Members of the public are increasingly turning to ambulance services for help with ‘urgent’ problems that could successfully be managed in primary care. The reasons for this are complex and appear to vary across different global settings and between ambulance systems. In the UK – as with other similar EMS systems – the impact of these so-termed ‘primary care sensitive’ problems is being felt across the entire acute healthcare infrastructure. This presentation will summarise findings from several related pieces of work on this issue, seeking to understand the reasons behind the rise in demand, and presenting a model to conceptualise some of the influencing factors.
The results of a systematic mapping review and qualitative thematic synthesis will be discussed, highlighting some of the emerging themes that appear consistent across EMS systems internationally. There is evidence to suggest socioeconomic and demographic characteristics traditionally associated with minority status and deprivation are associated with ambulance use for primary care problems. Formal and informal care-givers exhibit strong influences on decision making. However, there is a lack of consensus on what defines ‘inappropriate’ ambulance use, and from who’s perspective this should be determined. Some of the research implications for this will be discussed.
In addition, an update of ongoing research work into patient and carer decision-making with UK Ambulance Services will be presented. Insights gained from using ethnographic observation techniques in the pre-hospital setting, along with ambulance call ‘conversation analysis’ methodologies will be discussed.
About the Speaker
Dr Matthew Booker is an Academic General Practitioner at the University of Bristol, UK, and also works clinically as an Ambulance Doctor and in Primary Care. Matthew has broad research interests in pre-hospital and urgent care, but in particular with exploring the interfaces between primary- secondary- and ambulance-care. Matthew has led research in the evaluation of pre-hospital interventions to reduce avoidable hospital admissions, and work that seeks to explore patient and carer decision-making processes. Matthew is interested in a variety of mixed-methods approaches, but particularly focus on qualitative approaches, including thematic analysis, qualitative synthesis/meta-synthesis, and the use of ethnographic techniques in the pre-hospital setting.