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Background In the absence of effective pre-hospital health care facilities in Greece, patients with acute or chronic pain are forced to present immediately to the Emergency Outpatient Departments (EOD) of the on-call public hospitals. Thus, the treatment of headache patients may result in a relevant increase in the burden of work of the EOD. Materials and methods In an open prospective study design, epidemiological and clinical data were collected from all patients presenting with headache as their main symptom at the Emergency Outpatient Department (EOD) of Papageorgiou Hospital, a tertiary health care facility in metropolitan Thessaloniki, from August 2006 to January 2007. Results During the study period, a total of 2813 patients presented at the EOD. 420 (14,9 %) of those patients complained about headache as their main symptom. They were 133 (31,6% of headaches) men, 291 (68,4%) women, with a mean age of 36,6 years in male and 39,7 years in female headache patients. A primary headache was diagnosed in 214 (50,9%) patients, secondary headache in 101 (24,0%) patients and 105 (25,1%) patients did not fulfil the diagnostic criteria for a distinct headache. 65 (15,4%) patients were admitted to hospital, about half of them (n=30, 7,1%) to a one day care unit, and 35 (8,30%) to a ward). 24 (5,7%) patients arrived with public emergency transport services, but only 11 were admitted to hospital. Conclusions Subjective and objective severity of headache consi-derably increase the burden of the local EOD to a degree that turns use of EOD into misuse. [ABSTRACT FROM AUTHOR]

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. Materials and 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 transportation were eventually admitted to a hospital ward. Conclusions 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. [ABSTRACT FROM AUTHOR]