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Patients' aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital : A longitudinal and comparative study

Forsgärde, Elin Sofie ; Elmqvist, Carina ; Fridlund, Bengt LU ; Svensson, Anders ; Andersson, Richard and Rööst, Mattias LU (2020) In BMJ Open 10(11).
Abstract

Objectives Patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and... (More)

Objectives Patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: Age, sex, symptom, triage level, scene, time, day and season. Results The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. Conclusions The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
accident & emergency medicine, geriatric medicine, organisation of health services
in
BMJ Open
volume
10
issue
11
article number
e038885
publisher
BMJ Publishing Group
external identifiers
  • scopus:85096947341
  • pmid:33243795
ISSN
2044-6055
DOI
10.1136/bmjopen-2020-038885
language
English
LU publication?
yes
id
7016da48-5307-4437-b598-0cbde4e3929e
date added to LUP
2020-12-11 09:42:27
date last changed
2024-05-31 03:51:01
@article{7016da48-5307-4437-b598-0cbde4e3929e,
  abstract     = {{<p>Objectives Patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: Age, sex, symptom, triage level, scene, time, day and season. Results The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p&lt;0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. Conclusions The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old. </p>}},
  author       = {{Forsgärde, Elin Sofie and Elmqvist, Carina and Fridlund, Bengt and Svensson, Anders and Andersson, Richard and Rööst, Mattias}},
  issn         = {{2044-6055}},
  keywords     = {{accident & emergency medicine; geriatric medicine; organisation of health services}},
  language     = {{eng}},
  number       = {{11}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open}},
  title        = {{Patients' aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital : A longitudinal and comparative study}},
  url          = {{http://dx.doi.org/10.1136/bmjopen-2020-038885}},
  doi          = {{10.1136/bmjopen-2020-038885}},
  volume       = {{10}},
  year         = {{2020}},
}