Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-27T07:07:57.493Z Has data issue: false hasContentIssue false
  • English
  • Français

Frequent Use of Emergency Medical Services by the Elderly: A Case-Control Study Using Paramedic Records

Published online by Cambridge University Press:  28 June 2012

Niels Tangherlini ,
Mark J. Pletcher ,
Mark A. Covec  and
John F. Brown
Niels Tangherlini*
Affiliation:
Emergency Medical Services Division, San Francisco Fire Department, San Francisco, California, USA
Mark J. Pletcher
Affiliation:
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA
Mark A. Covec
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University, New York, New York, USA
John F. Brown
Affiliation:
Department of Emergency Medicine, University of California, San Francisco and San Francisco General Hospital and Trauma Center, San Francisco, California, USA
*
San Francisco Fire Department EMS Division, 698 Second Street, San Francisco, California 94107, USA E-mail: niels.tangherlini@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The objective of this study was to identify the factors that lead to increased use of emergency medical services (EMS) by patients ≥65 years of age in an urban EMS system.

Methods:

Retrospective, case-control study of frequent EMS use among elderly patients transported during one year in an urban EMS system. Three distinct groups were examined for transports that took place in 1999: (1) 1–3 transports per year (low use); (2) 4–9 times per year (high use); and (3) those transported 10+ times (very high use). This frequency-use indicator variable is the primary outcome measurement. Predictors included age, gender, preexisting medical diseases, ethnicity, number of medications, number of medical problems, primary physician, psychiatric diagnosis, and homelessness. Analysis of predictors was done using ordinal logistic regression model, and a global test of interaction terms.

Results:

Male gender, black ethnicity, homelessness, and a variety of types of medical problems were associated with increased use of EMS resources. The strongest single predictor of case status remained homelessness, which was nearly eight times as commonly associated with frequent EMS use than for the controls. The number of medical problems and medications also were significantly associated with EMS use in this patient population. There was a lack of association of alcohol, substance abuse, and psychiatric disorders with EMS use. Patients with asthma who did not have a primary care physician were more likely to use EMS services than were those who had a physician.

Conclusions:

This analysis highlights homelessness as being strongly associated with frequent EMS use among the elderly and downplays other associated factors, such as psychiatric disease and substance use. Medical illness severity, particularly asthma when no primary care physician is available, also appears to drive frequent EMS use. Both findings have implications in terms of targeting of public resources; providing housing to medically ill elderly and primary care to asthmatics in particular, may provide dividends not only in terms of social welfare and medical care, but in preventing frequent EMS use by the elderly.

Keywords

elderly patientemergency medical serviceshomelessnessutilization
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 3 , June 2010 , pp. 258 - 264
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Shah, MN, Glushak, C, Karrison, TG, et al: Predictors of emergency medical services utilization by elders. Acad Emerg Med 2003;10(1):52–58.CrossRefGoogle ScholarPubMed
2.Reeder, T, Locascio, E, Tucker, J, et al: ED utilization: The effect of changing demographics from 1992 to 2002. Amer J Emerg Med 2002;20(7):583–587.CrossRefGoogle Scholar
3.Machlin, SR: Expenses for a Hospital Emergency Room Visit 2003. Statistical Brief #111, January 2006. Agency for Healthcare Research and Quality, Rockville, Md. Available at http://www.meps.ahrq.gov/papers/st111/stat111.pdf.Google Scholar
4.Schull, MJ, Morrison, LJ, Vermeulen, M, Redelmeir, DA: Emergency department overcrowding and ambulance transport delays for patients with chest pains. CMAJ 2003;168(3):277–287.Google Scholar
5.Ruger, JP, Richter, CJ, Spitznagel, EL, Lewis, LM: Analysis of costs, length of stay, and utilization of emergency department services by frequent users: Implications for health policy. Acad Emerg Med 2004;11(12):1311–1317.CrossRefGoogle ScholarPubMed
6.Weiss, SJ, Ernst, AA, Miller, P, Russell, S: Repeat EMS transports among elderly emergency department patients. Prehosp Emerg Care 2002;6(1):6–10.CrossRefGoogle ScholarPubMed
7.Pope, D, Fernandes, CMB, Bouthillette, F, Etherington, J: Frequent users of the emergency department: A program to improve care and reduce visits. CMAJ 2000;162(7):1017–1020.Google Scholar
8.Derlet, RW, Richards, JR: Overcrowding in the nation's emergency departments: Complex causes and disturbing effects. Ann Emerg Med 2000;35(1):63–68.CrossRefGoogle ScholarPubMed
9.Cook, LJ, Knight, S, Junkins, EP Jr, et al: Repeat patients to the emergency department in a statewide database. Acad Emerg Med 2004;11(3):256–263.CrossRefGoogle Scholar
10.Sun, BC, Burstin, HR, Brennan, TA: Predictors and outcomes of frequent emergency department users. Acad Emerg Med 2003;10(4):320–328.CrossRefGoogle ScholarPubMed
11.Hansagi, H, Olsson, M, Sjoberg, S, et al: Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med 2001;37(6):561–567.CrossRefGoogle ScholarPubMed
12.Kerr, T, Wood, E, Grafstein, E, Ishida, T: High rates of primary care and emergency department use among injection drug users in Vancouver. J Pub Health 2004;10(1093):189–194.Google Scholar
13.Byrne, M, Murphy, AW, Plunkett, PK, et al: Frequent attenders to an emergency department: A study of primary health care use, medical profile and psychosocial characteristics. Ann Emerg Med 2003;41(3):309–318.CrossRefGoogle Scholar
14.Lang, T, Davide, A, Diakite, B, et al: Using the hospital emergency department as a regular source of care. Europ J Epidemiol 1997;13(2):223–228.CrossRefGoogle ScholarPubMed
15.Pearson, DA, Brugman, RA, Haukoos, JS: Out of hospital and ED utilization by adult homeless patients. Ann Emerg Med 2007;50(6):646–652.CrossRefGoogle ScholarPubMed
16.Gallagher, TC, Andersen, RM, Koegel, P, Gelberg, L: Determinants of regular source of care among homeless adults in Los Angeles. Medical Care 1997;35(8):814–830.Google Scholar
17.US Census Bureau: State and County QuickFacts, 2006.Google Scholar
18.Osganian, SK, Zapka, JG, Feldman, HA, et al: Use of emergency medical services for suspected acute cardiac ischemia among demographic and clinical patient subgroups: The REACT trial. Prehosp Emerg Care 2002;6(2):175–185.Google Scholar
19.Patrick, DL, Unutzer, J, Simon, G, et al: Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: A four year perspective study. JAMA 1997;277(20):1618–1623.Google Scholar
20.Passarelli, MC, Jacob-Filho, W, Figueras, A: Adverse drug reactions in an elderly hospitalised population: Inappropriate prescription is a leading cause. Drugs Aging 2005;22(9):767–777.Google Scholar
21.Hanlon, JT, Pieper, CF, Hajjar, ER, et al: Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 2006;61(5):511–515.Google Scholar
22.Barnett, NP, Spirito, A, Colby, SM, et al: Detection of alcohol use in adolescent patients in the emergency department. Acad Emerg Med 1998;5(6):607–612CrossRefGoogle ScholarPubMed
23.Craig, RJ: Emergency room admissions for acute drug reactions in a VA hospital. Am J Drug Alcohol Abuse 1979;6(1):73–78.CrossRefGoogle Scholar
24.Bindman, AB, Grumbach, K, Osmond, D, et al: Preventable hospitalization and access to health care. JAMA 1995 274(4):305–311.CrossRefGoogle ScholarPubMed