Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region

Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Torben; Jensen, Flemming Bøgh; Lindskou, Tim Alex; Holdgaard, Hans Ole; Hansen, Poul Anders; Johnsen, Søren Paaske; Christiansen, Christian Fynbo

doi:10.1136/bmjopen-2016-014508

Cited by 39 publications

(36 citation statements)

References 30 publications

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“…As in other studies, women more often than men contacted out-of-hours primary care, and a considerable part of calls to out-of-hours primary care concerned children [29][30][31][32]. Two Danish studies on EMS contacts reported similar percentages of calls made by women, but these studies found a slightly lower mean age than found in our study [33,34]. This difference is likely to be due to our stratification into groups (children and adults) and exclusion of patients aged 13-18 years.…”

Section: Comparison With Existing Literaturesupporting

confidence: 62%

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Huibers¹,

Carlsen²,

Moth³

et al. 2020

BMC Emerg Med

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Background: Patients in need of acute health care do not always contact the most suitable health care service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific health care provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods: We conducted a cross-sectional observational study by sending a questionnaire to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two health care service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results: Three key motives for contacting the two service providers were identified: 'unpleasant symptoms', 'perceived need for prompt action' and 'perceived most suitable health care provider'. Other important motives were 'need arose outside office hours' and 'wanted to talk to a physician' (out-of-hours primary care) and 'expected need for ambulance' and 'worried' (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions: Patient motives for contacting the two health care service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute health care. This knowledge could help optimise existing health care services, such as patient safety and the service level, without increasing health care costs.

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Section: Comparison With Existing Literaturesupporting

confidence: 62%

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Huibers¹,

Carlsen²,

Moth³

et al. 2020

BMC Emerg Med

View full text Add to dashboard Cite

show abstract

“…Women more often than men contacted OOH-PC, and a considerable part of calls to OOH-PC concerned children [29][30][31][32]. Two Danish studies on EMS contacts reported similar percentages of calls made by women, but these studies found a slightly lower mean age than found in our study [33,34]. This difference is likely to be due to our stratification into groups (children and adults) and exclusion of patients aged 13-18 years.…”

Section: Comparison With Existing Literaturecontrasting

confidence: 68%

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Huibers¹,

Carlsen²,

Moth³

et al. 2019

Preprint

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Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

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“…These studies did not investigate whether the patients arrived at hospital after calling EMS or OOH-PC. However, it has previously been shown that a large proportion of patients brought to hospital after ambulance transport by EMS receive a broad range of diagnoses including nonurgent and/or non-specific diagnoses [21,38,39] and that a substantial proportion of patients with serious conditions such as myocardial infarction or stroke initially contact primary care (both during daytime and OOH) [40][41][42][43][44]. This could indicate some overlap in patient populations.…”

Section: Comparison With Literaturementioning

confidence: 99%

Acute care pathways for patients calling the out-of-hours services

Søvsø

Huibers

Bech

et al. 2020

BMC Health Serv Res

Self Cite

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Background: In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark. Methods: Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (< 24 h) or admissions (≥24 h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours. Results: OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older. Conclusions: EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.

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Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region

Cited by 39 publications

References 30 publications

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Acute care pathways for patients calling the out-of-hours services

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