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Ambulance use for ‘primary care’ problems: an ethnographic study of seeking and providing help in a UK ambulance service
  1. Matthew James Booker,
  2. Sarah Purdy,
  3. Rebecca Barnes,
  4. Ali R G Shaw
  1. Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr Matthew James Booker; Matthew.Booker{at}Bristol.ac.uk

Abstract

Objectives To explore what factors shape a service user’s decision to call an emergency ambulance for a ‘primary care sensitive’ condition (PCSC), including contextual factors. Additionally, to understand the function and purpose of ambulance care from the perspective of service users, and the role health professionals may play in influencing demand for ambulances in PCSCs.

Design An ethnographic study set in one UK ambulance service. Patient cases were recruited upon receipt of ambulance treatment for a situation potentially manageable in primary care, as determined by a primary care clinician accompanying emergency medical services (EMS) crews. Methods used included: structured observations of treatment episodes; in-depth interviews with patients, relatives and carers and their GPs; purposeful conversations with ambulance clinicians; analysis of routine healthcare records; analysis of the original EMS ‘emergency’ telephone call recording.

Results We analysed 170 qualitative data items across 50 cases. Three cross-cutting concepts emerged as central to EMS use for a PCSC: (1) There exists a typology of nine ‘triggers’, which we categorise as either ‘internal’ or ‘external’, depending on how much control the caller feels they have of the situation; (2) Calling an ambulance on behalf of someone else creates a specific anxiety about urgency; (3) Healthcare professionals experience conflict around fuelling demand for ambulances.

Conclusions Previous work suggests a range of sociodemographic factors that may be associated with choosing ambulance care in preference to alternatives. Building on established sociological models, this work helps understand how candidacy is displayed during the negotiation of eligibility for ambulance care. Seeking urgent assistance on behalf of another often requires specific support and different strategies. Use of EMS for such problems—although inefficient—is often conceptualised as ‘rational’ by service users. Public health strategies that seek to advise the public about appropriate use of EMS need to consider how individuals conceptualise an ‘emergency’ situation.

  • ambulance
  • emergency medical services
  • urgent care
  • primary care sensitive conditions
  • decision-making

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Twitter @MatthewBooker

  • Contributors MJB, SP and ARGS conceived and designed the study. MJB acquired and analysed the data. SP, ARGS and RB contributed significantly to the analysis and interpretation of the data. MJB drafted the manuscript. All authors revised the manuscript for important intellectual content and gave final approval for the version to be published.

  • Funding MJB was funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship. This paper presents independent research funded by the National Institute for Health Research (NIHR).

  • Disclaimer The views expressed are those of the authors, and not necessarily the NIHR, the NHS or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received a favourable opinion from South West (Frenchay) Research Ethics Committee (reference 15/SW/0307), and appropriate local governance approvals were obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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