In this paper we report the patterns of utilization of house calls by SOS doctors in the area of Attica, Greece, during the period 1/11/2000 – 31/10/2005. In accordance to other studies, our analysis revealed that the elderly and the female patients requested more house calls during the period examined compared to younger and male patients, respectively [12, 13]. It is also worth noting that a considerable proportion of house calls were performed from 4 pm – 12 pm (40.1%) and midnight – 8 am (13.4%), a finding also observed in other relevant studies [14, 15]. These data show that the SOS doctors' house call service accommodates patients with urgent health problems during periods of the day when the majority of physicians' offices are closed.
Our analysis shows that infections of the upper and the lower respiratory tract were the most likely cause of requesting house call services by the SOS doctors in Attica. Also, the secular trends of the distribution of house calls due to upper respiratory tract infections clearly depict the epidemic nature of these infections. We noted one or two peaks of requests for management of upper respiratory tract infections for each year during the 5-year study. It is interesting that these peaks occurred during different times in winter and early spring (from December to March). Public health authorities may find useful the real-time, ongoing collection of data regarding house calls by SOS doctors for the purpose of surveillance of infectious diseases.
The low utilization of SOS doctors' house calls during September deserves to be emphasized. We should acknowledge that there is no clear explanation for this observation. An effect of summer vacations (that are taken by most Greeks during August) on morbidity is an intriguing possibility. It is likely that the physical and psychological rejuvenation, change of environment, and increase of physical exercise during vacation may have a considerable effect on morbidity.
Another noteworthy finding of our analysis is that the services provided by SOS doctors in Attica, Greece have been extremely valuable during the vacations periods. This is especially true in August when a considerable proportion of hospital doctors take their annual leave at a time when the number of tourists is high in Greece, including Attica where the metropolitan area of Athens is located.
Although the practice of making medical house calls has diminished significantly during the last 30–40 years in many parts of the world, they remain an important component of the health care system in several countries. The most representative example is Great Britain where general practice, including patient house calls, is one of the factors that distinguish primary care in Britain, from that in many other western countries . It seems that is in the British culture for patients to expect their family physician to make house calls and for doctors to agree that house calls are valuable for good patient care. It should be emphasized that the house calls that are declining throughout the world are mostly those done during regular hours by personal doctors. However emergency services that SOS doctors provide are another organizational form.
The major provider of health care home services in Greece is IKA (the major public heath insurance provider of the country) that offer the possibility of house calls by general practitioners within the same day and mainly during working hours. We do not know the number of patients examined daily via this services system.
Our study is not without limitations. It is a retrospective analysis with all limitations inherent to this study design. Thus, the research questions were formulated after the data had been collected in a routine fashion, a fact that is sometimes associated with missing information for some variables for a proportion of patients included in the analysis. We acknowledge that a study using a prospective design would offer the opportunity for additional analyses. Research questions regarding the occurrence of various diseases during different hours of the day or during different months and seasons of the year would offer interesting data of higher quality compared to those of a retrospective study. Such circadian and seasonal differences in the incidence of various diseases may have potential pathophysiological implications and clinical importance.
Although we tried to retrieve annual data, unfortunately there was no information regarding the population of the area of Attica for each of the years 2000–2005 separately. The Greek population census takes place every 10 years. The last population census took place in Greece on March 18, 2001, and, according to that data, Attica was inhabited by 3,894,573 citizens . Therefore, it was not possible to further describe the trends in utilization over the 5-year period for specific subsets of population.