Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs

Abstract

Elderly patients with less urgent medical needs represent a high proportion of all emergency patients in Japan; this trend is gradually increasing, presenting a burden on the emergency medical system. To design effective interventions, it is important to understand the basic characteristics of emergency service use. For elderly Japanese patients, there is currently no detailed report on less urgent cases (LUC), or those cases that could be diagnosed by primary care physicians. Since there is a need for a timely reporting of detailed LUC data, we used data of 2004-2006 from an immediately available database at the Yao Tokushukai General Hospital. With a focus on LUC, we analyzed 7,800 cases of elderly patients, aged over 65 years, who were transported via ambulance to a secondary emergency hospital in Osaka. Of these, 3,354 patients (43.0%) were classified as having initial emergencies and were given outpatient care in the emergency department, and 1,544 patients (19.8%) were LUC, in which 541 subjects (6.9%) may have used ambulance services somewhat inappropriately owing to a lack of alternate transportation. In the remaining 1,003 patients, ambulance use could have been avoided if primary care clinics were available at night and during holidays. We therefore focus on three important points: awareness-raising activities to prevent inappropriate ambulance use, strengthening of transport services to healthcare facilities, and expanding primary care clinic office hours. This study is the first detailed report on the use of ambulance services in Japan by elderly patients with less urgent medical needs.

Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital

“…Regarding access to emergency and regional medical services, one study suggests that access to a primary care clinic helps prevent some inappropriate use of ambulance services . In our study, however, approximately 50% of patients in the inappropriate use group were aware of an out‐of‐hours primary care clinic provided by a municipal or local medical association.…”

Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan

“…Older people are vulnerable to contracting severe diseases, including brain and neurological diseases and heart disease [4]. However, it has been pointed out that a substantial number of patients with mild conditions may also arise in this age group [5]. Approximately half of ambulance transports have been determined on arrival to be for such mild cases [6], and this proportion has not greatly varied (or improved) in Japan over the past two decades [1].…”

“…Approximately half of ambulance transports have been determined on arrival to be for such mild cases [6], and this proportion has not greatly varied (or improved) in Japan over the past two decades [1]. Unnecessary ambulance use by patients with mild conditions can be regarded as a waste of medical resources and can potentially lead to the congestion of emergency outpatient services and even the loss of the quality in clinical services [5,[7][8][9][10].…”

“…Such information is essential to improving emergency services at local level. As the individuals who use emergency services vary geographically and spatially, owing to the different characteristics of disease and different demographic structures, understanding the epidemiological distribution of the above-described mild cases according to age, disease, and severity could help in achieving optimal use of ambulance services in the future [5].…”

The Impact of Demographic Changes on the Organization of Emergency Medical Services: the Case of Slovenia

“…Slovenia ranks among those European countries that will be most affected by the consequences of population ageing (Ministry of Health, 2013). A number of countries have reported on a growth trend of healthcare treatments that are the result of population ageing (Salvi et al, 2007;Caley and Sidhu, 2010;Horibata and Takemura, 2015). Because older inhabitants more often become ill due to various chronic diseases, they are more frequent users of healthcare services (Verdel, 2015, pp.…”