Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-19T00:42:11.391Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of Demand for Emergency Prehospital Care: An Australian Study

Published online by Cambridge University Press:  28 June 2012

Michele J. Clark ,
Jennifer Purdie ,
Gerry J. FitzGerald ,
Noelene G. Bischoff  and
Peter K. O'Rourke
Michele J. Clark*
Affiliation:
The University of Queensland Medical SchoolHerston, Qld, Australia
Jennifer Purdie
Affiliation:
The University of Queensland Medical SchoolHerston, Qld, Australia
Gerry J. FitzGerald
Affiliation:
The University of Queensland Medical SchoolHerston, Qld, Australia
Noelene G. Bischoff
Affiliation:
The University of Queensland Medical SchoolHerston, Qld, Australia
Peter K. O'Rourke
Affiliation:
The University of Queensland Medical SchoolHerston, Qld, Australia
*
Department of Social and Preventive Medicine The University of Queensland Medical School Herston Road, Herston, Qld, Australia 4006. E-mail: M.Clark@spmed.uq.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Determining the predictors of demand for emergency prehospital care can assist ambulance services in undertaking policy and planning activities.

Hypothesis:

Demand for prehospital care can be explained by demographic, health status, and economic determinants.

Methods:

The study used a cross-sectional design to investigate the association of demographic, health status, and insurance factors with the use of prehospital, ambulance care. Core data items including age, gender, marital status, country of origin, triage score, diagnosis, time of presentation, method of arrival, and patient disposition were collected for every patient who pre-sented at the Emergency Department of the study hospital over a four-month period. Ambulance usage was analysed using Poisson regression.

Results:

For the 10,229 patients surveyed, only a small number were triaged as having the highest level of urgent medical need (0.8%), but the majority of these used prehospital emergency medical care (90.2%). Predictors of ambulance use included age >65years (Prevalence Ratio [Prevalence Ratio] = 2.92; 95% confidence interval [ Confidence Interval]: 2.35–3.63), being married or in a defacto relationship (Prevalence Ratio = 0.69; 95% Confidence Interval: 0.60–0.79) or divorced, separated, or widowed (Prevalence Ratio = 0.83; 95% Confidence Interval: 0.70–0.98), triage score level 1 or 2 (Prevalence Ratio = 1.95; 95% Confidence Interval: 1.68–2.28), or triage score level 3 (Prevalence Ratio = 1.54; 95% Confidence Interval: 1.38–1.72), diagnosis involving either mental (Prevalence Ratio = 4.29; 95% Confidence Interval: 1.84–10.01), nervous (Prevalence Ratio = 2.74; 95% Confidence Interval: 1.19–6.31) or trauma (Prevalence Ratio = 2.33; 95% Confidence Interval: 1.03–5.27) conditions, and insurance status (Prevalence Ratio =1.54; 95% Confidence Interval: 1.40–1.71). Ethnicity, gender, and time of day were not associated with usage.

Conclusion:

Demand for ambulance services can be predicted by a number of demographic, medical status, and insurance variables. Age and triage levels are key influences on demand for ambulance services. Ambulance insurance status provides an economic incentive to use ambulance services regardless of the urgency of the medical condition.

Keywords

ambulance servicesemergency carehealth services utilisationpredictors of demandprehospital caretriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 14 , Issue 3 , September 1999 , pp. 60 - 66
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Australian Institute of Health and Welfare: Health Expenditure Bulletin, 13 (July). Canberra: Australian Institute of Health and Welfare, 1997.Google Scholar
2. Billittier, AJ, Moscati, R, Janicke, D, Lerner, EB, Seymore, J, Olsson, D: A multi-site survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med 1996;3;1046–1052.Google Scholar
3. Cadigan, RT, Bugarin, CE: Predicting demand for emergency ambulance service. Ann Emerg Med 1989;18:618–621.CrossRefGoogle ScholarPubMed
4. Rademaker, AW, Powell, DG, Read, JH: Inappropriate use and unmet need in paramedic and non-paramedic ambulance systems. Ann Emerg Med 1987;16:553–556.CrossRefGoogle Scholar
5. Rucker, DW, Edwards, RA, Burstin, HR, O'Neil, QC, Brennan, TA: Patient specific predictors of ambulance use. Ann Emerg Med 1997;29:484–490.CrossRefGoogle ScholarPubMed
6. Smith, D, Knickman, J, Berry, C: Managing the demand for emergency service: The New York City EMS. Disaster Management 1994;6:151–159.Google Scholar
7. Spear, SF: Life-threatening emergencies: Patterns of demand and response of a regional Emergency medical services system. Am J Prey Med 1986;2:163–168.CrossRefGoogle ScholarPubMed
8. Butler, JRG: Factors affecting the demand for ambulance services. Int J Trans Econ 1981;8:225–238.Google Scholar
9. Butler, JRG: Estimating the welfare loss from non-optimal pricing of ambulance services. Int J Trans Econ 1983;20:77–110.Google Scholar
10. Australian Bureau of Statistics: 1996 Census of Population and Housing. Canberra; 26 Australia: Australian Bureau of Statistics, 1996.Google Scholar
11. Australasian College for Emergency Medicine: National triage scale. Emeg Med 1994;4:145–146.Google Scholar
12. Hollis, GB, Sprivulis, P: Reliability of the national triage scale with changes in emergency department activity level. Emerg Med 1996;8:231–234.CrossRefGoogle Scholar
13. Jelinek, GA, Little, M: Inter-rater reliability of the national triage scale over 11,500 simulated occasions of triage. Emerg Med 1996;8:226–230.CrossRefGoogle Scholar
14. Lee, J: Odds ratio or relative risk for cross-sectional data? Int J Epidemiol 1994;23:201–203.CrossRefGoogle ScholarPubMed
15. Caplan, GA, Brown, A, Croker, WD, Doolan, J: The DEED (Discharge from the emergency department) study. Emerg Med 1997;9:74.Google Scholar
16. Ettinger, WH, Casani, JA, Coon, PJ, Muller, DC, Piazza-Appel, K: Patterns of use of the emergency department by elderly patients. J Gerontol 1987;42:638–642.CrossRefGoogle ScholarPubMed
17. Lamb, I, Eddey, D, Cameron, P: Emergency department utilisation by the elderly. Emerg Med 1995;7,2:75–79.CrossRefGoogle Scholar
18. Street, P, McKay, S., Appleby, N, Gilchrist, J, Moore, W, Hendrie, J, Dent, A, Aguis, S: Emergency Department Use by the Elderly: A Study of Older People's Use of the Emergency Departments of Three Melbourne Hospitals. Melbourne: Bundoora Centre for Applied Gerontology: 1996.Google Scholar
19. Clark, MJ, FitzGerald, GJ: Older people's use of ambulance services: A population-based analysis. J Acc and Emerg Med 1999;16:108–111.CrossRefGoogle ScholarPubMed
20. Australian Institut e of Health and Welfare: Australia's Health 1992: The Third Biennial Report of the Australian Institute of Health and Welfare. Canberra: Australian Government Printing Service, 1992.Google Scholar
21. Abraham, B, d'Espaignet, ET, Stevenson, C: Australian Health Trends 1995. Australian Institute of Health and Welfare: Canberra, 1995.Google Scholar
22. FitzGerald, GJ: Emergency Department Triage [dissertation]. University of Queensland, Australia: August; 1989.Google Scholar
23. Walker, LL: Inpatient and emergency department utilization: The effects of distance, social class, age, sex and marital status. J Am Coll Emerg Phys 1976;5:105–110.CrossRefGoogle ScholarPubMed
24. Australian Institute of Health &Welfare: Australia's Health 1996: The Fifth Biennial Report of the Australian Institute of Health and Welfare. Canberra: Australian Government Printing Service:1996.Google Scholar
25. Broom, D: Masculine, feminine illness: Gender and health, In: Lupton, GM, Najman, J (eds): Sociology of Health and Illness, 2d ed. Melbourne: Macmillan Company of Australia Pty Ltd, 1995: pp 121–134.Google Scholar
26. Malone, RE: Heavy users of emergency services: Social construction of a policy problem. Soc Sci Med 1995;7:75–79.Google Scholar
27. Padgett, DL, Brodsky, B: Psychological factors influencing non-urgent use of the emergency room: A review of the literature and recommendations for research and improved service delivery. Soc Sci Med 1992;35:1189–1197.CrossRefGoogle Scholar
28. Hu, S, Kao, W: Outcomes in severely ill patients transported without prehospital ALS. Am J Emerg Med 1996;14:86–88.CrossRefGoogle ScholarPubMed
29. Demetriades, D, Chan, L, Cornwell, E, Belzberg, H, Berne, TV, Asensio, J, Chan, D, Eckstein, M, Alo, K: Paramedic vs private transportation of trauma patients. Effect on outcome. Arch Surg 1996;131:133–138.CrossRefGoogle Scholar