A Survey of Patient Utilization and Trust of Emergency Medical Services
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Abstract
Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race.
Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV.
23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p<0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV.
Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.
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References
Agarwal G., Lee J., McLeod B., Mahmuda S., Howard M., Cockrell K., & Ageles R. (2019). Social factors in frequent callers: a description of isolation, poverty and quality of life in those calling emergency medical services frequently. BMC Public Health, 19 (684). https://doi.org/10.1186/s12889-019-6964-1.
Ashman, J. J., Schappert, S. M., & Santo, L. (2020). Emergency Department Visits Among Adults Aged 60 and Over: United States, 2014-2017. NCHS data brief, (367), 1–8. https://www.cdc.gov/nchs/data/databriefs/db367-h.pdf
Billittier, A.J., Moscati, R., Janicke, D., Lerner, B., Seymour, J., Olsson, D. (1996). A multisite Survey of Factors Contributing to Medically Unnecessary Ambulance Transports. Academic Emergency Medicine, 3(11), 1046-1050. https://doi.org/10.1111/j.1553-2712.1996.tb03352.x
Borg, B. A., & Mosier, J. M. (2021). Mode of Arrival to the Emergency Department and Outcomes in Nontraumatic Critically Ill Adults. Critical care explorations, 3(3), e0350. https://doi.org/10.1097/CCE.0000000000000350
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Bureau, T. U. S. C. (2020). American FactFinder. https://archive.vn/20200213033345/http://factfinder.census.gov/bkmk/table/1.0/en/DEC/10_ DP/DPDP1/0500000US18097
Canto, J.G., Zalenski, R.J., Ornato, J.P., Rogers ,W.J., Kiefe, C. I., Magid, D., Shlipak, M.G., Frederick, P.D., Lambrew, C.G., Littrell, K.A., Barron, H.V (2002). Use of Emergency Medical Services in Acute Myocardial Infarction and Subsequent Quality of Care: Observations from the National Registry of Myocardial Infarction 2, Circulation, 106(24). https://doi.org/10.1161/01.CIR.0000041246.20352.03
Cairns, C., Kang, K., & Santo, L. (2022). National Hospital Ambulatory Medical Care Survey: 2018 emergency department summary tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018-ed-web-tables-508.pdf
Cash, R. E., Powell, J. R., Peters, G. A., Goldberg, S. A., Panchal, A. R., & Camargo, C. A., Jr (2022). Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011-2019. Journal of the American College of Emergency Physicians open, 3(4), e12776. https://doi.org/10.1002/emp2.12776
Chhabra, K. R., McGuire, K., Sheetz, K. H., Scott, J. W., Nuliyalu, U., & Ryan, A. M. (2020). Most Patients Undergoing Ground And Air Ambulance Transportation Receive Sizable Out-Of-Network Bills. Health affairs (Project Hope), 39(5), 777–782. https://doi.org/10.1377/hlthaff.2019.01484
Dejean, D., Giacomini, M., Welsford, M., Schwartz, L., & Decicca, P. (2016). Inappropriate Ambulance Use: A Qualitative Study of Paramedics' Views. Healthcare policy, 11(3), 67-79. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817967/
Domingues, A. C., Santiago, L. M., Rodrigues, A. R., Pires, B., Velho, D., & Ferreira, P. L. (2019). Cross-cultural adaptation and validation of the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) for the Portuguese population. Patient preference and adherence, 13, 1145–1152. https://doi.org/10.2147/PPA.S211764
Duong, H. V., Herrera, L. N., Moore, J. X., Donnelly, J., Jacobson, K. E., Carlson, J. N., Mann, N. C., & Wang, H. E. (2018). National Characteristics of Emergency Medical Services Responses for Older Adults in the United States. Prehospital emergency care, 22(1), 7–14. https://doi.org/10.1080/10903127.2017.1347223
Gardner, G.J. (1990). The use and abuse of the emergency ambulance service: some of the factors affecting the decision whether to call an emergency ambulance. Emergency Medicine Journal, 7: 81-89.
Greene, J., Silver, D., Verrier, E., & Long, S. K. (2023). Is patients' trust in clinicians related to patient-clinician racial/ethnic or gender concordance?. Patient education and counseling, 112, 107750. https://doi.org/10.1016/j.pec.2023.107750
Health Research & Educational Trust. (2017). Social determinants of health series: Transportation and the role of hospitals. Chicago, IL: Health Research & Educational Trust. https://www.aha.org/transportation
Hojat, M., DeSantis, J., & Gonnella, J. S. (2017). Patient Perceptions of Clinician's Empathy: Measurement and Psychometrics. Journal of patient experience, 4(2), 78–83. https://doi.org/10.1177/2374373517699273
Kline, J. A., Lin, M. P., Hall, C. L., Puskarich, M. A., Dehon, E., Kuehl, D. R., Wang, R. C., Hess, E. P., Runyon, M. S., Wang, H., & Courtney, D. M. (2020). Perception of Physician Empathy Varies With Educational Level and Gender of Patients Undergoing Low-Yield Computerized Tomographic Imaging. Journal of patient experience, 7(3), 386–394. https://doi.org/10.1177/2374373519838529
Langabeer, J. R., 2nd, Gonzalez, M., Alqusairi, D., Champagne-Langabeer, T., Jackson, A., Mikhail, J., & Persse, D. (2016). Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments. The western journal of emergency medicine, 17(6), 713–720. https://doi.org/10.5811/westjem.2016.8.30660
Meisel, Z. F., Pines, J. M., Polsky, D., Metlay, J. P., Neuman, M. D., & Branas, C. C. (2011). Variations in ambulance use in the United States: the role of health insurance. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 18(10), 1036–1044. https://doi.org/10.1111/j.1553-2712.2011.01163.x
Mell, H. K., Mumma, S. N., Hiestand, B., Carr, B. G., Holland, T., & Stopyra, J. (2017). Emergency Medical Services Response Times in Rural, Suburban, and Urban Areas. JAMA surgery, 152(10), 983–984. https://doi.org/10.1001/jamasurg.2017.2230
National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625.
Peters, G. A., Goldberg, S. A., Hayes, J. M., & Cash, R. E. (2023). Patients who use emergency medical services have greater severity of illness or injury compared to those who present to the emergency department via other means: A retrospective cohort study. Journal of the American College of Emergency Physicians open, 4(4), e13017. https://doi.org/10.1002/emp2.13017
Sasson, C., Haukoos, J. S., Ben-Youssef, L., Ramirez, L., Bull, S., Eigel, B., Magid, D. J., & Padilla, R. (2015). Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado. Annals of emergency medicine, 65(5), 545–552.e2. https://doi.org/10.1016/j.annemergmed.2014.10.028
Shekhar, A. C., & Blumen, I. (2021). Evaluating Emergency Medical Service Provider Perceptions About Patient Acuity Across Various Transport Vehicles. Air medical journal, 40(2), 139–140. https://doi.org/10.1016/j.amj.2020.11.011
Shelton, R. C., Winkel, G., Davis, S. N., Roberts, N., Valdimarsdottir, H., Hall, S. J., & Thompson, H. S. (2010). Validation of the group-based medical mistrust scale among urban black men. Journal of general internal medicine, 25(6), 549–555. https://doi.org/10.1007/s11606-010-1288-y
Thompson, H. S., Valdimarsdottir, H. B., Winkel, G., Jandorf, L., & Redd, W. (2004). The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Preventive medicine, 38(2), 209–218. https://doi.org/10.1016/j.ypmed.2003.09.041
Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., & Mehrotra, A. (2013). Emergency department visits for nonurgent conditions: systematic literature review. The American journal of managed care, 19(1), 47–59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156292/
Ward, C. E., Badolato, G. M., Taylor, M. F., Brown, K. M., Simpson, J. N., & Chamberlain, J. M. (2023). Clinician and Caregiver Determinations of Acuity for Children Transported by Emergency Medical Services: A Prospective Observational Study. Annals of emergency medicine, 81(3), 343–352. https://doi.org/10.1016/j.annemergmed.2022.09.002