Use and Misuse of Emergency Medical services by Neurological patients presenting to a Greek Tertiary Health Care facility

Dermitzakis E., Rudolf J., Gravas I., Kyriakidis P., Bouziani C., Georgiadis G., Tsiptsios I.

Department of Neurology, General Hospital "Papageorgiou", Thessaloniki, Greece

Background:
With a population of about 1.000.000 inhabitants, Metropolitan Thessalo­niki is the second largest town in Greece and the capital of the region of Macedonia. Among the city?s 12 public hospitals, Papageorgiou General Hospital is one of its four tertiary health care facilities. In the metropolitan areas of Athens and Thessaloniki, public hos­pitals are on-call not on a daily, but on a one-in-four-days rotation basis. This sys­­tem leads to an immense number of patients that presents every day to the Emer­gen­cy Outpatient Departments (EOD) of Greek public hospitals, but exact data on the use (and maybe misuse) of public health facilities remain scarce.

Methods:
In a prospective observational study, demographic and medical data were col­lec­ted from all patients presenting for a presumed neurological disorder to the EOD of Papageorgiou General Hospital, with special respect to the use of public emergency transport services (PETS). The study covered the time period from 1.2.2006 to 31.1.2007.

Results:
The absolute number of patients examined for a presumed neurological disor­der during the study period was 5901. Final diagnosis was stroke (all subtypes) in 36.3%, vertigo in 13.4%, episodic loss of consciousness in 9.6%, psychiatric disorder in 9.4%, epileptic fits in 7.9%, headache in 4.2%, stupor or coma in 4.2% and other diag­no­sis in 15.0% of the patients. From this total of 5901 patients, 1242 (21,0%) used PETS for their transportation to the EOD.  In summer (June to August), PETS were used by 17.9% of the patients, while this percentage rose to 22.8% in winter (Novem­ber - January).  Only 705 (56.8%) of these 1242 patients that used PETS for transport­tation were eventually admitted to a hospital ward.

Conclusion:
The Greek National Health System is hospital-based.  The paucity of public primary health care facilities forces patients to present immediately to a secondary or tertiary health care facility.  Inevitably, this results in a misuse of PETS that becomes evident from the fact that more than 40% of the patients presenting to the EOD using PETS were not even admitted to hospital.  Thus, misuse of PETS increases the finan­cial burden of the Greek National Health System.