Deprivation is associated with hospital conveyance among patients who are terminally ill.

IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE
Maddy French, Michelle Waddington, Pete Dixon, Kieran Potts, Sandra Igbodo, Jane Simpson, Nancy Preston
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Abstract

Background: Hospital admissions of patients who are terminally ill can be associated with poor experiences and unwanted outcomes, such as dying away from home. While area deprivation is associated with emergency hospital admissions in the last year of life, few studies have explored the relationship between deprivation and ambulance clinicians' decisions to convey a patient to the hospital. The aim of this study is to understand the overall proportion of terminally ill patients conveyed to hospitals by paramedics in North West England, and to explore the associations between hospital conveyance and area deprivation.

Methods: This is an observational study using routinely collected ambulance data held by the North West Ambulance Service NHS Trust in England, UK. Data on adult patients (aged 18+ years) who were coded by ambulance personnel as having a terminal illness were extracted for the period from March 2021 to February 2022. Logistic regression mixed models were used to examine the associations between hospital conveyance and area deprivation. To control for confounding variables, additional data were collected on age, gender, ethnicity, location, clinical assessment codes and place of residence.

Results: The number of calls attended by ambulance clinicians for terminally ill patients included in the analysis was 1737. Ten per cent of these calls resulted in the patient being taken to the hospital. The odds of being taken to hospital were 1.51 (95% CI 1.06 to 2.16) times greater for patients living in the 20% most deprived areas compared with those in less deprived areas, in the final model adjusted for age, gender, place of residence and the initial coded reason for the call.

Conclusion: This study suggests that patients with terminal illnesses living in the most deprived areas are more likely to be taken to hospital by ambulance clinicians, compared with those in less deprived areas. Overall, however, a small proportion of patients classed as terminally ill in all areas were taken to hospital. This implies that most end-of-life care provided by ambulance clinicians in this region will be in a patient's place of residence, with implications for time, resources and training.

剥夺与临终病人的住院运输有关。
背景:临终病人的住院可能与糟糕的经历和不想要的结果有关,比如离开家而死。虽然区域剥夺与生命最后一年的急诊住院有关,但很少有研究探讨剥夺与救护车临床医生决定将患者送往医院之间的关系。本研究的目的是了解在英格兰西北部由护理人员送往医院的绝症患者的总体比例,并探讨医院运送和区域剥夺之间的关系。方法:这是一项观察性研究,使用英国英格兰西北救护车服务NHS信托定期收集的救护车数据。提取了2021年3月至2022年2月期间由救护车人员编码为患有绝症的成年患者(18岁以上)的数据。使用Logistic回归混合模型来检验医院运输与区域剥夺之间的关系。为了控制混杂变量,收集了年龄、性别、种族、地点、临床评估代码和居住地等附加数据。结果:纳入分析的终末期病人救护车临床医生接诊次数为1737次。这些电话中有10%的结果是病人被送往医院。根据年龄、性别、居住地和最初的电话编码原因调整后的最终模型,生活在20%最贫困地区的患者被送往医院的几率是贫困程度较低地区的患者的1.51倍(95% CI 1.06至2.16)。结论:本研究表明,生活在最贫困地区的绝症患者比生活在较贫困地区的患者更有可能被救护车临床医生送往医院。然而,总体而言,在所有地区被列为绝症的患者中,有一小部分被送往医院。这意味着该地区救护车临床医生提供的大多数临终关怀将在患者居住地进行,这对时间、资源和培训都有影响。
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来源期刊
Emergency Medicine Journal
Emergency Medicine Journal 医学-急救医学
CiteScore
4.40
自引率
6.50%
发文量
262
审稿时长
3-8 weeks
期刊介绍: The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.
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