Holzinger Felix, Oslislo Sarah, Resendiz Cantu Rebecca, Möckel Martin, Heintze Christoph
Institute of General Practice, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Division of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte and Virchow, Berlin, Germany.
BMC Res Notes. 2021 Mar 24;14(1):113. doi: 10.1186/s13104-021-05517-8.
Diversion of less urgent emergency medical services (EMS) callers to alternative primary care (PC) is much debated. Using data from the EMACROSS survey of respiratory ED patients, we aimed to characterize self-referred EMS patients, compare these with non-EMS patients, and assess scope and acceptability of a potential redirection to alternative PC.
Of n = 292 self-referred patients, n = 99 were transported by EMS. Compared to non-EMS patients, these were older, triaged more urgently and arrived out-of-hours more frequently. The share of chronically and severely ill patients was greater. Out-of-hours ED visit, presence of a chronic pulmonary condition as well as a hospital diagnosis of respiratory failure were identified as determinants of EMS utilization in a logistic model, while consultation for access and quality motives as well as migrant status decreased the probability. EMS-transported lower urgency outpatients visiting during regular physicians' hours were defined as potential PC cases and evaluated descriptively (n = 9). As a third was medically complex and potentially less suitable for PC, redirection potential could be estimated at only 6% of EMS cases. This would be reduced to 2% if considering patients' judgment concerning the appropriate setting. Overall, the scope for PC diversion of respiratory EMS patients seems limited.
将不太紧急的紧急医疗服务（EMS）呼叫者转至替代初级保健（PC）备受争议。利用来自呼吸科急诊患者EMACROSS调查的数据，我们旨在描述自我转诊的EMS患者特征，将这些患者与非EMS患者进行比较，并评估转向替代PC的可能性范围和可接受性。
在n = 292名自我转诊患者中，n = 99名由EMS转运。与非EMS患者相比，这些患者年龄更大，分诊更紧急，非工作时间就诊更频繁。慢性重症患者的比例更高。在逻辑模型中，非工作时间的急诊就诊、存在慢性肺部疾病以及医院诊断为呼吸衰竭被确定为EMS使用的决定因素，而因就诊便利性和质量动机进行的咨询以及移民身份则降低了使用EMS的可能性。在普通医生工作时间就诊的由EMS转运的低紧急程度门诊患者被定义为潜在的PC病例并进行描述性评估（n = 9）。由于三分之一的患者病情复杂，可能不太适合初级保健，因此估计转向初级保健的可能性仅为EMS病例的6%。如果考虑患者对合适就诊机构的判断，这一比例将降至2%。总体而言，呼吸科EMS患者转向初级保健的可能性似乎有限。
