Parental factors predicting unnecessary ambulance use for their child with acute illness: A cross‐sectional study

Abstract

Aims To examine characteristics of parents of children with acute, albeit mild, illnesses who used ambulance transport unnecessarily. Design A cross‐sectional study. Methods From 2016 ‐ 2017, we recruited parents who visited the emergency room of a Japanese paediatric hospital and whose children were discharged without hospitalization. Participants whose children arrived by ambulance were classified as using ambulance services unnecessarily. Participants answered a questionnaire consisting of parents’ characteristics, including health literacy scales and the Parents’ Uncertainty regarding their Children with Acute Illness Scale. We conducted a receiver operating characteristic analysis to convert the Parents’ Uncertainty regarding their Children with Acute Illness Scale results to binary scores. We analysed questionnaire responses using logistic regression analysis. Results Analysed data were from 171 participants. The cut‐off score was 59 for the Parents’ Uncertainty regarding their Children with Acute Illness Scale. Results of the logistic regression indicated that parents who did not use resources to obtain information regarding their child's illness, had low health literacy, were observing presenting symptoms for the first time in their child, or had high uncertainty, were significantly more likely to unnecessarily use ambulances. Conclusion Publicizing available resources regarding child health information, social healthcare activities to raise parents’ health literacy and providing explanations in accordance with parents’ uncertainty, especially when confronting new symptoms in their child, might reduce unnecessary ambulance use. Impact Of patients transported to hospitals by ambulance, the rate of paediatric parents with mild conditions has been found to be high. The study findings could contribute to the appropriateness of using ambulances and have implications for policymakers and healthcare providers, particularly in the Japanese paediatric emergency system. In particular, parental uncertainty, one of four significant characteristics, could be resolved in clinical settings. Generalization for global health services requires further research.

Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain

“…Lack of transport has also been identified as important in another study 14. Health literacy has been identified as a factor in previous studies: one study found that low parental health literacy was related to unnecessary use of ambulance for children with mild acute illness 15. Similarly, our findings for attending EDs were similar to a previous review where a key factor was that people expected to need investigations,4 and similar to a population survey in Australia where people perceived care to be better in EDs 16…”

Health literacy interventions for reducing the use of primary and emergency services for minor health problems: a systematic review

“…24 More recent studies support this conclusion. Examples include unnecessary use of the ambulance service in Japan, 25 ED use for minor or non-urgent problems in the USA, 26 ED return rates 27 and use of EDs by first-generation Chinese immigrants in Australia. 28 A 2020 British population survey of demand for emergency ambulances and EDs for minor health problems identified that people with a lower level of health literacy had a greater tendency to contact emergency ambulances.…”

“…To encourage patients to seek care from their PCP and reduce the number of visits to the PED for minor illness l Researcher/doctor l PED l Individual: F2F, telephone, discussion, written l Detailed review (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) minutes with each family) of the child's medical record with the parents and explanation of what to expect at future well-child visits, and discussion of the role of the PCP. Families were informed that the PCP's hours were being expanded so that children with minor illness could be seen during evening and weekend hours, and given a phone number they could call 24 hours a day for advice from their PCP .…”

Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review

“…A study published in 2014 found that approximately 10% of infants (<1 year old) attending A&E had no discernible medical abnormality [13], and a 2017 report of emergency attendance across Yorkshire and Humber determined that there was a 31% rate of nonurgent visits for children (with nonurgent defined for the study as an issue that could have been addressed by a general practitioner) [14]. This behavior is not unique to the United Kingdom; studies around the world have observed high rates of emergency services attendance for nonurgent conditions [15][16][17][18], with parental health literary identified as a potential factor in nonurgent attendances [16,17]. The 4-hour A&E target (95% of patients addressed within 4 hours) has not been achieved since 2013 [19], highlighting the current strain on urgent-care hospital resources.…”