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Unmet Need and Inappropriate Use in Emergency Ambulance Service

응급 환자 이송서비스의 적절성: 미충족 의료와 부적절한 이용

  • Kang, Kyunghee (Department of Emerergency Health Science, Gachon University)
  • Received : 2014.10.01
  • Accepted : 2014.12.18
  • Published : 2014.12.31

Abstract

Background: The objective of this study was to evaluate the efficiency of an emergency ambulance system and to investigate socio-economic and clinical characteristics associated with emergency ambulance service. Methods: Based on 2011 Korea health panel, unmet need and inappropriate use of emergency ambulance service were measured by Gibson in 1977. Furthermore, the factors associated with unmet need and inappropriate use of emergency ambulance service were identified by Fisher's exact tests and multiple logistic regression models. Results: Unmet need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 59.8%. Inappropriate use, defined as the proportion of emergency patient receiving ambulance care who did not clinically need it, was found to be 37.2%. There were statistically significant differences between appropriate and inappropriate groups in overall variables of socio-economic and clinical characteristics. Specifically, gender, age, relationship to household, and reasons of visiting emergency department (accident/disease) were statistically significant factors associated with appropriate use of emergency ambulance service. Conclusion: Unmet ambulance need is a useful measure for patients needs assessment, and inappropriate ambulance use is a valid criteria in judging the efficiency of emergency ambulance system. To improve and understand emergency ambulance system, unmet need and inappropriate use of emergency ambulance service should be more concerned.

Keywords

References

  1. Donabedian A. Aspects of medical care administration. Cambridge (MA): Harvard University Press; 1973.
  2. Sanmartin C, Murphy K, Choptain N, Conner-Spady B, McLaren L, Bohm E, et al. Appropriateness of healthcare interventions: concepts and scoping of the published literature. Int J Technol Assess Health Care 2008;24(3): 342-349. DOI: http://dx.doi.org/10.1017/S0266462308080458
  3. Park RE, Fink A, Brook RH, Chassin MR, Kahn KL, Merrick NJ, et al. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health 1986;76(7):766-772. DOI: http://dx.doi.org/10.2105/ajph.76.7.766
  4. Gibson G. Evaluative criteria for emergency ambulance systems. Soc Sci Med 1973;7(6):425-454. DOI: http://dx.doi.org/10.1016/0037-7856(73)90011-5
  5. Gibson G. Measures of emergency ambulance effectiveness: unmet need and inappropriate use. JACEP 1977;6(9):389-392. DOI: http://dx.doi.org/ 10.1016/s0361-1124(77)80002-6
  6. Brown E, Sindelar J. The emergent problem of ambulance misuse. Ann Emerg Med 1993;22(4):646-650. DOI: http://dx.doi.org/10.1016/s0196-0644(05)81841-4
  7. Billittier AJ, Moscati R, Janicke D, Lerner EB, Seymour J, Olsson D. A multisite survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med 1996;3(11):1046-1052. DOI: http://dx.doi.org/10.1111/j.1553-2712.1996.tb03352.x
  8. Camasso-Richardson K, Wilde JA, Petrack EM. Medically unnecessary pediatric ambulance transports: a medical taxi service? Acad Emerg Med 1997;4(12):1137-1141. DOI: http://dx.doi.org/10.1111/j.1553-2712.1997.tb03696.x
  9. Richards JR, Ferrall SJ. Inappropriate use of emergency medical services transport: comparison of provider and patient perspectives. Acad Emerg Med 1999;6(1):14-20. DOI: http://dx.doi.org/10.1111/j.1553-2712.1999.tb00088.x
  10. Kost S, Arruda J. Appropriateness of ambulance transportation to a suburban pediatric emergency department. Prehosp Emerg Care 1999;3(3):187-190. DOI: http://dx.doi.org/10.1080/10903129908958934
  11. Weaver MD, Moore CG, Patterson PD, Yealy DM. Medical necessity in emergency medical services transports. Am J Med Qual 2012;27(3):250-255. DOI: http://dx.doi.org/10.1177/1062860611424331
  12. Morris DL, Cross AB. Is the emergency ambulance service abused? Br Med J 1980;281(6233):121-123. DOI: http://dx.doi.org/10.1136/bmj.281.6233.121
  13. Gardner GJ. The use and abuse of the emergency ambulance service: some of the factors affecting the decision whether to call an emergency ambulance. Arch Emerg Med 1990;7(2):81-89. DOI: http://dx.doi.org/10.1136/emj.7.2.81
  14. Palazzo FF, Warner OJ, Harron M, Sadana A. Misuse of the London ambulance service: how much and why? J Accid Emerg Med 1998;15(6):368-370. DOI: http://dx.doi.org/10.1136/emj.15.6.368
  15. Little GF, Barton D. Inappropriate use of the ambulance service. Eur J Emerg Med 1998;5(3):307-311. DOI: http://dx.doi.org/10.1097/00063110-1998 09000-00005
  16. Patton GG, Thakore S. Reducing inappropriate emergency department attendances: a review of ambulance service attendances at a regional teaching hospital in Scotland. Emerg Med J 2013;30(6):459-461. DOI: http://dx.doi.org/10.1136/emermed-2012-201116
  17. Reed B. Ambulance utilisation in serious health emergencies in rural populations: measuring unmet need [Internet]. New South Wales: Ambulance Research Institute; 2011 [cited 2014 Jun 14]. Available from: http://www.ruralheti.health.nsw.gov.au/_documents/ complete-projects/ buck_ reed_rrcbp_report_final_191011.pdf.
  18. Rademaker AW, Powell DG, Read JH. Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems. Ann Emerg Med 1987;16(5):553-556. DOI: http://dx.doi.org/10.1016/s0196-0644(87)80684-4
  19. Chen JC, Bullard MJ, Liaw SJ. Ambulance use, misuse, and unmet needs in a developing emergency medical services system. Eur J Emerg Med 1996;3(2):73-78. DOI: http://dx.doi.org/10.1097/00063110-199606000-00003
  20. Kim YK, Ryoo JH, Moon WS, Chun BJ, Heo T, Min YI. An analysis on the patient transported via 119 system. J Korean Soc Emerg Med 2000; 11(2):190-195.
  21. Bae HA, Ryu JY, Eo EK, Jung KY. Study of the appropriateness of 119 rescue usage. J Korean Soc Emerg Med 2004;15(1):36-46.
  22. Lee HK, Do BS, Lee SB. Appropriateness of the use of emergency medical services and propensities toward choice by local residents of hospitals. J Korean Soc Emerg Med 2010;21(5):525-530.
  23. Park SW, Lee BK, Ryu HH, Jeung KW, Heo T. Out-of-jurisdiction transport of patients by the 119 rescue group. J Korean Soc Emerg Med 2010; 21(5):531-538.
  24. Lim JE, Yeom SR, Cho SJ, Han SK, Park SW, Lee SH. Field triage of severely injured patients and transportation by the EMS rescue group of Busan and Kyungnam, Korea: is it appropriate? J Trauma Inj 2012;25(4): 145-151.
  25. Ministry of Health and Welfare. 2013-2017 Emergency medicine plan. Seoul: Ministry of Health and Welfare; 2013.
  26. Korea Institute for Health and Social Affairs, National Health Insurance Service. Korea health panel 2008-2011 annual data (version 1.0) [Internet]. Seoul: Korea Institute for Health and Social Affairs, National Health Insurance Service; 2014 [cited 2014 Apr 14]. Available from: http://www.khp.re.kr/.
  27. Ohshige K, Kawakami C, Kubota K, Tochikubo O. A contingent valuation study of the appropriate user price for ambulance service. Acad Emerg Med 2005;12(10):932-940. DOI: http://dx.doi.org/10.1197/j.aem.2005.05.033
  28. Schuman LJ, Wolfe H, Sepulveda J. Estimating demand for emergency transportation. Med Care 1977;15(9):738-749. DOI: http://dx.doi.org/10.1097/00005650-197709000-00002
  29. Patterson PD, Moore CG, Brice JH, Baxley EG. Use of ED diagnosis to determine medical necessity of EMS transports. Prehosp Emerg Care 2006;10(4):488-493. DOI: http://dx.doi.org/10.1080/10903120600886918
  30. Jacob SL, Jacoby J, Heller M, Stoltzfus J. Patient and physician perspectives on ambulance utilization. Prehosp Emerg Care 2008;12(2):176-181. DOI: http://dx.doi.org/10.1080/10903120701710058
  31. Park IC, Lee KR, Lee HS. The severity of emergency patient via ambulance. J Korean Soc Emerg Med 1996;7(1):104-111.
  32. Chung SH, Yoon HD, Na BJ. Characteristics of non-emergent patients at emergency departments. Korean J Health Policy Admin 2006;16(4):128-146. https://doi.org/10.4332/KJHPA.2006.16.4.128
  33. Lee EK, Ji EJ. Analysis of older patients using a regional emergency center. J Korean Gerontol Nurs 2009;11(1):71-80.
  34. Cho HJ, Kim DH, Han KS, Park JS, Moon SW, Lee SW, et al. Analysis of emergency department patients transferred from geriatric hospitals: case series descriptive study. J Korean Soc Emerg Med 2011;22(5):531-535.