Use Of Ambulance Services Research Articles

The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia

BackgroundIn pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City.MethodA cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05.ResultsAmbulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7).ConclusionAlthough the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.

Perceptions and experiences of paramedics managing people with non-traumatic low back pain: a qualitative study of Australian paramedics

BackgroundParamedics are often first providers of care to patients experiencing non-traumatic low back pain (LBP), though their perspectives and experiences with managing these cases remain unclear.ObjectivesThis study explored paramedic views...

Defining a threshold above which an adult can be considered to frequently use ambulance services: a retrospective cross-sectional study of emergency calls to an ambulance service in England.

There is no empirical definition of adult frequent use of ambulance services. This study aimed to define a threshold, and utilise this to explore characteristics of people frequently using services. This was a retrospective cross-sectional study in a single ambulance service in England. Routinely collected, pseudo-anonymised call- and patient-level data were collected for two months (January and June 2019). Incidents, defined as independent episodes of care, were analysed using a zero-truncated Poisson regression model to determine a suitable frequent-use threshold, with comparisons subsequently made between frequent and non-frequent users. A total of 101,356 incidents involving 83,994 patients were included in the analysis. Two potentially appropriate thresholds were identified: five incidents per month (A); and six incidents per month (B). Threshold A produced 3137 incidents from 205 patients, with five patients likely false-positive identifications. Threshold B produced 2217 incidents from 95 patients, with no false-positive identifications but 100 false-negatives compared to threshold A. Regardless of threshold, frequent users compared to non-frequent users had relatively reduced service use between 08:00 and 15:00, were younger and were more likely to receive lower-priority responses (all p < 0.001). We identified several chief complaints indicative of increased frequent use, including chest pain, psychiatric/suicide attempt and abdominal pains/problems. We suggest a threshold of five incidents per month, with recognition that a small number of patients may be incorrectly identified as using ambulance services frequently. The rationale for this choice is discussed. This threshold may be applicable in wider UK settings and could be used for the routine automated identification of people using ambulance services frequently. The identified characteristics can help inform interventions. Future research should examine applicability of this threshold in other UK ambulance services and countries where patterns and determinants of frequent ambulance use may differ.

Utilization of Ambulance Services and Associated Factors during Pregnancy and Labor Among Lactating Mothers in Buno Bedele Zone, Southwest Ethiopia.

In Ethiopia, the use of ambulance services for urgent obstetric care improved institutional delivery and reduced maternal mortality. However, poor infrastructure, delayed response from dispatchers, and other socioeconomic factors influence service utilization. The present study assessed the utilization of ambulance services and associated factors during pregnancy and labor among lactating mothers in the Buno Bedele administrative zone of Southwest Ethiopia. Community-based cross-sectional study design with a sample of 792 lactating mothers was carried out. A multi-stage sampling technique was employed, and data were collected through structured questionnaire, and focus group discussions (FGD). Among the 792 study participants, 618 (78%) had antenatal care (ANC) follow up and 705 (89%) were aware of information on the availability of free ambulance services. Eighty one percent study participants requested for ambulance services, and 576 (79%) utilized during their pregnancy and delivery periods. Awareness of free ambulance service (AOR = 3, 95% CI [1.4, 7.1], P = .006), maternal formal education (AOR = 3.9, 95% CI [1.46, 9.8], P = .006) and ANC follow up (AOR = 4.5, 95% CI [8.9, 23.3], P = .001) were identified factors responsible for enhanced ambulance services utilization in the study area. The finding of the present study revealed that pregnant women had a higher tendency to use ambulance services during their obstetric emergency. However, poor communication and road infrastructure, as well as delayed dispatcher response hampered better service utilization.

Paramedic management of back pain: a scoping review

BackgroundResearch examining paramedic care of back pain is limited.ObjectiveTo describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics.MethodsWe included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews.ResultsFrom 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data.ConclusionParamedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain.

707 RESEARCH PRIORITIES FOR PREHOSPITAL CARE OF OLDER PATIENTS WITH INJURIES: SCOPING REVIEW

Abstract Introduction The use of ambulance services by older patients with injuries increases within the impacts of ageing-related changes leading to adverse patient outcomes. There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature. Methods A systematic scoping review guided by the Arksey and O’Malley framework reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between (2001–2021) years. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles. Results 65 studies were identified and reviewed, and 25 included. Five categories were identified: ‘field triage, “ageing impacts”, ‘decision-making’, ‘paramedic’ awareness’ and ‘paramedic’s behaviour’. Undertriage &amp; overtriage (sensitivity &amp; specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. More research is required into paramedic knowledge of geriatric care &amp; ageing changes and the potential impact of paramedic care. Conclusion This is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. This review has identified the prehospital triage for older trauma victims and studies of paramedic knowledge of older trauma care as key priorities. Investigating and understanding these can improve providing prehospital trauma care of older patients.

Ambulance service use by patients with lower back pain: an observational study.

Lower back pain (LBP) is the leading cause of disability globally and can be distressing for patients. It is commonly reported that serious pathologies underlying LBP are rare and most patients would be more appropriately managed in primary care. However, recent literature suggests patients accessing emergency care may differ from those accessing primary care. Currently, little is known about the use of ambulance services by people with LBP. The aim of this study was to investigate the extent and nature of ambulance services utilisation by patients presenting with LBP. This observational study is a retrospective analysis of ambulance service calls in the North East of England presenting with LBP from 1 August 2016 to 31 July 2017 (Health Research Authority registration 17/WS/0216). Of 484,495 answered calls, 3315 (0.7%) calls were categorised as initially presenting with LBP. Women represented 59% of callers. Most calls were from those aged 41-50 and 71-80 years old. Almost half of patients (48%) initially presenting with LBP were later categorised with a problem elsewhere. Of the patients, 49% received analgesia, including Entonox (24%) and morphine (13%). Most patients (69%) were transported to an emergency department while 28% remained at home. LBP is a relatively common reason to call the ambulance service. Contrary to data from primary care, non-spinal causes, which include medical emergencies, make up a significant proportion of this. Current guidance on back pain focuses on primary care and specialist settings. Future updates may need to consider emergency care as a distinct setting with a potentially different patient population.

The prehospital care experiences and perceptions of ambulance staff and Eastern European patients: An interview study in Lincolnshire, UK

BackgroundEU enlargement after 2004 was a major factor in increasing Eastern European migration to the UK. This population requires access to high quality public services generally, and ambulance services more specifically. To understand how Eastern European migrants use ambulance care, this study explored the perceptions and experiences of ambulance staff and the Eastern European patients themselves. MethodsWe undertook qualitative semi-structured interviews across Lincolnshire. Purposive and maximum variation sampling ensured that participants were knowledgeable about Eastern European patients’ use of ambulance care and were demographically diverse. Data were analysed using framework analysis. ResultsThere were interviews with 15 ambulance staff and 12 Eastern European patients. A staff interviewee problematised “Health Tourism”, which suggests that migrants deliberately exploit state-funded healthcare. However, most disagreed. Patient interviewees often undertook medical travel to access healthcare in response to perceived healthcare problems in the UK. Medical travel increased the likelihood of ambulance staff encountering foreign medication. Variable quality of, and access to, professional interpreters prompted patients to rely instead on informal interpreters. Patients did not register with GPs perhaps due to limited understanding of how the NHS worked. This led to inappropriate use of ambulance services. Recommendations for service delivery improvements included: Eastern European language information on how and when to use ambulance care; improving GP registration; and greater engagement between the ambulance service and Eastern European communities. ConclusionsFrequent medical travel can limit how Eastern Europeans acculturate to the NHS and anchor roots in the UK. Acculturation is about how migrant cultures adjust to the host country. This is not assimilation, where they dilute their cultural identity. Language and communication barriers, as well as inadequate availability and quality of interpreting services, can impede patient-staff dialogue in time-critical emergencies.

A Study on the Role of Public Health in Reducing the Abuse of Ambulance Services

Background Demand for emergency medical services or ambulance response is situated within the context of other healthcare and social welfare services. Worldwide ambulance providers have a wide variety of services available, but many services are struggling to meet service demand. Inappropriate use of ambulance services is one of the biggest concerns globally. The burden of using the ambulance services includes transporting non-critical patients to the hospital. Misuse of the ambulance services is a serious problem that must be addressed and solved. Objective The purpose of this study is to evaluate the public perception of appropriate usage of ambulance services and determine the applicable role of public health to reduce the inappropriate use of an ambulance. Methodology A cross-sectional study was conducted to collect data from the general public using an online survey. The survey contains 9 questions that evaluate the public awareness of appropriate ambulance use. Participants are people from the public within the age of 18 and above. Sample Size A total of N=97 of participants’ responses were used to analyze the data. Inclusion Criteria Complete surveys and answer data using the English language. Exclusion Criteria Uncompleted surveys, and answered with other languages. Results During the online survey, a total of n=97 participants enrolled voluntarily. The majority of the residents are aware of when to and whom to call in case of a medical emergency. N=35 (36%) of the participants believe that ambulance services are misused. Conclusion The conducted study demonstrated that almost 36% of participants believed abuse of ambulance services, though there might be numerous reasons for calling ambulance unnecessary. Public health plays a vital role to reduce inappropriate ambulance calls when both ambulance services and public health are integrated into one system of care.

Clinical Profile of Patients Presenting with Acute Myocardial Infarction in United Arab Emirates: A Tertiary Care Center Government Hospital Experience

Background: Acute myocardial infarction (AMI) is one of the major causes of hospitalization and mortality worldwide. There has been limited data available to characterize AMI presentation, contemporary patterns of medical care, and outcomes in Dubai, United Arab Emirates. Methods: A single-center observational registry for patients with AMI was used. All patients admitted to Dubai Hospital with AMI (ST elevation and non-ST elevation) with positive troponin from the mid of August 2017 till the end of April 2018 were included in this registry. Clinical data, prior history, demographics, treatments, and outcomes were recorded from the patient’s electronic medical file of the hospital. Result: A total of 329 patients (male 92%, mean age 53.6 years) were included in our registry. The use of ambulance service was only 25%. Electrocardiogram findings of ST-segment elevation myocardial infarction (STEMI) were found in 57% and non-STEMI in 43%. History of prior ischemic heart disease was present in 21% of all cohort, diabetes in 36%, hypertension in 38%, and the current smoking rate was 35%. Reperfusion therapy was provided to 94% of the patients with STEMI; only 32% of them had primary angioplasty, and medical reperfusion was performed in 68%. One-third of them received thrombolysis within 30 min, and primary percutaneous coronary intervention (PCI) was provided to 38% within 90 min. All the patients received aspirin and adenosine diphosphate inhibitors within the first 24 h. The majority of the patients received other key medicines like beta-blocker, statin, and anticoagulant agents within 24 h. The in-hospital mortality rate was about 3%. Conclusions: Using data from the registry may provide an overview of the current status of AMI in Dubai. Medical reperfusion therapy is the most common reperfusion modality in our center, and this will raise the question of whether we need to launch a 24-h primary PCI program in our center.

The Stepping On Fall Prevention Program Scale-Up in NSW: Program Reach and Fall-Related Health Service Use

IntroductionFalls in older adults are associated with increased healthcare costs. Falls may be prevented or minimised with multifactorial interventions including exercise and behavioural modification.&#x0D; Objectives and ApproachTo describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged 65 years and older in NSW, Australia; and fall-related ambulance service use and fall-related hospitalisations after scale-up. Routinely-collected data on program reach, fall-related ambulance usage and fall-related hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following implementation of Stepping On using multilevel models.&#x0D; ResultsFrom 2009 to 2014 the program was delivered in 1,077 sites to 10,096 people with an average (SD) age of 81.0 (7.2) years. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (p&lt;.001). Overall, the interaction between time and program delivery was not significant for fall-related ambulance use or hospital admissions. The time-related increase in fall-related ambulance usage in people aged 75-84 years may have been moderated by Stepping On (RR 0.97, 95% CI 0.93–1.00, p=.045).&#x0D; Conclusion / ImplicationsThere was no indication of either a reduced rate of fall-related ambulance use or hospital admissions across the entire sample. There was a suggestion of a reduction in ambulance call-outs for falls in people aged 75-84. The lack of a detectable impact on fall-related health service usage may be due to the use of routinely collected data not intended for research purposes or inability to remove those who would be ineligible for Stepping On from the data analyses. Increasing the program reach and targeting groups contributing most to health service utilisation may improve program outcomes.

Residential aged care homes: Why do they call '000'? A study of the emergency prehospital care of older people living in residential aged care homes.

To describe the clinical characteristics, medical interventions and patterns of ambulance service use related to the emergency, prehospital care of older people living in residential aged care (RAC) homes. Retrospective cohort study using secondary analyses of routinely collected clinical and administrative data from Ambulance Victoria and population data from the Australian Bureau of Statistics for the state of Victoria, Australia. Participants included people aged 65 years and over, attended by emergency ambulances from 2008 to 2013, with data captured in the Ambulance Victoria electronic record. The mean (standard deviation) age of RAC residents attended by emergency ambulance was 85 (7.3) years and 63% were women. Common comorbidities included dementia (32.7%), ischaemic heart disease (27.7%) and osteoarthritis (24.6%). Polypharmacy was prevalent with 70% currently prescribed antibiotics, over 20% prescribed sedatives and a further 14.9% antipsychotics. Fifteen percent of attendances were for falls, which were more frequent among women than men. Other common reasons for ambulance call-out included uncontrolled pain, respiratory tract infection, non-specific febrile illness and altered conscious state. Almost 90% of people were transported to hospital from the RAC, with just over half of call-outs occurring out-of-hours. This is the first study to describe emergency prehospital care, case-mix and intervention of frail, older people living in RAC. These results demonstrate a clinically complex group of people with high rates of comorbidity, cognitive impairment and polypharmacy. These valuable data will inform education and training of prehospital clinicians, assist in targeting preventative medicine and primary care programmes and further development of alternate, acute and emergency care pathways for this unique patient group.

Scale-up of the Stepping On fall prevention program amongst older adults in NSW: Program reach and fall-related health service use.

We describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged ≥65years in NSW, along with fall-related ambulance service use and fall-related hospitalisations after scale-up. Data on program provision were received from Local Health Districts. Routinely collected fall-related ambulance usage and hospital admissions in NSW residents aged ≥65years between 2009 and 2015 were compared within Statistical Local Areas prior to and following the implementation of Stepping On using multilevel models. Between 2009 and 2014 the program was delivered in 1077 sites to 10096 older adults. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (P<.001). The interaction between time and program delivery was not significant for fall-related ambulance use or hospital admissions. The time-related increase in fall-related ambulance usage in people aged 75-84years may have been moderated by the Stepping On program (rate ratio 0.97, 95% CI 0.93-1.00, P=.045). There was no indication of a reduced rate of fall-related ambulance use or hospital admissions across the entire sample. Ambulance call-outs for falls in people aged 75-84years may have reduced following program participation. SO WHAT?: Program scale-ups need to reach a large proportion of the target population with a focus on those groups contributing most to fall-related health service utilisation. Linking individual participants' health data as part of large-scale evaluations may provide better insights into program outcomes.

Ambulance Services Associated with Extreme Temperatures and Fine Particles in a Subtropical Island

This study evaluated the association between the risk of events requiring ambulance services and the ambient temperature and particulate matter of 2.5 μm (PM2.5) and 10 μm (PM10) for populations living in subtropical Taiwan. We used a distributed lag nonlinear model with a quasi-Poisson function to assess the roles of ambient temperature, PM10 and PM2.5 in the use of ambulance services for respiratory distress, coma and unconsciousness, chest pain, lying down in public, headaches/dizziness/vertigo/fainting/syncope and out-of-hospital cardiac arrest (OHCA). The relative risk (RR) and 95% confidence interval (CI) of each specific event were calculated in association with the ambient conditions. In general, the events that required ambulance services had a V-shaped or J-shaped association with the temperature, where the risks were higher at extreme temperatures. The RR of each event was significant when the patients were exposed to temperatures in the 5th percentile (<15 °C); patients with OHCA had the highest adjusted RR of 1.61 (95% CI = 1.47–1.77). The risks were also significant for coma/unconsciousness, headaches/dizziness/vertigo/fainting/syncope, and OHCA but not for respiratory distress, chest pain and lying down in public, after exposure to the 99th percentile temperatures of >30 °C. The risks for use of ambulance services increased with PM exposure and were significant for events of respiratory distress, chest pain and OHCA after exposure to the 99th percentile PM2.5 after controlling for temperatures. Events requiring ambulance services were more likely to occur when the ambient temperature was low than when it was high for the population on the subtropical island of Taiwan. The association of the risk of events requiring ambulance services with PM were not as strong as the association with low temperatures.

Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan.

Understanding the epidemiological distributions of ambulance transport for patients with mild conditions according to age, disease, and geographic region could help in achieving optimal use of ambulance services. In the present study, we explored the descriptive epidemiology of ambulance transports in Hokkaido, the northernmost prefecture of Japan, identifying potential factors that determine the frequency of transports for mild diseases. Of the total 153,667 ambulance transports in Hokkaido during 2016, we found that two-thirds were for older people, of which about 60% resulted in hospital admission. There were 74,485 transports for mild cases, which were most commonly for psychiatric disorders among working-age adults (n = 4805), heart diseases among older people (n = 4246), and sensory organ diseases among older people (n = 3589). Examining the ecological correlations over 58 geographic units of ambulance services, the total unemployment rate and distance to the nearest tertiary care hospital were, respectively, positively and negatively correlated with the standardized transport ratio for multiple mild diseases. The proportion of working-age adults was uniquely identified as a possible positive predictor in mild cases of psychiatric disorders. As the identified potential predictors could be helpful in considering countermeasures, the causal links should be examined in future studies.

Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana

BackgroundTimely access to emergency obstetric care is crucial in preventing mortalities associated with pregnancy and childbirth. The referral of patients from lower levels of care to higher levels has been identified as an integral component of the health care delivery system in Ghana. To this effect, in 2012, the National Referral Policy and Guidelines was developed by the Ministry of Health (MOH) to help improve standard procedures and reduce delays which affect access to emergency care. Nonetheless, ensuring timely access to care during referral of obstetric emergencies has been problematic. The study aimed to identify barriers associated with the referral of emergency obstetric cases to the leading national referral centre. It specifically examines the lived experiences of patients, healthcare providers and relatives of patients on the referral system.MethodsKorle Bu Teaching Hospital, Accra was used as a case study in 2016.The qualitative method was used and in-depth interviews were conducted with 89 respondents: healthcare providers [n = 34];patients [n = 31] and relatives of patients [n = 24] using semi-structured interview guides. Purposive sampling techniques were used in selecting healthcare providers and patients and convenience sampling techniques were used in selecting relatives of patients.ResultsThe study identified a range of barriers encountered in the referral process and broadly fall under the major themes: referral transportation system, referrer-receiver communication barriers, inadequate infrastructure and supplies and insufficient health personnel. Some highlights of the problem included inadequate use of ambulance services, poor management of patients during transit, lack of professional escort, unannounced emergency referrals, lack of adequate information and feedback and limited supply of beds, drugs and blood. These findings have implications on type II and III of the three delays model.ConclusionsInitiatives to improve the transportation system for the referral of obstetric emergencies are vital in ensuring patients’ safety during transfer. Communication between referring and receiving facilities should be enhanced. A strong collaboration is needed between teaching hospitals and other stakeholders in the referral chain to foster good referral practices and healthcare delivery. Concurrently, supply side barriers at referred facilities including ensuring sufficient provision for bed, blood, drugs, and personnel must be addressed.

Analysis of the Use of Ambulance Services Among Pregnant, Childbearing, and Postpartum Women Using Data from the Korea Health Panel

Analysis of the Use of Ambulance Services Among Pregnant, Childbearing, and Postpartum Women Using Data from the Korea Health Panel

Utilization and Costs of Health Care in a Kidney Supportive Care Program.

Kidney supportive care (KSC) is a patient-centered model of multidisciplinary care designed for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Our goal was to characterize the types, frequencies, and costs of services accessed by patients enrolled in a KSC program. We analyzed health care utilization data prospectively collected from 102 patients who enrolled in the KSC program during the first 52 weeks of its existence. The data comprised program appointments, emergency department presentations, ambulance service use, outpatient visits, inpatient episodes, and dialysis treatments made within the Brisbane area of Metro North. Costs of resource use were estimated using Queensland Health funding principles and guidelines. Analyses included descriptive statistics, correlations, and multivariate regressions. During the median program participation of 22 weeks, patients had 3975 contacts with health care, with the total value of services amounting to nearly A$3 million. Dialysis treatments accounted for 70% of visits and 49% of costs. Patients receiving dialysis had higher utilization of outpatient services and associated cost, compared to patients who were not dialyzed. The presence of diabetes and the choice of conservative pathway were both predictors of higher frequency and cost of services. Longer program participation was associated with lower weekly utilization and cost. The program attracted patients representing various characteristics, pathways, needs, and outcomes. Exploring these patterns will enable better understanding of the patient population and improved service planning, in KSC and similar programs that aim to comprehensively address the needs of patients with advanced CKD and ESKD.

Repeated ambulance use is associated with chronic diseases - a population-based historic cohort study of patients\u2019 symptoms and diagnoses

BackgroundThere is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways of delivering care. We examined the symptom at time of emergency call and the hospital diagnosis for those ambulance users who repeatedly received an ambulance.MethodsPopulation-based historic cohort study of patients receiving an ambulance after an emergency call between 2011 and 2014: one-time users (i.e. one ambulance run in any 12 month period) were compared to two-time users (two runs in any 12 month period) and frequent users (>two runs). The presenting symptom according to the Danish Index for Emergency Care from the EMS calls and the hospital ICD-10 discharge diagnoses were obtained from patient records.ResultsWe included 52 533 patients (65 932 emergency ambulance runs). Repeated users constituted 16% of the patients (two-time users 11% and frequent users 5%) and one third of all ambulance runs. The symptoms showing the largest increase in frequency with increasing ambulance use were breathing difficulty (N = 3 905–15% were frequent users); seizure (N = 2 437–10% were frequent users), chest pain (N = 7 616–17% were frequent users), and alcohol intoxication (N = 1 998–5% were frequent users). The hospital diagnoses with a corresponding increase were respiratory diseases (N = 4 381) - 13% were frequent users), mental disorders (predominately abuse of alcohol) (N = 3 087–10% were frequent users) and neurological diseases (predominately epilepsy) (N = 2 207–6% were frequent users). 5% of one-time users, 12% of two-time users and 16% of frequent users had a Charlson Comorbidity Index > = 3.ConclusionRepeated use of ambulance services was common and associated with chronic health problems such as chronic respiratory diseases, epilepsy, mental disorders with alcohol abuse and comorbidity. Alternative methods of caring for many of these patients should be considered.Trial registrationNone.

Abstract TP283: Ambulance Service Use and Associations With Hospital Care and 90-day Outcomes for Acute Stroke: The Australian Stroke Clinical Registry (AuSCR)

Introduction: Hospital arrival via ambulance may influence treatment options and outcomes of acute stroke. A national study for Australia has not previously been reported, and inclusion of long-term outcomes is rare. We aimed to determine differences in the characteristics of patients and their outcomes by route of hospital presentation. Methods: Patient-level data linkage of Australian Stroke Clinical Registry (AuSCR) patients with first-ever strokes between January 2010 and December 2013 (n=40 hospitals) were merged with emergency and hospital admissions, and death records. Multilevel regression models were used to determine associations with hospital care and outcome by type of transport to hospital. Results: Among 9315 patients with first-ever stroke, 5601 (60%) arrived by ambulance (52% male; 79% ischemic). Compared to patients arriving by private transport, those arriving by ambulance were older (ambulance, median 77 vs. private, 72 years; P&lt;0.001), more often had an intracerebral hemorrhage (ICH, ambulance 18% vs 15%; P&lt;0.001), and were unable to walk (proxy for stroke severity: ambulance 73% vs. 50%; P&lt;0.001). Median times to hospital were shorter via ambulance (135 vs. 229 mins; P&lt;0.001), and patients arriving by private transport were less likely to receive acute therapies (rtPA for ischemic stroke, ambulance 16% vs 8%; aspirin &lt;48 hrs, ambulance 75% vs 63%) or swallow screen/assessment (ambulance 89% vs 75%). After accounting for patient/hospital characteristics, compared with patients arriving by private transport, those using ambulances more often received inpatient rehabilitation (aOR 1.57, 95%CI 1.30-1.64), but more often died within 30-days (aOR 1.23) or reported worse quality-of-life at 90-180 days (coefficient: -4.4, 95%CI -7.4 to -1.4). Conclusion: Patients with first-ever stroke who take private transport to hospital experience treatment disadvantages but not worse outcomes. Public education on calling an ambulance for stroke symptoms remains important.