Department of Paramedicine, Monash University, Clayton, Vic, Australia; and Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Vic, Australia.
Department of Paramedicine, Monash University, Clayton, Vic, Australia.
Aust J Prim Health. 2024 Aug;30. doi: 10.1071/PY23204.
Background Ambulance callouts and conveyances continue to increase disproportionately to population growth. This is largely driven by low- and medium-acuity patients who do not require ambulance management. We aimed to estimate the proportion of patients paramedics have conveyed to an emergency department (ED) via ambulance whom they considered suitable for primary care, and understand the barriers that contributed to these decisions. Methods A cross-sectional survey of registered paramedics in Victoria, Australia, was undertaken using an online questionnaire during 2022. Responses are presented using descriptive statistics, and logistic regression was used to identify associations between paramedic characteristics and barriers influencing primary care pathway referral. Results A total of 367 responses were received. Of these, 70% of paramedics reported that at least half of the patients they conveyed to an ED were suitable for a primary care pathway. Paramedics reported high levels of confidence and support for primary care pathways in lieu of transport, however this had no correlation with their self-reported practice. The most common barrier to primary care pathway referral was limited access to a suitable primary care pathway (68%) followed by fear of an internal complaint, litigation or organisational pressure to convey patients to an ED (66%). Paramedics regarded themselves as more supportive of primary care pathway referral than those around them, including their peers, mentors, employers and university. They also reported that the COVID-19 pandemic had increased their personal support for primary care pathways, as well as organisational support from their employer, without corresponding increase in the broader medical and public communities. In fact, paramedics reported the COVID-19 pandemic had decreased support from the public and patients to refer patients to primary care pathways, and 57% of paramedics reported conveying a patient that had declined their primary care referral in the past week. Conclusions Paramedics frequently convey to an ED patients who they believe are appropriate for a primary care pathway. Paramedics face practical barriers such as a lack of available primary care providers and perceived lack of cultural support that contribute to this practice.
救护车出动和转运的数量继续不成比例地增长，超过了人口的增长。这在很大程度上是由低中度紧急程度的患者推动的，这些患者不需要救护车管理。我们旨在估计通过救护车转送至急诊科（ED）的患者中，有多少被认为适合初级保健，并了解促成这些决策的障碍。
2022 年，澳大利亚维多利亚州的注册护理人员进行了一项横断面调查，使用在线问卷。结果以描述性统计呈现，并使用逻辑回归来确定护理人员特征与影响初级保健途径转介的障碍之间的关联。
共收到 367 份回复。其中，70%的护理人员报告称，他们转送至 ED 的至少一半患者适合初级保健途径。护理人员报告说，他们对替代转运的初级保健途径有高度的信心和支持，但这与他们的自我报告实践没有相关性。初级保健途径转介的最常见障碍是可获得合适的初级保健途径有限（68%），其次是担心内部投诉、诉讼或组织压力要求将患者转至 ED（66%）。护理人员认为自己比周围的人更支持初级保健途径转介，包括他们的同行、导师、雇主和大学。他们还报告说，COVID-19 大流行增加了他们个人对初级保健途径的支持，以及雇主对初级保健途径的组织支持，而公众和医疗社区对初级保健途径的支持并没有相应增加。事实上，护理人员报告说，COVID-19 大流行降低了公众和患者将患者转至初级保健途径的支持，并且 57%的护理人员报告在过去一周中转送了一位拒绝其初级保健转介的患者。
护理人员经常将他们认为适合初级保健途径的患者转送至 ED。护理人员面临缺乏可用的初级保健提供者和感知到的缺乏文化支持等实际障碍，这促成了这种做法。
