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dc.contributor.authorSiriwardena, Aloysius
dc.contributor.authorLaw, Graham
dc.contributor.authorSmith, M.D.
dc.contributor.authorIqbal, Mohammad
dc.contributor.authorPhung, Viet-Hai
dc.contributor.authorSpaight, Anne
dc.contributor.authorBrewster, Amanda
dc.contributor.authorMountain, P.
dc.contributor.authorSpurr, K.
dc.contributor.authorRay, M.
dc.contributor.authorIdris, I.
dc.contributor.authorKhunti, Kamlesh
dc.date.accessioned2020-02-06T09:43:16Z
dc.date.available2020-02-06T09:43:16Z
dc.date.issued2019-04-26
dc.identifier.citationSiriwardena, A.N. et al, 2019. Ambulances attending diabetes-related emergencies in care homes – cross sectional database study. BMJ Open, 9 (Suppl 2), A11 – A12.en_US
dc.identifier.issn2044-6055
dc.identifier.doi10.1136/bmjopen-2019-EMS.30
dc.identifier.urihttp://hdl.handle.net/20.500.12417/698
dc.description.abstractBackground Diabetes, affecting 1 in 5 care home residents, may lead to ambulance call-outs and hospitalisation. We aimed to investigate the epidemiology of diabetes-related emergencies involving ambulance attendances to care home residents. Method Cross-sectional design investigating ambulance attendance to people presenting with diabetes-related emergencies in the East Midlands, UK, between 2012 and 2017. We analysed dispatch and ambulance clinical data with care home data, including call category, timing, location, care home type, clinical or physiological measures, treatments, conveyance (transport to hospital) and costs. Results Overall 2 19 722 (6.7% of 3.3 million) ambulances attended care homes over 6 years, with 12 080 (5.5%) to diabetes-related emergencies. Of 3152 care home patients categorised as having a ‘diabetic problem’, 1957 (62.1%) were conveyed to hospital, similar to that for community residents taking into account other factors. Factors associated with conveyance included reduced consciousness (OR 0.91, 95% CI 0.87–0.95), elevated heart (1.01, 1.01–1.02) or respiratory rate (1.08, 1.06–1.10), no treatment for hypoglycaemia (0.54, 0.34–0.86) or additional medical (but not psychiatric) problems. Ambulance costs were significantly lower when a patient was conveyed, by some £18 (95% CI £11.94–£24.12), but this would be outweighed by downstream hospital care costs. For a simulation in which all trusts’ mean NHS Reference Costs were used, conveyance was no longer significant in the cost model. Conclusion Conveyance following diabetes-related emergencies was as common for care home as for other community residents despite access to trained staff, and more likely with impaired consciousness, abnormal physiological measures or lack of treatment for hypoglycaemia. Conflict of interest None. Funding National institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, UK., https://bmjopen.bmj.com/content/9/Suppl_2/A11.2. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2019-EMS.30
dc.language.isoenen_US
dc.subjectDiabetes Mellitusen_US
dc.subjectPre-hospital Careen_US
dc.subjectEmergency Careen_US
dc.subjectGeriatric Medicineen_US
dc.subjectEmergency Medical Servicesen_US
dc.titleAmbulances attending diabetes-related emergencies in care homes – cross sectional database studyen_US
dc.typeConference Paper/Proceeding/Abstract
dc.source.journaltitleBMJ Openen_US
rioxxterms.versionNAen_US
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
rioxxterms.licenseref.startdate2020-01-28
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2019-04-26
html.description.abstractBackground Diabetes, affecting 1 in 5 care home residents, may lead to ambulance call-outs and hospitalisation. We aimed to investigate the epidemiology of diabetes-related emergencies involving ambulance attendances to care home residents. Method Cross-sectional design investigating ambulance attendance to people presenting with diabetes-related emergencies in the East Midlands, UK, between 2012 and 2017. We analysed dispatch and ambulance clinical data with care home data, including call category, timing, location, care home type, clinical or physiological measures, treatments, conveyance (transport to hospital) and costs. Results Overall 2 19 722 (6.7% of 3.3 million) ambulances attended care homes over 6 years, with 12 080 (5.5%) to diabetes-related emergencies. Of 3152 care home patients categorised as having a ‘diabetic problem’, 1957 (62.1%) were conveyed to hospital, similar to that for community residents taking into account other factors. Factors associated with conveyance included reduced consciousness (OR 0.91, 95% CI 0.87–0.95), elevated heart (1.01, 1.01–1.02) or respiratory rate (1.08, 1.06–1.10), no treatment for hypoglycaemia (0.54, 0.34–0.86) or additional medical (but not psychiatric) problems. Ambulance costs were significantly lower when a patient was conveyed, by some £18 (95% CI £11.94–£24.12), but this would be outweighed by downstream hospital care costs. For a simulation in which all trusts’ mean NHS Reference Costs were used, conveyance was no longer significant in the cost model. Conclusion Conveyance following diabetes-related emergencies was as common for care home as for other community residents despite access to trained staff, and more likely with impaired consciousness, abnormal physiological measures or lack of treatment for hypoglycaemia. Conflict of interest None. Funding National institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, UK., https://bmjopen.bmj.com/content/9/Suppl_2/A11.2. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2019-EMS.30en_US


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