Vilke Gary M, Sardar Winfred, Fisher Roger, Dunford James D, Chan Theodore C
Department of Emergency Medicine, University of California, San Diego 92103, USA.
Prehosp Emerg Care. 2002 Oct-Dec;6(4):391-5. doi: 10.1080/10903120290938003.
To obtain medical follow-up and determine reasons why elderly patients access paramedics via 9-1-1 and then refuse transport.
A telephone survey of patients aged 65 years and older who refused transport and signed out against medical advice (AMA) after accessing paramedics via 9-1-1 was performed to obtain information about the patients' experiences, reasons why they refused, medical follow-up, and patient outcomes.
One hundred of 121 (83%) patients who were contacted by telephone participated in the survey. Patients stated that financial concerns were a major determinant in refusing to be transported. Overall, 70% of the patients reported receiving follow-up medical care. Care was obtained at an emergency department (ED) via a second 9-1-1 call in 16% of cases, at an ED via private vehicle in 13%, at an urgent care clinic by a private vehicle in 35%, and with a family physician via private car in 38% of cases. Of the patients who obtained follow-up, there was a 32% hospital admission rate, with 39% of those admitted to an intensive care unit setting. Finally, 80% of the sample studied did not speak to a physician online, with 49% stating that they would have changed their minds if a physician had suggested transport.
The majority of patients who were 65 years of age and older and refused transport received follow-up care, with a significant number requiring admission to the hospital at the time of their follow-up.
获得医疗随访情况，并确定老年患者通过911呼叫护理人员后又拒绝转运的原因。
对65岁及以上、通过911呼叫护理人员后拒绝转运并签署自动出院（AMA）的患者进行电话调查，以获取有关患者经历、拒绝原因、医疗随访及患者结局的信息。
121名患者中，100名（83%）通过电话联系的患者参与了调查。患者表示，经济担忧是拒绝转运的主要决定因素。总体而言，70%的患者报告接受了后续医疗护理。16%的患者通过再次拨打911呼叫被送往急诊科（ED），13%的患者乘坐私家车前往ED，35%的患者乘坐私家车前往紧急护理诊所，38%的患者乘坐私家车联系家庭医生。在接受随访的患者中，住院率为32%，其中39%的患者被收入重症监护病房。最后，80%的研究样本未与医生进行在线交流，49%的患者表示，如果医生建议转运，他们会改变主意。
大多数65岁及以上拒绝转运的患者接受了后续护理，相当一部分患者在随访时需要住院治疗。
