Global financial crisis and surgical practice: the Greek paradigm

Recent trends (2010-2018) in traumatic brain injury in Greece: Results on 2042 patients

BACKGROUND

Recent analysis on the epidemiology of traumatic brain injury (TBI) within Europe indicates an increase in fall-related injuries and in the incidence of hospitalization among older adults as well as a decrease in contribution of road traffic accidents (RTA). Given the paucity of recent national data, we analyzed TBI-related admissions from the Athens Head Trauma Registry during the largest part of the past decade (2010-2018), a period marked by a profound national socioeconomic crisis.

METHODS

Demographic and clinical data of admitted TBI patients were collected and analyzed statistically.

RESULTS

The mean age of patients (N=2042, 68% men) was 59 years (median 64 years). Patient age showed an upward trend across the study period. Most cases were mild, while moderate and severe injuries were indicated in, 11% and 20%, respectively. Falls were the predominant cause of injury (46% of cases), followed by RTA (38%). An upward trend in the frequency of fall-related injury was apparent across the study period; RTA-related injury frequency displayed a downward trend during the second part of the study period. Assault-related injury accounted for 6%. Surgery took place in 11% of cases. In-hospital mortality (IHM) was 21%. Fall-related mortality contributed to 56% of total IHM; RTA-related mortality contributed to 30%. The mean length of hospital stay was 13 days (median: 5 days).

CONCLUSIONS

The present findings suggest a shift in the epidemiologic profile of TBI patients in Greece with a rise in the proportion of elderly patients, a concomitant increase in fall-related injuries and a reduction in RTA-related injury. They also highlight fall-related injury as the predominant cause of IHM. Our results point towards the urgent need for the intensification of fall prevention strategies, continuing medical education as well as public information campaigns on the risks of geriatric fall-related injury.

Ophthalmology Training in Greece as Perceived by Resident Ophthalmologists in the Times of Crisis: A National, Questionnaire-based Survey

Purpose:

To assess the level of perceived satisfaction with the current level of ophthalmology training in Greece from the perspective of residents and to identify deficiencies in the training curriculum.

Methods:

This is a prospective, cross-sectional questionnaire-based study. An online, semi-structured questionnaire was designed to evaluate ophthalmology residents' extent of satisfaction with the quality of their postgraduate medical training. The survey was divided in two parts: demographics and evaluation of training. Resident ophthalmologists in all teaching hospitals in Greece were contacted and encouraged to complete it.

Results:

A response rate of 53.8% was achieved. Two out of three participants stated their disappointment with the quality of training they received and deemed the four-year residency training program as insufficient. Surgical training was also viewed as unsatisfactory by the majority of the respondents. An interest in subspecialty training, as well as a significant participation in research activities, was noted.

Conclusions:

Both training and overall satisfaction with working conditions must be improved to preserve the appeal of ophthalmology for young academics. A new, structured curriculum, reduction of unnecessary bureaucracy, and improved surgical training rank among the most essential priorities in order to improve postgraduate ophthalmology training.

The effect of financial crisis on the profile of the patients examined at the surgical emergencies of an academic institution in Greece

BACKGROUND

Greece is suffering an economic recession of enormous magnitude, but whether its health has deteriorated as a result, has not yet been well established. We aim to present and analyze differences in demographics and clinical distribution of patients examined at the emergency room (ER) in the era of financial crisis.

METHODS

A retrospective data analysis of all patients that were examined to surgical ER, between January 1st 2008 and December 31st 2014, was conducted. We only analyzed and evaluated data for the years 2008, 2011 and 2014. We evaluated the etiology of the examination (main complaint of the patient), the gender, the ethnic origin, the age and the severity of the disease, whenever it was feasible. The diseases that presented differences that were statistically significant were analyzed in terms of medical, social and financial aspects.

RESULTS

The number of patients being examined in the ER in 2011 was higher compared with that of 2014 and to 2008 respectively (P<0.05). Throughout the years, there was a decline in vascular emergencies (veins, arteries, AAA; P<0.05). An increased incidence of soft tissue infections (STIs) was also found (P<0.05). Finally, an increased incidence of anal diseases and patients with abdominal pain was also noted (P<0.05).

CONCLUSIONS

Financial crisis seems to have a multivariable effect on epidemiology and clinical diversity of patients being examined in the ER.

Health policy making under information constraints: an evaluation of the policy responses to the economic crisis in Greece

INTRODUCTION

Cost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities.

METHODS

Drawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections.

RESULTS

Between 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed.

CONCLUSION

Cost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals' right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system.

A virtual outpatient department provides a satisfactory patient experience following endoscopy

PURPOSE

The purpose of this study was to investigate telephone follow-up of post-endoscopy patients as an alternative to attendance at the outpatient department.

METHODS

Access to outpatient appointments is often a target for improvement in healthcare systems. Increased outpatient clinic capacity is not feasible without investment and extra manpower in an already constrained service. Outpatient attendance was audited at a busy colorectal surgical service. A subset of patients appropriate for follow-up in a "virtual outpatient department" (VOPD) were identified. A pilot study was designed and involved telephone follow-up of low-risk endoscopic procedures. Patient satisfaction was assessed using the Medical Interview Satisfaction Scale (MISS), which is a standardised survey of patient satisfaction with healthcare experiences. This was conducted via anonymous questionnaire at the end of the study.

RESULTS

Of a total of 166 patients undergoing endoscopy in the time period, 79 were prospectively recruited to VOPD follow-up based on eligibility criteria. Overall, 67 (84.8 %) were successfully followed up by telephone consultation; nine patients (11.4 %) were contacted by mail. The remaining three patients (3.8 %) were brought back to the OPD. Patients recruited were more likely to be younger (55.82 ± 14.96 versus 60.78 ± 13.97 years, P = 0.029) and to have had normal examinations (49.4 versus 31.0 %, χ (2) = 5.070, P = 0.025). Nearly three quarters of patients responded to the questionnaire. The mean scores for all four aspects of the MISS were satisfactory, and overall patients were satisfied with the VOPD experience.

CONCLUSION

VOPD is a target for improved healthcare provision, with improved efficiency and a high patient satisfaction rate.

Effects of a cost-effective surgical workflow on cosmesis and patient's satisfaction in open thyroid surgery

PURPOSE

In thyroid surgery, minimally invasive procedures are thought to improve cosmesis and patient's satisfaction. However, studies using standardized tools are scarce, and results are controversial. Moreover, minimally invasive techniques raise the question of material costs in a context of health spending cuts. The aim of the present study is to test a cost-effective surgical workflow to improve cosmesis in conventional open thyroid surgery.

METHODS

Our study ran between January 2009 and November 2010, and was based on a prospectively maintained thyroid surgery register. Patients operated for benign thyroid diseases were included. Since January 2010, a standardized surgical workflow was used in addition to the reference open procedure to improve the outcome. Two groups were created: (1) G1 group (patients operated with the reference technique), (2) G2 group (patients operated with our workflow in addition to reference technique). Patients were investigated for postoperative outcomes, self-evaluated body image, cosmetic and self-confidence scores.

RESULTS

820 patients were included in the present study. The overall body image and cosmetic scores were significantly better in the G2 group (P < 0.05). No significant difference was noted in terms of surgical outcomes, scar length, and self-confidence.

CONCLUSIONS

Our surgical workflow in conjunction with the reference technique is safe and shows significant better results in terms of body image and cosmesis than do the reference technique alone. Thus, we recommend its implementation in order to improve outcomes in a cost-effective way. The limitations of the present study should be kept in mind in the elaboration of future studies.