Seeking an integrated approach to re-profiling emergency medical services in Greece

Paul Giesen

Strong primary care offers important opportunities to manage and treat the growing burden of chronic diseases. In doing so, primary care prevents the need for acute care services, including emergency medical services (EMS). Furthermore, strengthened primary care can treat a significant proportion of the acute care demands otherwise placed on EMS.

Without primary care that takes the lead in managing chronic conditions and preventing acute care demands on EMS, emergency departments become unnecessarily congested and unsafe, and admit patients to hospitals unnecessarily.

Managing the current congestion of EMS in Greece and across the WHO European Region means understanding that strong primary care requires a network of health providers and settings that are equipped, supported, incentivized and trained to manage chronicity, polypharmacy and multimorbidity.

When acute care cannot be prevented, strong primary care can effectively stabilize chronic patients, provide behaviour counselling, perform basic diagnostics and minor surgeries, provide community-based palliative care, and handle minor injuries. Out-of-hours primary care networks, when co-located with emergency departments and hospitals, can provide primary care to treat these acute care demands on evenings and weekends.

Integrated hospital networks that concentrate highly specialized services and treat lower-complexity cases in medium to small hospitals can also help decrease the strain on emergency departments. Supporting people and their families in navigating these health services is a key component of high-quality, people-centred integrated services.

These challenges and opportunities related to re-profiling EMS in Greece were discussed during a visit organized by WHO/Europe in collaboration with the Ministry of Health of Greece on 23–27 January 2017. Over the course of the week, visits were made to the National Centre for Emergency Medical Services (EKAV) and its Elefsina Heli-Centre, the Psachna Health Centre, the Regional Clinic of Drosia in Evia, the Chalkida Hospital Emergency Department and the Ippokrateio General Hospital Emergency Department.

The aim of the visit was to identify priorities for the reorganization of EMS in the context of upcoming primary care reform in Greece. It included meetings with leaders from the Ministry of Health and key professional groups. A workshop was also held with relevant stakeholders to share good practices from Italy and the Netherlands.

The Ministry of Health of Greece is committed to implementing its medium-term reform plan, which includes reorganizing the country’s EMS, and recently initiated a collaboration with WHO/Europe in this strategic area. The visit, which was part of this collaboration, took place within the Strengthening Capacity for Universal Coverage (SCUC) initiative.

About the SCUC initiative

The SCUC initiative is funded by the European Union through a grant agreement between the European Commission and WHO/Europe. Its general objective is to contribute to improving health and health equity in Greece, especially among the most vulnerable in the crisis-stricken population, by helping Greek authorities move towards universal coverage and strengthen the effectiveness, efficiency and resilience of their health system.