Factors affecting ambulance utilization for asthma attack treatment: understanding where to target interventions

Raun, Loren; Ensor, Katherine B.; Campos, Laura; Persse, David

doi:10.1016/j.puhe.2015.02.009

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…9 , 10 The repercussions of the loss of these services may be particularly detrimental in low-income communities, which rely more heavily on prehospital care and have a higher increased incidence of severe, life-threatening illnesses. 11 , 12 , 13 , 14 , 15…”

Section: Introductionmentioning

confidence: 99%

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

et al. 2018

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Key Points Question Are ambulance 9-1-1 times longer in high-income compared with low-income areas, and how do response times compare with national benchmarks across income quartiles? Findings In this US national, cross-sectional study of 63 600 patients with out-of-hospital cardiac arrest, EMS times remained 10% longer in the poorest areas and were more likely to meet 8-minute and 15-minute cutoffs in high-income areas. Meaning Patients with cardiac arrest from the poorest neighborhoods had longer EMS times that were less likely to meet national benchmarks compared with those from the wealthiest neighborhoods, which may lead to increased disparities in the delivery of prehospital care over time.

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Section: Introductionmentioning

confidence: 99%

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

et al. 2018

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“… 22 However, the majority of previous studies conducted in the field have assessed the impact of asthma education in large urban centers or hospitals. 23 – 25 The effect of these interventions in rural areas has been less well investigated.…”

Section: Discussionmentioning

confidence: 99%

Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

et al. 2018

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ObjectiveIt is well known that parent/patient education helps to reduce the burden of asthma in urban areas, but data are scarce for rural areas. This study explored the impact of asthma education in Ector County, a rural part of Health Services Region 9 in Texas, which has one of the highest prevalence rates of asthma in the state.MethodsThis prospective study investigated an interactive asthma education intervention in pediatric patients aged 2–18 years and their caregivers. Change in parental/caregiver knowledge about their child’s asthma along with frequency of missed school days, emergency department (ED) visits and hospital admissions was obtained via telephone surveys before and after the educational intervention was delivered.ResultsThe study enrolled 102 pediatric patients and their parents/caregivers. Asthma education was associated with significantly fewer school absences, ED visits and hospitalizations. Parents/caregivers reported feeling better educated, knowing what triggers an asthma exacerbation, identifying the signs of a severe asthma attack in their child, feeling confident about managing asthma and feeling that the asthma was under control.ConclusionAsthma education of caregivers and children was associated with better symptom management and fewer acute exacerbations, pointing to the relevance and importance of asthma education among pediatric patients in rural areas.

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“…There are relatively few studies that describe disparities in pediatric EMS care and utilization. A geospatial study identified increased use of EMS among asthmatic children with particularly high EMS utilization among asthmatic children from poor, black, and less-educated populations 8. In addition, adults with lower socioeconomic status are more likely to use EMS 9.…”

Section: Discussionmentioning

confidence: 99%

Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

Hansen¹,

Loker²,

Warden³

2016

WestJEM

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IntroductionThe association between geographic factors, including transport distance, and pediatric emergency medical services (EMS) run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls.MethodsThis was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots) of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables.ResultsWe identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic regression. The locations of intubations were superimposed on hot spots of all pediatric EMS runs. This map demonstrates that most of the intubations occurred within areas where pediatric EMS calls were highly clustered. By mapping the intubation procedures and pediatric population density, we found that intubation procedures were not clustered in a similar distribution to the pediatric population in the county.ConclusionIn this geographically diverse county the location of intubation procedures was similar to the clustering of pediatric EMS calls, and increased distance from the hospital was associated with reduced odds of intubation after controlling for several potential confounding variables.

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Factors affecting ambulance utilization for asthma attack treatment: understanding where to target interventions

Cited by 11 publications

References 13 publications

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

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