- (2015) Volume 9, Issue 1
Dimitris Theofanidis*
Lecturer, Nursing Department, Alexandreio Educational Institute of Thessaloniki, Greece
Pharmacogenetics explores heritable genetic polymorphisms that can effect responses to drug therapy. Many studies have focused on several genetic polymorphisms, which are involved in cholesterol metabolism, trying to define their contribution to a potential genotype-guided treatment against dyslipidemia adult.
Keywords
Statins; Pharmacogenetics; Gene polymorphism
The Greek healthcare system was ranked 14th worldwide in the overall assessment by the World Health Organization, placing Greece above other European countries such as the UK and Germany [1]. For the past four decades, governments have put strong emphasis on public health care which is essentially free of charge at the point of delivery [2].
The health care sector bloomed during the late 1970s as the country was returning from the 7 year military junta to democracy and by 1983, the new Greek National Health System (NHS) was introduced.
At its peak, the Greek NHS was comprised of more than 200 hundred hospitals and 40.000 beds which were considered rather excessive for its 10m inhabitants. Currently, the country has been under heavy recession for the last 6 years and now resulting minimum staff so services are stretched to the limit.
However, the Greek NHS’s problems started long before the recession. The centralized infrastructure of the health care system, the oversupply of hospital-based physicians, the absence of a referral system and a growing public demand for equal rights and free access to health for all, has led the tertiary health care sector in particular to grow out of proportion [3,4].
As a result, a unique-to-Greece rota system for hospital emergencies evolved, by modifying the notion of the rota-based system for 24-hour pharmacies. Essentially, this means that hospitals rotate to be on 24-hour duty for admitting new cases. Each designated hospital operates alone, or in pairs depending on the city size.
So the designated hospital’s Accident & Emergencies (A&E) department would accept all incoming patients for a 24-hour period at a time. The rest of the city’s hospitals would not accept new cases but only offer continuing care to in-patients.
This arrangement creates numerous logistic problems as every so often the hospital has to face a pressure on bed availability and other resources, resulting often in early discharges in order to free beds in anticipation of an influx with the next rota on-call period [5].
By law, the A&E department is not permitted to admit cases when not on-call, unless a major event takes place right outside the premises. In such a case, the hospital staff is obliged to stabilize the patient and transfer him to the appropriate on-call hospital.
Patients arriving for emergency treatment at a hospital which is not open to emergencies are redirected to the rota allocated hospital regardless of how serious the condition may be. Yet, this can cause unnecessary and unwanted delays for treatment which may affect outcomes as valuable time is lost.
Criticisms of the rota system with typical examples include:
• Unnecessary delays, e.g. patients are not always aware of which hospital is on-call, often ending up to a hospital which is not admitting for the day, or having to call ambulance services in order to get quick access.
• Underuse of all available resources e.g. a medium sized Greek city may have three hospitals, working on a rota basis instead of a major hospital with concentrated services steadily servicing the city.
• Expertise is not fully used, e.g. sophisticated services and specialized units found in one particular hospital may only be available for new admissions until the next time this particular hospital is on call.
• Some patient follow unwanted health behaviour patterns, e.g. there are reports whereby patients may even postpone an urgently needed visit to the A&E in order to wait until a particular hospital of their choice is on-call, based on proximity to their home, or the hospital’s perceived status.
• Due to the rota system, it can be argued that health care resources are not readily available to everyone. Overall, it is evident that despite great past success in improving health care services of the population, the Greek health care system is now facing serious structural problems concerning adequate financing, sensible resource allocation, skilled organization, efficient management and proper delivery of services.
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