Reasons why patients choose an ambulance and willingness to consider alternatives.
OBJECTIVE
To test a hypothesis that patients would accept alternatives to transport to an emergency department (ED) by ambulance and to evaluate factors related to patient willingness to consider alternatives. Concerns about resource utilization have prompted emergency medical services (EMS) systems to explore alternatives to ambulance transport to an ED, but studies have evaluated the safety of alternatives, not patient preferences.


METHODS
Trained research assistants surveyed patients transported by ambulance to a university ED. Interfacility transfers, trauma patients, and critically ill patients were excluded. The primary outcome was willingness to accept one of several presented alternatives to ambulance transport to the ED for that visit. Demographic and clinical factors were evaluated for association with willingness to consider alternatives. Relative risks (RR) and 95% confidence intervals (95% CI) were determined by using Mantel-Haenszel stratified methods.


RESULTS
Three hundred fifteen subjects completed the survey. Two hundred forty-seven (78.4%) were willing to consider at least one alternative. One hundred ninety-four (61.6%) were willing to consider transportation by car, and 177 (56.2%) were willing to consider transportation by taxi. Factors associated with willingness to consider alternatives included the following: age 18-65 years (RR, 1.25; 95% CI = 1.03 to 1.49), being unemployed (RR, 1.08; 95% CI = 1.08 to 1.33), use of the ED for routine care (RR, 1.25; 95% CI = 1.17 to 1.35), and not being admitted to the hospital (RR, 1.19; 95% CI = 1.04 to 1.40). Race, gender, health insurance status, and EMS interventions en route were not associated with willingness to consider transportation alternatives.


CONCLUSIONS
Many patients transported by ambulance to an ED would have considered an alternative, if one were offered.
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA. yarrisl@ohsu.edu
Lalena M
LM
Yarris
Raymond
R
Moreno
Terri A
TA
Schmidt
Annette L
AL
Adams
Heather S
HS
Brooks
D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017060:Patient Satisfaction; D014187:Transportation of Patients