Factors influencing hospital conveyance following ambulance attendance for people with diabetes: A retrospective observational study.
Adolescent
Adult
Aged
Aged, 80 and over
Allied Health Personnel
/ statistics & numerical data
Ambulances
/ statistics & numerical data
Diabetes Mellitus
/ epidemiology
Emergency Medical Services
/ statistics & numerical data
Emergency Service, Hospital
/ statistics & numerical data
Female
Hospitalization
/ statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Scotland
/ epidemiology
Socioeconomic Factors
Young Adult
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
13
07
2020
received:
13
02
2020
accepted:
19
07
2020
pubmed:
20
1
2021
medline:
1
2
2022
entrez:
19
1
2021
Statut:
ppublish
Résumé
To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions. A national retrospective data set including 30 999 diabetes-related callouts from the Scottish Ambulance Service was utilized covering a 5-year period between 2013 and 2017. The relationship between diabetes-related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week. In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre-hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001). A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre-hospital services and treatment may help to reduce hospital conveyance rates.
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14384Informations de copyright
© 2020 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
Références
Public Health England, National Cardiovascular Intelligence Network. Diabetes Prevalence Model Estimates for Local Authorities; 2015. Available at https://www.gov.uk/government/publications/diabetes-prevalence-estimates-for-local-populations Last accessed July 1 2020.
Holman N, Forouhi NG, Goyder E, Wild SH. The Association of Public Health Observatories (APHO) Diabetes Prevalence Model: estimates of total diabetes prevalence for England, 2010-2030. Diabet Med. 2011;28:575-582.
NHS Scotland, Scottish Diabetes Data Group. Scottish Diabetes Survey. 2018. Available at https://www.diabetesinscotland.org.uk/wp-content/uploads/2019/12/Scottish-Diabetes-Survey-2018.pdf Last accessed July 1 2020.
Diabetes UK. Us, diabetes and a lot of facts and stats. London: Diabetes UK, 2019. Available at https://www.diabetes.org.uk/resources-s3/2019-02/1362B_Facts%20and%20stats%20Update%20Jan%202019_LOW%20RES_EXTERNAL.pdf Last accessed 6 July 2020.
Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. 2012;29:855-862.
NHS Digital. National Diabetes Inpatient Audit 2017, National Report. Available at https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-inpatient-audit/national-diabetes-inpatient-audit-nadia-2017 Last accessed 6 July 2020.
Holman N, Hillson R, Young RJ. Excess mortality during hospital stays among patients with recorded diabetes compared with those without diabetes. Diabet Med. 2013;30:1393-1402.
Allan B, Sampson M; Joint British Diabetes Societies for Inpatient Care. Admission Avoidance and Diabetes: Guidance for Clinical Commissioning Groups and Clinical Teams; 2013. Available at http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_Admissions_Avoidance_Diabetes.pdf Last accessed July 1 2020.
Twigg SM, Kazemi MR, Craig ME. Flash continuous glucose monitoring and its IMPACT to REPLACE blood glucose monitoring in the management of type 1 and type 2 diabetes. US Endocrinology. 2017;13:57-62.
O’Cathain A, Knowles E, Turner J, et al. Explaining variation in emergency admissions: a mixed-methods study of emergency and urgent care systems. Health Serv Deliv Res. 2014;2:62-107.
Scottish Ambulance Service. Annual Report and Accounts for year ended 31 March 2019. 2019: Available at https://www.scottishambulance.com/userfiles/file/TheService/Annual%20report/2019-06-26%20Final%20Board%20approved%20Annual%20Accounts%2018-19%20v2.pdf Last accessed 6 July 2020.
Evans R, McGovern R, Birch J, Newbury-Birch D. Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature. Emerg Med J. 2014;31:594-603.
NHS England,Urgent and Emergency Care Review Programme Team. Transforming Urgent and Emergency Care Services in England: Clinical Models for Ambulance Services; 2015. Available at https://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR-ambulance-guidance-FV.PDF Last accessed 6 July 2020.
Cain E, Ackroyd-Stolarz S, Alexiadis P, Murray D. Prehospital hypoglycaemia: the safety of not transporting treated patients. Prehosp Emerg Care. 2003;7:458-465.
Farmer AJ, Brockbank KJ, Keech ML, England EJ, Deakin CD. Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabet Med. 2012;29:1447-1450.
Walker A, James C, Bannister M, Jobes E. Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team. Emerg Med J. 2006;23:449-451.
Scottish Government, APS Group Scotland. Introducing the Scottish Index of Multiple Deprivation; 2016. Available at https://www2.gov.scot/Resource/0050/00504809.pdf Last accessed 6 July 2020.
Box GEP, Tidwell PW. Transformation of the independent variables. Technometrics. 1962;4:531-550.
Weston CF, McCabe MJ. Audit of an emergency ambulance service: impact of a paramedic system. J R Coll Physicians Lond. 1992;26:86-89.
Scottish Ambulance Service. Ambulance Control Centre, A Guide to Booking an Ambulance; 2017. Available at https://www.glasgowlmc.co.uk/download/Sessional%20General%20Practitioners/SAS-Guide-to-GP-Ambulance-Booking.pdf Last accessed 6 July 2020.
Scottish Government, NHS Scotland. National Health and Social Care Workforce Plan: Part Three - Improving Workforce Planning for Primary Care in Scotland; April 2018. Available at https://www.gov.scot/publications/national-health-social-care-workforce-plan-part-3-improving-workforce/pages/10/ Last accessed 6 July 2020.
Herring R, Russell-Jones DL, Pengilley C, et al. Management of raised glucose: a clinical decision tool to reduce length of stay of patients with hyperglycaemia. Diabet Med 2013;30:81-87.
Durning P, Chestnutt IG, Morgan MZ, Lester N. The relationship between orofacial clefts and material deprivation in Wales. Cleft Palate Craniofac J. 2007;44:203-207.
American Diabetes Association Workgroup on Hypoglycemia. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005;28:1245-1249.
World Health Organization. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of a WHO/IDF Consultation; 2006. Available at https://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf Last accessed 6 July 2020.