Outhospital emergency medicine experience of SOS Doctors, Athens, Greece
George Peppas,MD, Spyridon Barbas, MD,Michael Savvidis, MD, Christos Tsakonas, MD, Spiropoulos Theodore, MD, George Theocharis, MD
House calls remain an important but underestimated part of medical care in Europe. House calls can be characterized as part of primary care medicine. When house calls are performed by organized, 24hour based medical organizations, then a big part of them can be characterized as emergency medicine cases. SOS Doctors, Athens, Greece, is an organized 24 hour based network of specialized physicians that performs house calls.
Object:
To present a model of outhospital emergency medicine according to the
SOS Doctors, Athens, experience.
Material:
We analyzed retrospectively for the year 2009 the data for 37.063 cases dealt by SOS Doctors, concerning sex and age of the patients and the principal complaints versus the final diagnoses after doctor’s visit.
Results:
From the total of 37.063 house calls performed during the evaluated period, the most frequent principal complaints were: fever for 6.937 (18.7%) cases, abdominal pain for 1.716 (4.6 %), vomiting for 1.522 (4.1%), cough for 1.322 (3.6%), dizziness and/or vertigo for 1.209 (3.3%), hypertension for 1.205 (3.2%), respiratory distress for 822 (2.2%), diarrhea for 671 (1.8%), chest pain for 548 (1.5%), lumbar pain for 493 (1.3%), fainting for 491 (1.3%), sore throat for 473 (1.3%) and headache for 423 (1.1%).
Patients older than 65 years requested 56.2% of the house calls followed by patients aged between 41-65 (21%). Females requested more house calls during the studied period compared to males (60.9% versus 39.1%).
Regarding the emergency nature of the cases, finally 29.031 (80.4%) of those were characterized as urgent. The most frequent diagnoses were: infections of the upper respiratory tract for 6.294 (17%), gastroenteritis for 1.877 (5.1%), hypertension for 1.231 (3.3%), vertigo for 1.076 (2.9%), urinary tract infections for 602 (1.6%) and stress disorders for 578 (1.6%).
A total of 7.082 (19.6%) can be characterized as non urgent medical cases. Most frequent diagnoses were: urinary catheterization for 736 (10.4%), insertion of nasogastric tube for 350 (4.9%), treatment of decubitus ulcers for 291 (4.1%), constipation for 198 (2.8%) and dementia for 195 (2.8%).
Hospital admission rate was 6.5% after the evaluation at home for the urgent cases and only 0.4% of patients of non urgent cases.
Discussion:
The main finding of our study is that house calls organized on a 24hour basis can be an alternative way of management for a considerable part of emergency cases in big cities. We consider that house calls for acute cases are an integral part of emergency medicine and that community emergency medicine need to be reorganized with doctors offering upgraded, immediate care in patients’ houses. This kind of medicine is important for management of epidemics of influenza or gastroenteritis and also for a big variety of emergency cases that can be controlled in patients’ house without transfer in the Hospital Emergency Departments.
Conclusion:
According to the experience of SOS Doctors, Athens, house calls can be considered as an effective form of emergency medical care, especially for the elderly patients. Providing 24 hours availability, in home diagnosis and treatment of emergency medical cases may contribute to a better quality of medical care, which is well appreciated by the patients, especially the elderly, and may reduce overcrowding of Hospital Emergency Departments.