title: Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service.
abstract: BACKGROUND
  A minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients.
  
  
  OBJECTIVE
  The present study aimed to (i) profile frequent callers to the ambulance service and (ii) evaluate the impact of a case management interventional approach on frequent caller behaviour.
  
  
  METHODS
  A retrospective review of data from a 2-year period (from 1 April 2009 to 31 March 2011) was conducted. Patients were included in the analysis if they had been accepted for case management intervention by the Patient-Centred Action Team during this period and met the study inclusion criteria.
  
  
  RESULTS
  The review identified 110 frequent callers who met the study inclusion criteria. The majority of frequent callers (86%) had multiple and complex reasons for calling, including frequent medical need, acute or chronic mental health condition, older age and unmet personal or social care needs. In the majority of cases (82%), multiple interventional strategies were required. A significant reduction in median call volume was observed from preintervention to postintervention (from five calls/month to zero calls/month).
  
  
  CONCLUSIONS
  Effective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour.
authors.affiliation: Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: Patient Experiences Department, London Ambulance Service NHS Trust, London, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Bassett
authors.affiliation: Patient Experiences Department, London Ambulance Service NHS Trust, London, UK.
authors.forename: Levi
authors.initials: L
authors.lastname: Sinden
authors.affiliation: Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK.
authors.forename: Rachael T
authors.initials: RT
authors.lastname: Fothergill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D000069342:Medical Overuse; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult
keywords: emergency ambulance systems; prehospital care