Factors that motivate people to initiate 999 emergency ambulance services for non-urgent healthcare needs remain an area that is poorly understood. With increasing demands on emergency ambulances, it can be argued that the pressure to utilise healthcare resources effectively has never been higher.
The authors highlight that much research surrounding patients’ decisions as to whether to call for an ambulance has been carried out in other countries, or if UK based, it was undertaken before the development of various alternative urgent care pathways.
This qualitative study focuses on the patients’ and/or carers’ experiences of calling for an emergency ambulance for ‘primary care-appropriate health problems’ in an attempt to understand the factors that influenced their decisions to do this.
Undertaken in the Great Western Ambulance Service NHS Trust, a primary care doctor went out with ambulance staff responding to 999 calls, and between them they purposively selected and recruited patients whom they agreed were presenting with conditions that could be managed in primary care settings.
In total, 16 people (including 5 carers/relatives) between the ages of 18–88 years (mean age=59.6 years) participated in semi-structured interviews covering topics such as: issues that led up to the 999 call; exploration of trigger factors; knowledge of other potential care options and sources of advice; previous experience of using urgent healthcare facilities; and views about their recent experience including consideration of how they might manage future healthcare events.
Interviews were audio-recorded and transcribed word-for-word. During processes of thematic analysis, an overarching theme of ‘patient and carer anxiety in urgent care decision making’ emerged, with four sub-themes identified as: a) perceptions of community-based urgent care; b) perceptions of ambulance-based urgent care; c) influences of previous urgent care experiences in decision making; d) interpersonal factors in the assessment of risk and decision making.
Findings include participants’ perceptions about the limitations of other community-based urgent care facilities and the belief that ambulance staff will very quickly assess patients’ needs and get them the appropriate care in a short period of time. Added to this, patients with chronic illness expressed a view that the ambulance service would be able to avoid taking them to hospital as patients/carers considered that ambulance staff possess skills and/or equipment to treat the patient at home.
Perhaps unsurprisingly, previous experiences of using urgent healthcare facilities shaped decision making, as participants identified the ambulance service as being reliable and quick as opposed to having to wait for several hours in, for example, an urgent care walk-in centre.
Anxiety precipitated use of emergency ambulance services, especially if people were not sure about what was happening to them. They wanted immediate reassurance that their condition was not serious or, if it was, that they were going to get rapid and appropriate treatment.
Of note were the reported interpersonal factors and significance of friends/family in the construction of behaviours linked to initiating a 999 call. Examples were given of people who called for an ambulance as they were concerned that their relatives would rebuke them if they did not, or alternatively, informal carers described advising the patient that if they were worried at all, they should call an ambulance as a precaution.
The authors discuss the limitations of their small scale study including concern that the primary care doctor’s perspective may have influenced the analysis, although they do not specifically indicate in what way.
This is a useful study which begins to close a gap in evidence in UK literature, but there is room for more work to be done in this area. If ambulance services are to manage demand, they need improved understanding as to their patients’ motivations to make the 999 call, just as much as patients need to better understand the healthcare system and how ambulance services contribute to the overall care pathway.