Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial

被引：29

作者：

Snooks, Helen A. ^{[1
]}

Anthony, Rebecca ^{[1
]}

Chatters, Robin ^{[2
]}

Dale, Jeremy ^{[3
]}

Fothergill, Rachael T. ^{[4
]}

Gaze, Sarah ^{[1
]}

Halter, Mary ^{[5
,6
]}

Humphreys, Loan ^{[7
]}

Koniotou, Marina ^{[1
]}

Logan, Phillipa ^{[8
]}

Lyons, Ronan A. ^{[1
,9
]}

Mason, Suzanne ^{[2
]}

Nicholl, Jon ^{[2
]}

Peconi, Julie ^{[1
]}

Phillips, Ceri ^{[7
]}

Porter, Alison ^{[1
]}

Siriwardena, Aloysius Niroshan ^{[10
]}

Wani, Mushtaq ^{[11
]}

Watkins, Alan ^{[1
]}

Wilson, Lynsey ^{[1
]}

Russell, Ian T. ^{[1
]}

机构：

[1] Swansea Univ, Med Sch, Swansea, W Glam, Wales

[2] Univ Sheffield, Sch Hlth & Related Res, Sheffield, S Yorkshire, England

[3] Univ Warwick, Warwick Med Sch, Coventry, W Midlands, England

[4] London Ambulance Serv NHS Trust, Clin Audit & Res Unit, London, England

[5] Kingston Univ, Fac Hlth Social Care & Educ, London, England

[6] St Georges Univ London, London, England

[7] Swansea Univ, Swansea Ctr Hlth Econ, Swansea, W Glam, Wales

[8] Univ Nottingham, Community Hlth Sci, Nottingham, England

[9] Swansea Univ, Farr Inst, Swansea, W Glam, Wales

[10] Univ Lincoln, Sch Hlth & Social Care, Lincoln, England

[11] Morriston Hosp, Dept Geriatr & Stroke Med, Swansea, W Glam, Wales

来源：

ANNALS OF EMERGENCY MEDICINE | 2017年 / 70卷 / 04期

基金：

美国国家卫生研究院;

关键词：

PREVENTING FALLS; EMERGENCY AMBULANCE; PEOPLE; INTERVENTIONS; RELIABILITY; OUTCOMES; SERVICE; INJURY; CALL;

D O I：

10.1016/j.annemergmed.2017.01.006

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall. Methods: We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer the patient to a community-based falls service instead of transporting the patient to the emergency department. Control paramedics provided care as usual. The primary outcome was subsequent emergency contacts or death. Results: One hundred five paramedics based at 14 intervention stations attended 3,073 eligible patients; 110 paramedics based at 11 control stations attended 2,841 eligible patients. We analyzed primary outcomes for 2,391 intervention and 2,264 control patients. One third of patients made further emergency contacts or died within 1 month, and two thirds within 6 months, with no difference between groups. Subsequent 999 call rates within 6 months were lower in the intervention arm (0.0125 versus 0.0172; adjusted difference-0.0045; 95% confidence interval-0.0073 to- 0.0017). Intervention paramedics referred 8% of patients (204/2,420) to falls services and left fewer patients at the scene without any ongoing care. Intervention patients reported higher satisfaction with interpersonal aspects of care. There were no other differences between groups. Mean intervention cost was $23 per patient, with no difference in overall resource use between groups at 1 or 6 months. Conclusion: A clinical protocol for paramedics reduced emergency ambulance calls for patients attended for a fall safely and at modest cost.

引用

页码：495 / 505

页数：11

共 30 条

[11] Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis [J].