Booker Matthew J, Purdy Sarah, Shaw Alison R G
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
BMJ Open. 2017 Aug 3;7(8):e016832. doi: 10.1136/bmjopen-2017-016832.
To understand the reasons behind, and experience of, seeking and receiving emergency ambulance treatment for a 'primary care sensitive' condition.
A comprehensive, qualitative systematic review. Medline, Embase, PsychInfo, Cumulative Index of Nursing and Allied Health, Health Management Information Systems, Healthcare Management Information Consortium, OpenSigle, EThOS and Digital Archive of Research Theses databases were systematically searched for studies exploring patient, carer or healthcare professional interactions with ambulance services for 'primary care sensitive' problems. Studies using wholly qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. An analytical thematic synthesis was undertaken, using a line-by-line qualitative coding method and a hierarchical inductive approach.
Of 1458 initial results, 33 studies met the first level (relevance) inclusion criteria, and six studies met the second level (methodology and quality) criteria. The analysis suggests that patients define situations worthy of 'emergency' ambulance use according to complex socioemotional factors, as well as experienced physical symptoms. There can be a mismatch between how patients and professionals define 'emergency' situations. Deciding to call an ambulance is a process shaped by practical considerations and a strong emotional component, which can be influenced by the views of caregivers. Sometimes the value of a contact with the ambulance service is principally in managing this emotional component. Patients often wish to hand over responsibility for decisions when experiencing a perceived emergency. Feeling empowered to take control of a situation is a highly valued aspect of ambulance care.
When responding to a request for 'emergency' help for a low-acuity condition, urgent-care services need to be sensitive to how the patient's emotional and practical perception of the situation may have shaped their decision-making and the influence that carers may have had on the process. There may be novel ways to deliver some of the valued aspects of urgent care, more geared to the resource-limited environment.
了解因“初级保健敏感”状况寻求并接受紧急救护车治疗的背后原因及经历。
一项全面的定性系统评价。对Medline、Embase、PsychInfo、护理及相关健康累积索引、健康管理信息系统、医疗保健管理信息联盟、OpenSigle、EThOS和研究论文数字存档数据库进行系统检索，以查找探讨患者、护理人员或医疗保健专业人员就“初级保健敏感”问题与救护车服务互动的研究。纳入完全采用定性方法的研究或在方法和分析部分大量使用定性技术的混合方法研究。采用逐行定性编码方法和分层归纳法进行分析性主题综合。
在1458项初始结果中，33项研究符合一级（相关性）纳入标准，6项研究符合二级（方法学和质量）标准。分析表明，患者根据复杂的社会情感因素以及所经历的身体症状来界定值得使用“紧急”救护车的情况。患者和专业人员对“紧急”情况的定义可能存在差异。决定呼叫救护车是一个受实际考虑因素和强烈情感因素影响的过程，护理人员的观点可能会对其产生影响。有时与救护车服务接触的价值主要在于处理这种情感因素。患者在感知到紧急情况时通常希望将决策责任移交出去。在救护车护理中，感到有能力掌控局面是一个非常重要的方面。
在回应针对低 acuity 状况的“紧急”帮助请求时，紧急护理服务需要意识到患者对情况的情感和实际认知可能如何塑造了他们的决策，以及护理人员在这一过程中可能产生的影响。可能有一些新颖的方式来提供紧急护理的某些重要方面，使其更适合资源有限的环境。
