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

Søvsø, Morten Breinholt; Kløjgaard, Torben Anders; Hansen, Poul Anders; Christensen, Erika Frischknecht

doi:10.1186/s13049-019-0624-4

Cited by 20 publications

(21 citation statements)

References 16 publications

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“…The rate of chest pain patients transported by ambulance was comparable to the chest pain rate found in recent Swedish and Danish studies, but substantially higher than earlier reported in studies from Norway and the UK [2, 20–23]. The most likely reason for this higher rate is a temporal increase in chest pain cases also reported in other studies [23, 24].…”

Section: Discussionsupporting

confidence: 78%

Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study

Pedersen

Stengaard

Friesgaard

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. Methods Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. Results In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8–2.4) compared to 6.0% (95%CI 5.7–6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2–0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. Conclusion Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients. Electronic supplementary material The online version of this article (10.1186/s13049-019-0659-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 78%

Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study

Pedersen

Stengaard

Friesgaard

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…Despite having completed a specialist degree in ambulance care, the respondents felt that they lacked in‐depth knowledge about various mental disorders and comorbidities, particularly when patients had been exposed to different traumas. Several studies have shown that people with mental disorders, besides having more health problems and less adherence to medications, also tend to be at higher risk of complications after severe trauma, such as self‐inflicted injury, attempted suicide or penetrating trauma, where one‐third of major trauma patients had used alcohol, drugs or a medication overdose at the time of admission (Byles et al., 2014; Clous et al., 2017; Dekker et al., 2020; Holden et al., 2010; Lundin et al., 2016; Søvsø et al., 2019; Wang et al., 2007).…”

Section: Discussionmentioning

confidence: 99%

Perceptions of ambulance nurses on their knowledge and competence when assessing psychiatric mental illness

2020

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Aims and objectives To obtain the current perception of the knowledge and competence of pre‐hospital emergency specialist nurses (ambulance) in attending patients with psychiatric symptoms. Background Psychiatric illnesses have increased throughout the population. Consequently, pre‐hospital emergency services frequently attend individuals with suspected or known mental illnesses. Design We employed a set of quantitative and qualitative methods to gain a deeper understanding of ambulance nurses' self‐evaluated knowledge. Methods Seven ambulance nurses received and completed a survey questionnaire prior commencing employment in November 2019. Then, we conducted interviews to explore ambulance nurses' perceptions of their own knowledge and competence when attending individuals with mental disorders. The surveys were analysed with descriptive statistics, followed by content analysis. Results Three topics emerged: the encounter of patients with mental illness; the awareness of lacking knowledge about mental illnesses; and the expectations for future Prehospital Emergency Psychiatric Response Teams. Although ambulance nurses already possessed basic knowledge regarding psychiatric illnesses, it was insufficient, based on their perception of appropriate care. Ambulance nurses considered that combining pre‐hospital and psychiatric expertise in the pre‐hospital emergency unit would increase their in‐depth knowledge about various psychiatric illnesses, the treatment options and the alternatives regarding where to deliver patients for continued care.

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“…[1][2][3] So far, studies on patient characteristics associated with contacting an acute health care setting have either included patients contacting EMS or OOH-PC and mostly focus has been on inappropriate or recurrent use. [4][5][6][7][8] However, possible overlaps in the EMS and OOH-PC patient populations have been observed; some patients in need of acute care contact OOH-PC and some patients with non-specific complaints perhaps more suitable for OOH-PC contact EMS. [9][10][11][12] Besides the patient's self-perceived urgency and severity of the acute health problem, other factors play a role in the choice of entrance to out-of-hours (OOH) care.…”

Section: Introductionmentioning

confidence: 99%

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

Søvsø¹,

Bech²,

Christensen³

et al. 2020

CLEP

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Background: Out-of-hours (OOH) health care services are often divided into emergency medical services (EMS) and OOH primary care (OOH-PC). EMS and many OOH-PC use telephone triage, yet the patient still makes the initial choice of contacting a service and which service. Sociodemographic characteristics are associated with help-seeking. Yet, differences in characteristics for EMS and OOH-PC patients have not been investigated in any large-scale cohort studies. Such knowledge may contribute to organizing OOH services to match patient needs. Thus, in this study we aimed to explore which sociodemographic patient characteristics were associated with utilizing OOH health care and to explore which sociodemographic characteristics were associated with EMS or OOH-PC contact. Methods: A population-based observational cohort study of inhabitants in two regions (North Denmark Region and Capital Region of Copenhagen) with or without contact to OOH services during 2016 was conducted. Associations between sociodemographic characteristics and OOH contacts (and EMS versus OOH-PC contact) were evaluated by regression analyses. Results: We identified 619,857 patients with OOH contact. Female sex (IRR=1.16 (95% CI: 1.16-1.17)), non-western ethnicity (IRR=1.02 (95% CI: 1.01-1.02)), living alone (IRR=1.08 (95% CI: 1.08-1.09)), age groups ≥81 years (IRR=2.00 (95% CI: 1.98-2.02)) and 0-18 years (IRR=1.66 (95% CI: 1.66-1.67)) and low income (IRR=1.41 (95% CI: 1.40-1.42)) were more likely to contact OOH health care compared to males, Danish ethnicity, citizens cohabitating, age 31-65 years and high income. Disability pensioners more often contacted OOH care (IRR=1.79 (95% CI: 1.77-1.81) compared to employees. Old age (≥81 years) (OR=3.21 (95% CI: 3.13-3.30)), receiving cash benefits (OR=2.45 (95% CI: 2.36-2.54)), low income (OR=1.76 (95% CI: 1.72-1.81)) and living alone (OR=1.40 (95% CI: 1.37-1.42)) were all associated with EMS contacts rather than OOH-PC contacts. Conclusion: Several sociodemographic factors were associated with contacting a health care service outside office hours and with contacting EMS rather than OOH-PC. Old age, low income, low education and low socioeconomic status were of greatest importance.

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

Cited by 20 publications

References 16 publications

Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study

Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study

Perceptions of ambulance nurses on their knowledge and competence when assessing psychiatric mental illness

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

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