Hospital, Tripoli, Greece.,Third Neurological Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Internal Medicine, University of Thessaly, Larissa, Greece
| | | | | | | | | | | | | | - Maria Kazakou
- Neurological Department, Arcadia General Hospital, Tripoli, Greece
| | | | | | | | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Stavros Bellos
- Neurological Department, Arcadia General Hospital, Tripoli, Greece
| | | | - Maria Lypiridou
- Neurological Department, Arcadia General Hospital, Tripoli, Greece
| | | | | | - Erold Ajdini
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Nikolaos Gatselis
- Department of Internal Medicine, University of Thessaly, Larissa, Greece
| | | | - Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - George Ntaios
- Department of Internal Medicine, University of Thessaly, Larissa, Greece.,Hellenic Stroke Organization, Athens, Greece
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8
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Siskou O, Korompoki E, Ntaios G, Tsampalas E, Alexopoulou H, Kalliontzakis I, Kouridaki A, Tountopoulou A, Kouzi I, Vasilopoulou S, Milionis H, Evaggelou H, Karagkiozi E, Hatzitolios AI, Savopoulos C, Myrou A, Manios E, Mavraganis G, Vemmou A, Kaitelidou D, Galanis P, Papastefanatos S, Konstantakopoulou O, Karagkouni I, Vemmos K. Access of Stroke Patients' to Optimal Healthcare Technology in Greece: Messages to Policy Makers. Stud Health Technol Inform 2020; 272:421-424. [PMID: 32604692 DOI: 10.3233/shti200585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to evaluate accessibility of stroke patients to optimal healthcare technology in Greece. Methods: The study population consisted of 313 first ever stroke patients derived from the "Stroke Units Necessity for Patients, SUN4P" registry. Descriptive statistics were used, to present patients' characteristics and resources utilization Results: The vast majority of patients (91.7%) conducted a CT scan during the acute phase (within the first 24hours). Almost, (65%) were admitted to wards of Internal Medicine Departments, whereas only 21% of patients were admitted to a Stroke Unit. Of note, a total of 6.9% of ischemic stroke patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA). Conclusions: Preliminary results from SUN4P underline the urgent necessity for the re-organization of acute stroke care in Greece, as rates of admissions to stroke units and rtPA treatment during the acute phase are currently below optimal.
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Affiliation(s)
- Olga Siskou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Stroke Organization, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Hellenic Stroke Organization, Greece
| | | | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Vasilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Hara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos I Hatzitolios
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
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9
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Konstantakopoulou O, Galanis P, Kaitelidou D, Karagkouni I, Korompoki E, Ntaios G, Vemmos K, Papastefanatos S, Papastefanatos G, Tsampalas E, Alexopoulou H, Kalliontzakis I, Kouridaki A, Tountopoulou A, Kouzi I, Milionis H, Evaggelou C, Karagkiozi E, Hatzitolios AI, Savopoulos C, Myrou A, Mavraganis G, Vemmou A, Siskou O. Developing Patients' Experiences Database After Hospital Discharge: Another Step in Improving Stroke Care. Stud Health Technol Inform 2020; 272:441-444. [PMID: 32604697 DOI: 10.3233/shti200590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess stroke patients' experiences in regards to hospital stay and during discharge. A cross-sectional study with retrospective data collection was conducted including patients (n=135) with first-ever acute stroke, who were admitted in seven Public Hospitals in Greece ("Stroke Units Necessity for Patients, SUN4P" registry). The translated version of the NHS-Stroke Questionnaire in the Greek was used. 48.2% of patients rated their overall experience from the care they received as very good/excellent. 66% of patients reported that they participated in decision making about their care and 21.5% reported not having received help from the hospital's social services regarding any benefits/aids, thus lowering their overall patient experience score (p=0.017). Decision and policymakers must consider factors affecting stroke patients 'experiences during their hospitalization. The development of a national stroke patients' experiences database can help prioritize relevant actions and draw up a commonly accepted management and services redesign framework for patients.
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Affiliation(s)
- Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece.,Hellenic Stroke Organization, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece.,Hellenic Stroke Organization, Greece
| | | | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | | | | | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Chara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - Apostolos I Hatzitolios
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
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