Patients who call emergency ambulances for primary care problems: a qualitative study of the decision-making process

Booker, Matthew J; Simmonds, Rosemary; Purdy, Sarah

doi:10.1136/emermed-2012-202124

Cited by 58 publications

(67 citation statements)

References 21 publications

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“…A key finding here was that patient anxiety was strongly related to healthcare‐seeking behavior51, 52 and this linked closely with the reassurance that patients obtain from emergency services53 and their trust of ED services 54. In some cases anxiety was due to worries about the legitimacy of need,39 with patients not wishing to use services inappropriately.…”

Section: Resultsmentioning

confidence: 76%

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Coster

Turner

Bradbury

et al. 2017

Academic Emergency Medicine

250

234

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ObjectivesRising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care.MethodsSystematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer‐reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework‐based narrative synthesis.ResultsThirty‐eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty‐nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency‐based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations.ConclusionsWe identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.

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Section: Resultsmentioning

confidence: 76%

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Coster

Turner

Bradbury

et al. 2017

Academic Emergency Medicine

250

234

View full text Add to dashboard Cite

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“…On the other hand, it has been estimated that 11%–61% of the conveyances is medically not necessary [11]. Factors influencing these non-conveyance rates are patients with low-acuity problems or primary care problems who call an ambulance [12, 13], accuracy of triage systems at the EMS dispatch centre [14], and professional competencies [15]. …”

Section: Introductionmentioning

confidence: 99%

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

135

208

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BackgroundThis systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.MethodsWe systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.ResultsWe included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%–93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h–48 h after non-conveyance, 2.5%–6.1% of the patients have EMS representations, and 4.6–19.0% present themselves at the ED. Mortality rates vary from 0.2%–3.5% after 24 h, up to 0.3%–6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).ConclusionsNon-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0409-6) contains supplementary material, which is available to authorized users.

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“…A qualitative study of patients who called 999 for a condition that could have been treated in primary care4 suggested a number of reasons including perceived or actual barriers to accessing urgent care services, previous negative experience of urgent care services, the perception that the ambulance service could provide rapid triage and assessment, patient and carer anxiety, and carers’ feelings of responsibility and helplessness. Other reasons centre around a lack of awareness of alternative services, lack of transport to reach the emergency department (ED) and the wish to avoid a long wait in ED 3…”

Section: Introductionmentioning

confidence: 99%

Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

et al. 2014

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BackgroundA minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients.ObjectivesThe present study aimed to (i) profile frequent callers to the ambulance service and (ii) evaluate the impact of a case management interventional approach on frequent caller behaviour.MethodsA retrospective review of data from a 2-year period (from 1 April 2009 to 31 March 2011) was conducted. Patients were included in the analysis if they had been accepted for case management intervention by the Patient-Centred Action Team during this period and met the study inclusion criteria.ResultsThe review identified 110 frequent callers who met the study inclusion criteria. The majority of frequent callers (86%) had multiple and complex reasons for calling, including frequent medical need, acute or chronic mental health condition, older age and unmet personal or social care needs. In the majority of cases (82%), multiple interventional strategies were required. A significant reduction in median call volume was observed from preintervention to postintervention (from five calls/month to zero calls/month).ConclusionsEffective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour.

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Patients who call emergency ambulances for primary care problems: a qualitative study of the decision-making process

Cited by 58 publications

References 21 publications

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

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