Health needs in rural areas and the efficacy and cost-effectiveness of doctors and nurses.
OBJECTIVE
Because of a lack of GPs in rural areas of Greece it is mandatory for junior doctors to offer medical service in those areas for a year. The aim of this study is to determine the possibility of replacement of internships with nurses and to suggest the most cost-effective way of covering health needs in remote areas.


METHODS
Regional survey.


METHODS
Patients of primary care offices in two remote areas of Crete, Greece within a year.


METHODS
Comparative analysis of the level of preventive medicine (estimated by questionnaires) and health needs in the two areas. The reasons for visiting medical offices, references rates, percentages of glucose and blood pressure regulation are also studied.


RESULTS
Prescription of drugs for chronic diseases and blood pressure counting were the main reasons for office visits (2868/4594). Respiratory track infections (364/4594) follow. Apart from the high percentages of uncontrolled patients with blood pressure (34%) and diabetes mellitus (14%) there is a high percentage of ignorance or wrong opinions concerning preventive medicine, for example only 63% knew the value of a pap test.


CONCLUSIONS
More than two-thirds of "medical" visits in rural areas were for acts that nurses could easily do. The easy access to a junior doctor did not promote preventive medicine. Replacement of junior doctors with properly trained nurses cooperating with GPs responsible for greater regions would be more cost-effective than junior doctors improving health in rural areas. Legislation should change, mainly with regard to repeat prescriptions, in order to reduce house visits.
Vlastos
Ioannis M
IM
Department of General Surgery, Agios Nikolaos General Hospital, Lasithi, Greece. giannisvlastos@yahoo.gr
Mpatistakis
Antonios G
AG
Gkouskou
Kalliopi K
KK
D000368:Aged; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D020380:Needs Assessment; D009722:Nurse Practitioners / Q000191:economics; D010561:Personnel Staffing and Scheduling; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D012040:Regional Health Planning; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data; D000078329:Workforce