针对老年患者的基于紧急医疗服务的社会服务转诊项目评估。

Evaluation of an emergency medical services-based social services referral program for elderly patients.

作者信息

Kue Ricky, Ramstrom Edward, Weisberg Stacy, Restuccia Marc

机构信息

Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland 21209, USA.

出版信息

Prehosp Emerg Care. 2009 Jul-Sep;13(3):273-9. doi: 10.1080/10903120802706179.

DOI:10.1080/10903120802706179

PMID:19499461

Abstract

OBJECTIVE

To describe the preliminary experience of an emergency medical services (EMS)-based follow-up program providing elderly patients access to community-based social services.

METHODS

This was a retrospective, case series report. Inclusion criteria were adults aged 60 years and older requesting EMS for fall or lift assist; against medical advice (AMA) refusal of transport for a medical complaint; any social service or home care needs; request for nonmedical transportation; multiple prior EMS visits; or cases of elder abuse or neglect. Patients were identified either by paramedics at the time of the call or an EMS physician during routine chart review of "no-transport" calls. Patients were then contacted and offered referral follow-up with a social services worker. Data were collected for age, gender, presence of established social services, referral strategy, complaint type, referral acceptance rate, and follow-up plan.

RESULTS

Seventy patients were referred over eight months. Paramedics provided 33% of referrals (23/70) as well as a significantly higher number of social service-related complaints (48% vs. 15%, p = 0.005). Follow-up from a fall occurred more often after EMS physician chart review (53% vs. 30%, p = 0.07). Rates of established social services were similar for patients who accepted and those who declined follow-up (89% vs. 90%, p = 0.95) and between patients who were referred by paramedics and those who were referred by EMS physicians (93% vs. 90%, p = 0.72). Paramedic referral was associated with a significantly higher rate of acceptance (94% vs. 28%, p < 0.001).

CONCLUSION

EMS provides an invaluable opportunity to connect the elderly with social services at the time of contact. In this study, paramedics appeared to refer more social service-related complaints compared with other categories such as fall assistance. This highlights a difference in perception of social service needs among paramedics and represents an area for further training and education.

摘要

目的

描述一项基于紧急医疗服务（EMS）的随访项目的初步经验，该项目为老年患者提供社区社会服务。

方法

这是一项回顾性病例系列报告。纳入标准为60岁及以上的成年人因跌倒或需要抬升协助而呼叫EMS；违背医嘱（AMA）拒绝因医疗投诉而接受转运；有任何社会服务或家庭护理需求；请求非医疗运输；多次先前的EMS就诊；或存在虐待或忽视老年人的情况。患者由护理人员在呼叫时或EMS医生在对“不转运”呼叫进行常规病历审查时识别。然后与患者联系，并提供转介给社会服务工作者进行随访。收集了年龄、性别、现有社会服务情况、转介策略、投诉类型、转介接受率和随访计划的数据。

结果

在八个月内共转介了70名患者。护理人员提供了33%的转介（23/70），并且与社会服务相关的投诉数量显著更高（48%对15%，p = 0.005）。跌倒后的随访在EMS医生病历审查后更常发生（53%对30%，p = 0.07）。接受随访和拒绝随访的患者现有社会服务率相似（89%对90%，p = 0.95），护理人员转介的患者和EMS医生转介的患者之间也相似（93%对90%，p = 0.72）。护理人员转介的接受率显著更高（94%对28%，p < 0.001）。