title: Ambulance use is associated with higher self-rated illness seriousness: user attitudes and perceptions.
abstract: OBJECTIVE
  The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia.
  
  
  METHODS
  A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study.
  
  
  RESULTS
  Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%).
  
  
  CONCLUSIONS
  Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective.
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia. sam.toloo@qut.edu.au
authors.forename: Ghasem Sam
authors.initials: GS
authors.lastname: Toloo
authors.forename: Gerry J
authors.initials: GJ
authors.lastname: FitzGerald
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Aitken
authors.forename: Joseph Y S
authors.initials: JY
authors.lastname: Ting
authors.forename: Kirsten
authors.initials: K
authors.lastname: McKenzie
authors.forename: Joanna
authors.initials: J
authors.lastname: Rego
authors.forename: Emma
authors.initials: E
authors.lastname: Enraght-Moony
mesh_terms: D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011793:Queensland; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014600:Utilization Review