Reasons why patients choose an ambulance and willingness to consider alternatives

Lalena Yarris, Raymond Moreno, Terri Schmidt, Annette L. Adams, Heather S. Brooks

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: To test a hypothesis that patients would accept alternatives to transport to an emergency department (ED) by ambulance and to evaluate factors related to patient willingness to consider alternatives. Concerns about resource utilization have prompted emergency medical services (EMS) systems to explore alternatives to ambulance transport to an ED, but studies have evaluated the safety of alternatives, not patient preferences. Methods: Trained research assistants surveyed patients transported by ambulance to a university ED. Interfacility transfers, trauma patients, and critically ill patients were excluded. The primary outcome was willingness to accept one of several presented alternatives to ambulance transport to the ED for that visit. Demographic and clinical factors were evaluated for association with willingness to consider alternatives. Relative risks (RR) and 95% confidence intervals (95% CI) were determined by using Mantel-Haenszel stratified methods. Results: Three hundred fifteen subjects completed the survey. Two hundred forty-seven (78.4%) were willing to consider at least one alternative. One hundred ninety-four (61.6%) were willing to consider transportation by car, and 177 (56.2%) were willing to consider transportation by taxi. Factors associated with willingness to consider alternatives included the following: age 18-65 years (RR, 1.25; 95% CI = 1.03 to 1.49), being unemployed (RR, 1.08; 95% CI = 1.08 to 1.33), use of the ED for routine care (RR, 1.25; 95% CI = 1.17 to 1.35), and not being admitted to the hospital (RR, 1.19; 95% CI = 1.04 to 1.40). Race, gender, health insurance status, and EMS interventions en route were not associated with willingness to consider transportation alternatives. Conclusions: Many patients transported by ambulance to an ED would have considered an alternative, if one were offered.

Original languageEnglish (US)
Pages (from-to)401-405
Number of pages5
JournalAcademic Emergency Medicine
Volume13
Issue number4
DOIs
StatePublished - Apr 2006

Fingerprint

Ambulances
Hospital Emergency Service
Confidence Intervals
Emergency Medical Services
Patient Transfer
Insurance Coverage
Patient Preference
Health Insurance
Critical Illness
Health Status
Demography
Safety
Wounds and Injuries
Research

Keywords

  • Emergency medical services
  • Paramedic
  • Transport
  • Triage

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Reasons why patients choose an ambulance and willingness to consider alternatives. / Yarris, Lalena; Moreno, Raymond; Schmidt, Terri; Adams, Annette L.; Brooks, Heather S.

In: Academic Emergency Medicine, Vol. 13, No. 4, 04.2006, p. 401-405.

Research output: Contribution to journalArticle

Yarris, Lalena ; Moreno, Raymond ; Schmidt, Terri ; Adams, Annette L. ; Brooks, Heather S. / Reasons why patients choose an ambulance and willingness to consider alternatives. In: Academic Emergency Medicine. 2006 ; Vol. 13, No. 4. pp. 401-405.
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abstract = "Objectives: To test a hypothesis that patients would accept alternatives to transport to an emergency department (ED) by ambulance and to evaluate factors related to patient willingness to consider alternatives. Concerns about resource utilization have prompted emergency medical services (EMS) systems to explore alternatives to ambulance transport to an ED, but studies have evaluated the safety of alternatives, not patient preferences. Methods: Trained research assistants surveyed patients transported by ambulance to a university ED. Interfacility transfers, trauma patients, and critically ill patients were excluded. The primary outcome was willingness to accept one of several presented alternatives to ambulance transport to the ED for that visit. Demographic and clinical factors were evaluated for association with willingness to consider alternatives. Relative risks (RR) and 95{\%} confidence intervals (95{\%} CI) were determined by using Mantel-Haenszel stratified methods. Results: Three hundred fifteen subjects completed the survey. Two hundred forty-seven (78.4{\%}) were willing to consider at least one alternative. One hundred ninety-four (61.6{\%}) were willing to consider transportation by car, and 177 (56.2{\%}) were willing to consider transportation by taxi. Factors associated with willingness to consider alternatives included the following: age 18-65 years (RR, 1.25; 95{\%} CI = 1.03 to 1.49), being unemployed (RR, 1.08; 95{\%} CI = 1.08 to 1.33), use of the ED for routine care (RR, 1.25; 95{\%} CI = 1.17 to 1.35), and not being admitted to the hospital (RR, 1.19; 95{\%} CI = 1.04 to 1.40). Race, gender, health insurance status, and EMS interventions en route were not associated with willingness to consider transportation alternatives. Conclusions: Many patients transported by ambulance to an ED would have considered an alternative, if one were offered.",
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