Σχεδιασμός του χάρτη υγείας της 3ης και 4ης Υγειονομικής Περιφέρειας της χώρας, με βάση τον έλεγχο της ροής των ασθενών στην Κλινική της Στοματικής και Γναθοπροσωπικής Χειρουργικής

Abstract

Introduction: The health system is an idiosyncratic and complex system where human resources, processes and material resources coexist. Its main goal is to provide a high level of health services as well as to prevent and promote the health of the citizens. But in order for the health system to function effectively, it must react and anticipate the constant changes of the environment in which it is located and develop with actions that concern not only the provision of medical care, but its prevention and information as well as the holistic improvement of the citizens' health. This can be done only with the appropriate planning for the quality and smooth coverage of the existing health needs, but also the future coverage of the possible new needs, utilizing the possibilities of the system. Proper health services planning should include the organisational elements and refer to the process of assessing the overall needs of a geographical area or a specific population group, as well as how to allocate existing or future resources to meet these needs. The Health Map is a move in this direction as it is a mechanism for continuous collection and processing of data, regarding the level of health of Greek citizens as well as the provided health services of all levels of care including health promotion and prevention services. It emerges as a key tool in formulating a national health policy as it reflects the health needs of the population and in particular in relation to certain chronic diseases. Many of which are directly linked to certain oral diseases, as they have common risk factors such as cancer of the mouth and throat, diseases that affect not only health systems but also society and the economy. The prevention and early diagnosis and treatment of oral diseases is a challenge for public health and for health policy makers. The present dissertation focuses on the registration of patients in the Oral and Maxillofacial Clinic of the General Hospital "G. Papanikolaou ”, mainly from various areas of Northern Greece, who come either voluntarily or after referral by private doctors, dentists or clinics of other hospitals, in order to demonstrate the need to update the existing health map in terms of this specialty. Its aim is to provide safe conclusions about the mobility of this particular medical specialty, the ever-changing oral health needs of the Greek population and in particular of the inhabitants of Northern Greece, the diffusion of patients in large urban centers, due to the lack of the specialty of Oral and Maxillofacial Surgery in their area, the emergence of all those factors that are responsible for the non-operation of clinics of this specialty and in determining the degree of satisfaction of patients attending the Oral and Maxillofacial Clinic of the General Hospital "G. Papanikolaou ".Method: 6636 patients admitted to the Oral and Maxillofacial Clinic of the General Hospital "G. Papanikolaou ”during the periods 2015-2017 and 2018-2020, according to the clinic's archive. Collection of 575 patient satisfaction questionnaires that came to the outpatient clinics of the clinic to be examined. Satisfaction questionnaires were written by the researcher herself and in addition to the degree of satisfaction with the services provided to them by the clinic staff, also measured the waiting time of patients in the Outpatient Clinics, their referral, admission, diagnosis and treatment. Oral diseases were categorized according to ICD 10 into five categories, neoplasms, trauma, infections, malformations and various other diseases. The statistical processing of the results was done with the statistical program Statistical Package for the Social Sciences (SPSS) Version 26, for the production of graphs and correlation analyzes with non-parametric methods as the results were qualitative, but also with Microsoft Excel 2013 for some graphs. The x2 and Kruskal-Wallis tests were also used, for multiple variables Bonferroni correction was used, with a significance threshold of p <0.05. Cramer΄s V was used for comparisons between categorical variables. Results: The analysis and processing of the data showed that of the 6636 patients admitted to the Oral and Maxillofacial Clinic during the period 2015-2020, 3847 (57.97%) were men and 2789 (42.03%) were women. The majority of patients (38.6%) were 60 years of age or older and only 523 patients (7.89%) were under 20 years of age. The largest percentage of patients (49.54%) moved from areas 20 km away from the clinic and only 227 patients (3.52%) from more remote areas over 300 km. Health Region (HR) grouping showed an increased flow of patients from the 3rd and 4th HR. Most patients admitted to the clinic were diagnosed with a malignant tumor (31.89%), and fewer with an infection (29.63%). The majority (28.7%) of patients with malignant neoplasms were hospitalized for the majority of 1 to 2 days during the three years 2015-2017 while this percentage decreased to 22.4% in the second three years 2018-2020. In contrast, patients in the same category who remained in the clinic for 5 to 10 days increased in the second three years compared to the first from 18.5% to 18.9%. Of those who completed the satisfaction questionnaires, most said they were satisfied with the medical services offered (97.22%), while age and waiting time seemed to affect them positively or negatively. Conclusions: The development of the Health Map is a project based on online technologies for collecting information and recording them on digital maps based on GIS technology, but also in the political geoeconomics of health. However, even today, most healthcare providers do not have a systematic record and organized record of all these data, which could be a reliable database, such as the data collected from the present study. It is important to understand that for the design of the Health Map it is necessary to take into account the needs, condition and health behaviors of the population of the area or the wider area as well as its geographical location. But beyond that, the data related to the health services that are developed in the area and concern their organization and operation, the volume and type of patients they serve, as well as the resources they consume, a particularly important element. , as evidenced by the present research. Keywords: Satisfaction, health policy, patient flow, oral diseases, Health Charter

Η παρούσα διατριβή εστιάζει στην καταγραφή της ροής των ασθενών της Στοματικής και Γναθοπροσωπικής κλινικής του Γ.Ν.Θ «Γ. Παπανικολάου» κατά τη χρονική περίοδο 2015-2020, από διάφορες περιοχές της Βορείου Ελλάδος, που προσέρχονται αυτόβουλα ή μετά από παραπομπή από ιδιώτες ιατρούς, οδοντιάτρους ή από κλινικές άλλων νοσηλευτικών ιδρυμάτων. Σκοπός αυτής είναι να καταδείξει την αναγκαιότητα του υπάρχοντος Υγειονομικού Χάρτη, όσον αφορά τη συγκεκριμένη ειδικότητα. Η συλλογή των δεδομένων της έρευνας έγινε τόσο από το επίσημο αρχείο της κλινικής όσο και από τη συλλογή ερωτηματολογίων ικανοποίησης των ασθενών της. Από την ανάλυση των δεδομένων διαπιστώθηκε αύξηση του εισαγωγών κατά τη χρονική περίοδο 2018-2020 σε σχέση με τη χρονική περίοδο 2015-2017, ενώ παράλληλα αναδείχθηκε πως τα κακοήθη νεοπλάσματα και οι λοιμώξεις αυξήθηκαν κατά τη δεύτερη χρονική περίοδο. Επιπλέον, από την έρευνα προέκυψε πως οι αρμόδιοι για το σχεδιασμό του Υγειονομικού Χάρτη, θα πρέπει να λαμβάνουν υπόψη τους όχι μόνο τις υγειονομικές ανάγκες των κατοίκων της περιοχής αλλά και τον γεωγραφικό χαρακτήρα της περιοχής. Λέξεις – κλειδιά: Ικανοποίηση, πολιτική υγείας, ροή ασθενών, στοματικές παθήσεις, Υγειονομικός Χάρτης