The health behaviour and clinical characteristics of ambulance users with acute asthma

Smith, Sheree; Mitchell, Charles; Bowler, Simon; Heneghan, Carl; Perera, Rafael

doi:10.1136/emj.2008.059188

Cited by 4 publications

(5 citation statements)

References 37 publications

(31 reference statements)

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“…24 Respiratory problems have been identified as a common reason for calling an ambulance service in the USA, where 12% of encounters have been categorised as 'respiratory distress'. 25 Although research studies have described the epidemiology and outcomes of ambulance service users with respiratory distress, [25][26][27][28] they have focused on patients who are transported to emergency departments rather than those not conveyed. We could find only one study of non-conveyance of patients with breathing difficulties that focused on the impact of advanced paramedics on this condition.…”

Section: International Perspectivementioning

confidence: 99%

“…Internationally, a small number of research studies have been undertaken to describe the epidemiology and outcomes of ambulance service users with respiratory distress or breathing problems. [25][26][27][28] As stated in the introduction to this report, these studies focused on patients who were transported to emergency departments rather than those who were not conveyed. A study of the impact of advanced paramedics on admission rates of people calling 999 with breathing difficulties identified a hospital admission rate of 15% (18/119) within 72 hours for those attended by an advanced paramedic.…”

Section: Summary Of Findings In the Context Of Other Researchmentioning

confidence: 99%

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Understanding variation in ambulance service non-conveyance rates: a mixed methods study

O’Cathain

Knowles

Bishop-Edwards

et al. 2018

Health Serv Deliv Res

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Background In England in 2015/16, ambulance services responded to nearly 11 million calls. Ambulance Quality Indicators show that half of the patients receiving a response by telephone or face to face were not conveyed to an emergency department. A total of 11% of patients received telephone advice only. A total of 38% of patients were sent an ambulance but were not conveyed to an emergency department. For the 10 large ambulance services in England, rates of calls ending in telephone advice varied between 5% and 17%. Rates of patients who were sent an ambulance but not conveyed to an emergency department varied between 23% and 51%. Overall non-conveyance rates varied between 40% and 68%. Objective To explain variation in non-conveyance rates between ambulance services. Design A sequential mixed methods study with five work packages. Setting Ten of the 11 ambulance services serving > 99% of the population of England. Methods (1) A qualitative interview study of managers and paramedics from each ambulance service, as well as ambulance commissioners (totalling 49 interviews undertaken in 2015). (2) An analysis of 1 month of routine data from each ambulance service (November 2014). (3) A qualitative study in three ambulance services with different published rates of calls ending in telephone advice (120 hours of observation and 20 interviews undertaken in 2016). (4) An analysis of routine data from one ambulance service linked to emergency department attendance, hospital admission and mortality data (6 months of 2013). (5) A substudy of non-conveyance for people calling 999 with breathing problems. Results Interviewees in the qualitative study identified factors that they perceived to affect non-conveyance rates. Where possible, these perceptions were tested using routine data. Some variation in non-conveyance rates between ambulance services was likely to be due to differences in the way rates were calculated by individual services, particularly in relation to telephone advice. Rates for the number of patients sent an ambulance but not conveyed to an emergency department were associated with patient-level factors: age, sex, deprivation, time of call, reason for call, urgency level and skill level of attending crew. However, variation between ambulance services remained after adjustment for patient-level factors. Variation was explained by ambulance service-level factors after adjustment for patient-level factors: the percentage of calls attended by advanced paramedics [odds ratio 1.05, 95% confidence interval (CI) 1.04 to 1.07], the perception of ambulance service staff and commissioners that advanced paramedics were established and valued within the workforce of an ambulance service (odds ratio 1.84, 95% CI 1.45 to 2.33), and the perception of ambulance service staff and commissioners that senior management was risk averse regarding non-conveyance within an ambulance service (odds ratio 0.78, 95% CI 0.63 to 0.98). Limitations Routine data from ambulance services are complex and not consistently collected or analysed by ambulance services, thus limiting the utility of comparative analyses. Conclusions Variation in non-conveyance rates between ambulance services in England could be reduced by addressing variation in the types of paramedics attending calls, variation in how advanced paramedics are used and variation in perceptions of the risk associated with non-conveyance within ambulance service management. Linking routine ambulance data with emergency department attendance, hospital admission and mortality data for all ambulance services in the UK would allow comparison of the safety and appropriateness of their different non-conveyance rates. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: International Perspectivementioning

confidence: 99%

Section: Summary Of Findings In the Context Of Other Researchmentioning

confidence: 99%

Understanding variation in ambulance service non-conveyance rates: a mixed methods study

O’Cathain

Knowles

Bishop-Edwards

et al. 2018

Health Serv Deliv Res

View full text Add to dashboard Cite

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“…They pointed to possible connections between lower education, lower professional qualifications, and limited employment opportunities that may increase the likelihood of finding work in jobs with a higher exposure to environmental risk factors. In another example, Smith et al [30] found that asthma patients in the United States who were ambulance users tended to have lower levels of education. They suggested that a lack of access to public or private transportation among these populations may increase their likelihood of using ambulance services to seek medical care.…”

Section: Resultsmentioning

confidence: 99%

A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

Greenwood

Edwards

Hoogbruin

et al. 2011

BMC Med Res Methodol

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BackgroundThe term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes.MethodsA review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).ResultsOf the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.ConclusionsWithout more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.

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“…In other studies conducted in the UK and Australia, researchers reported comparable or higher rates of ambulance use (26%-58%), and stated that the optimal rate is not known and probably varies depending on assessment of risk and personal attitudes. 22,23 Thus, costly ambulance use for asthma requires further investigation and is another potential area for patient education.…”

Section: Discussionmentioning

confidence: 99%

Time to Seeking Emergency Department Care for Asthma: Self-Management, Clinical Features at Presentation, and Hospitalization

Mancuso¹,

Peterson²,

Gaeta³

et al. 2012

Journal of Asthma

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Objective Understanding events preceding emergency department (ED) asthma visits can guide patient education regarding managing exacerbations and seeking timely care. The objectives of this analysis were to assess time to seeking ED care, self-management of asthma exacerbations, and clinical status on presentation. Methods 296 patients were grouped according to time to seeking ED care: ≤ 1 day (22%), 2-5 days (44%), and > 5 days (34%) and were compared for clinical and psychosocial characteristics. Asthma severity at presentation was obtained from patient report with the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) and from physicians’ ratings using decision to hospitalize as an indicator of worse status. Results Mean age was 44 years, 72% were women, 10% had been in the ED in the prior week, and 28% came to the ED by ambulance. Patients who waited longer were more likely to be older, have more depressive symptoms, and to have been in the ED in the prior week. They also were more likely to have taken more medications, but they were not more likely to have visited or consulted their outpatient physicians. Patients who waited longer reported worse ACQ (p<.0001) and AQLQ (p=.0002) scores, and were more likely to be hospitalized for the current exacerbation (odds ratio 1.9, 95% confidence interval 1.1, 3.2, p=.03). Conclusions Patients who waited longer to come to the ED had worse asthma on presentation, more functional limitations, and were more likely to be hospitalized. Ability to gauge severity of exacerbations and use the ED in a timely manner are important but often overlooked self-management skills that patients should be taught. (ClinicalTrials.gov NCT00110409)

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The health behaviour and clinical characteristics of ambulance users with acute asthma

Cited by 4 publications

References 37 publications

Understanding variation in ambulance service non-conveyance rates: a mixed methods study

Understanding variation in ambulance service non-conveyance rates: a mixed methods study

A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

Time to Seeking Emergency Department Care for Asthma: Self-Management, Clinical Features at Presentation, and Hospitalization

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