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Serchen J, Johnson D, Cline K, Hilden D, Algase LF, Silberger JR, Watkins C. Improving Health and Health Care in Rural Communities: A Position Paper From the American College of Physicians. Ann Intern Med 2025. [PMID: 40163886 DOI: 10.7326/annals-24-03577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Rural communities throughout the United States experience disparities in health and access to health care. Low population densities, isolating terrain, and vast geographic distances to other population centers create barriers to attracting and retaining physicians and other health professionals. The characteristics of rural communities also pose barriers to facilitating robust economic activity conducive to the production of health and the presence of health care facilities. As such, rural communities have faced high levels of hospital closures and "diseases of despair," such as opioid misuse and suicide. The heterogeneity of rural geographies and population characteristics produces unique and differing challenges across communities that require tailored policy interventions. Interventions that are culturally appropriate for rural communities must be adopted that address diseases and health conditions that impact rural populations and the related social and economic conditions that create and perpetuate these diseases and health conditions. Policymakers must invest in the economies, social services, and infrastructure of rural communities, especially those programs that provide health coverage and services to them. Ensuring access to telehealth is a critical component of expanding health care access. Medical education institutions and the medical community at large have a responsibility to equip physicians and physicians-in-training to care for rural communities and provide opportunities for trainees to practice in rural settings. These institutions must be supported through public policy that incentivizes the recruitment and retainment of a qualified physician workforce in rural communities.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S., D.J., K.C.)
| | - Dejaih Johnson
- American College of Physicians, Washington, DC (J.S., D.J., K.C.)
| | - Katelan Cline
- American College of Physicians, Washington, DC (J.S., D.J., K.C.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Leslie F Algase
- University of Rochester School of Medicine and Dentistry, Honeoye Falls, New York (L.F.A.)
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Ericsson AA, McCurry AD, Tesnohlidek LA, Kearsley BK, Hansen-Oja ML, Glivar GC, Ward AM, Craig KJ, Chung EB, Smith SJ, Alomar TO, La Mue LA, Lopez KS, Goodwin JR, Kieu TT, Dingel AJ, Rockwell Hill CM, Casanova MP, Moore JD, Wiet R, Baker RT. Barriers to Providing Optimal Care in Idaho from the Perspective of Healthcare Providers: A Descriptive Analysis. Healthcare (Basel) 2025; 13:345. [PMID: 39942536 PMCID: PMC11816896 DOI: 10.3390/healthcare13030345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 01/30/2025] [Accepted: 02/03/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: Few studies have assessed barriers to providing care from the perspective of interprofessional healthcare providers. Despite Idaho's predominantly rural geography, limited research exists assessing barriers to providing care within the state. This study sought to assess barriers to providing optimal healthcare using a sample of 400 healthcare providers at 22 clinic sites across the state. Methods: A barriers to providing optimal care 9-factor, 41-item survey was modified from an existing survey. Healthcare providers rated barrier items using an 11-point Likert scale. The survey was distributed to a convenience sample of healthcare providers in 22 different clinic sites in rural Idaho. Results: Four hundred interprofessional healthcare providers in Idaho across 13 professional disciplines completed surveys. Items in the Service Access (mean = 7.14), Patient Complexity (mean = 6.59), and Resource Limitations (mean = 6.18) factors were reported as the most commonly perceived barriers to providing optimal care. Conclusions: Few studies have assessed rural interprofessional providers' perceived barriers to providing optimal, high-quality, care, specifically in the rural state of Idaho, where healthcare services are often not equitable compared to urban regions. The results suggest that commonly perceived barriers exist throughout the state, particularly Service Access, Patient Complexity, and Resource Limitations. Further research is needed to develop data-driven decisions to address these concerns.
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Affiliation(s)
- Alexis A. Ericsson
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Allie D. McCurry
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Lucas A. Tesnohlidek
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - B. Kelton Kearsley
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Morgan L. Hansen-Oja
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Gillian C. Glivar
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Allie M. Ward
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Kathryn J. Craig
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Eva B. Chung
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Skyler J. Smith
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Tabarak O. Alomar
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Luke A. La Mue
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Karina S. Lopez
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Jake R. Goodwin
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Thinh T. Kieu
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Audrey J. Dingel
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Catherine M. Rockwell Hill
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
| | - Madeline P. Casanova
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA;
| | - Jonathan D. Moore
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA;
| | - Ryan Wiet
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA;
| | - Russell T. Baker
- WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA; (A.A.E.); (A.D.M.); (L.A.T.); (B.K.K.); (M.L.H.-O.); (G.C.G.); (A.M.W.); (K.J.C.); (E.B.C.); (S.J.S.); (T.O.A.); (L.A.L.M.); (K.S.L.); (J.R.G.); (T.T.K.); (A.J.D.); (C.M.R.H.); (M.P.C.)
- School of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA;
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, 875 Perimeter Drive MS 4061, Moscow, ID 83844, USA;
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Gettings JV, Mohammad Alizadeh Chafjiri F, Patel AA, Shorvon S, Goodkin HP, Loddenkemper T. Diagnosis and management of status epilepticus: improving the status quo. Lancet Neurol 2025; 24:65-76. [PMID: 39637874 DOI: 10.1016/s1474-4422(24)00430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/01/2024] [Accepted: 10/11/2024] [Indexed: 12/07/2024]
Abstract
Status epilepticus is a common neurological emergency that is characterised by prolonged or recurrent seizures without recovery between episodes and associated with substantial morbidity and mortality. Prompt recognition and targeted therapy can reduce the risk of complications and death associated with status epilepticus, thereby improving outcomes. The most recent International League Against Epilepsy definition considers two important timepoints in status epilepticus: first, when the seizure does not self-terminate; and second, when the seizure can have long-term consequences, including neuronal injury. Recent advances in our understanding of the pathophysiology of status epilepticus indicate that changes in neurotransmission as status epilepticus progresses can increase excitatory seizure-facilitating and decrease inhibitory seizure-terminating mechanisms at a cellular level. Effective clinical management requires rapid initiation of supportive measures, assessment of the cause of the seizure, and first-line treatment with benzodiazepines. If status epilepticus continues, management should entail second-line and third-line treatment agents, supportive EEG monitoring, and admission to an intensive care unit. Future research to study early seizure detection, rescue protocols and medications, rapid treatment escalation, and integration of fundamental scientific and clinical evidence into clinical practice could shorten seizure duration and reduce associated complications. Furthermore, improved recognition, education, and treatment in patients who are at risk might help to prevent status epilepticus, particularly for patients living in low-income and middle-income countries.
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Affiliation(s)
- Jennifer V Gettings
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Fatemeh Mohammad Alizadeh Chafjiri
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Guilan University of Medical Sciences, Rasht, Iran
| | - Archana A Patel
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; University Teaching Hospitals Children's Hospital, Lusaka, Zambia
| | - Simon Shorvon
- University College London, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Howard P Goodkin
- Department of Neurology and Paediatrics, UVA Health, Charlottesville, VA, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Tanaka K, Haraguchi A, Iwasaki T, Inaba H. Higher Incidences of Severe Medical Emergencies and Poorer Out-of-Hospital Cardiac Arrest Outcomes in Farmlands Compared to Other Outdoor Workplaces. Cureus 2025; 17:e76838. [PMID: 39897225 PMCID: PMC11787623 DOI: 10.7759/cureus.76838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2025] [Indexed: 02/04/2025] Open
Abstract
INTRODUCTION Farmland is an essential yet hazardous workplace where an aging population is engaged. This study aimed to compare the characteristics and severity of emergencies between farmlands and other outdoor workplaces and clarify whether the rurality might influence the differences between farmlands and other outdoor workplaces. METHODS This retrospective cohort study analyzed the nationwide emergency medical service (EMS) transportation database between 2016 and 2021, combined with out-of-hospital cardiac arrest (OHCA) data. FINDINGS Farmlands emergencies accounted for 0.26% of all non-pediatric (≥15 years) emergencies (72,162 out of 27,998,839) and 40.6% of outdoor workplace emergencies (177,923 cases). These emergencies were less frequent in winter (12.9% versus 19.7%) and during daytime hours (83.3% versus 87%) but more common in rural areas (31.4% versus 15.7%) compared to other outdoor workplaces. Farmland emergencies involved a lower proportion of male patients (67.6% versus 94.1%) and a higher proportion of older adults (≥60 years) (85.9% versus 34%), medical emergencies (42.7% versus 33.8%), outpatient deaths (3.9% versus 1.1%), and out-of-hospital cardiac arrests (OHCA) (5.1% versus 2.7%). EMS response and transport times were significantly longer for farmland emergencies. These differences in characteristics were more pronounced in non-rural EMS areas. Farmlands were strongly associated with higher outpatient death rates even after adjustment for other factors, with this association further strengthened in specific subgroups: non-rural emergencies, daytime hours, females, and cases not transported to high-class emergency hospitals. Regardless of the EMS rurality, OHCA in farmlands exhibited lower bystander CPR rates, fewer shockable rhythms, and limited public access defibrillation compared to other outdoor workplaces, alongside higher proportions of unwitnessed and medical cases. Neurologically favorable one-month survival was significantly lower in farmlands (1.6% versus 5.4% in rural areas and 2.9% versus 10% in non-rural areas). However, after adjusting for OHCA characteristics, survival differences were not statistically significant (95% confidence interval (CI) of adjusted odds ratio (OR): 0.41-2.63 in rural and 0.52-1.10 in non-rural EMS). CONCLUSIONS Severe medical emergencies are more common in farmlands, and EMS and bystander responses to OHCA are poorer than in other outdoor workplaces, leading to worse outcomes in OHCA in farmlands. Implementing effective health and safety protocols and strategies to improve preventative health management programs and strengthening collaboration between local EMS and agricultural communities are critical to improving outcomes and aligning with the Sustainable Development Goals (SDGs) for agriculture.
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Affiliation(s)
- Koichi Tanaka
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata, JPN
| | - Ayako Haraguchi
- Department of Social Welfare, Niigata University of Health and Welfare, Niigata, JPN
| | - Takashi Iwasaki
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata, JPN
| | - Hideo Inaba
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, JPN
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Taguchi A, Aso S, Yamagami H, Yasunaga H. Difficult-to-transport cases and neurological outcomes of out-of-hospital cardiac arrest: A population-based nationwide study in Japan. Acute Med Surg 2025; 12:e70050. [PMID: 40041116 PMCID: PMC11876083 DOI: 10.1002/ams2.70050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 02/09/2025] [Accepted: 02/20/2025] [Indexed: 03/06/2025] Open
Abstract
Aim In Japan, emergency medical service personnel often have difficulty obtaining hospitals' acceptance of emergency cases owing to congestion in the emergency unit; such cases are called difficult-to-transport cases. Increased difficult-to-transport cases at a regional level may be associated with the prognosis of out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the association between the proportion of difficult-to-transport cases at a regional level and neurological outcomes in patients with OHCA, using the nationwide Utstein database linked to ambulance records in Japan. Methods In this retrospective cohort study from 2017 to 2021 in Japan, the proportion of difficult-to-transport cases was calculated as the number of difficult-to-transport cases divided by the number of emergency calls in each district on each day. Patients with OHCA were categorized into no, low, and high difficult-to-transport cases groups. The primary outcome was a Cerebral Performance Category 1 or 2 at 1 month. The secondary outcome was transportation time intervals. Multivariate regression analyses were conducted to assess the association between difficult-to-transport cases and patient outcomes. Results Among 592,021 eligible patients, the no, low, and high difficult-to-transport case groups included 282,747 (48%), 155,167 (26%), and 154,107 (26%) patients, respectively. The high difficult-to-transport cases group was associated with decreased favorable neurological outcomes (adjusted odds ratio, 0.91; 95% confidence interval, 0.86-0.95) and longer total transportation time (difference, 4.1 min; 95% confidence interval, 3.8-4.4). Conclusion A higher proportion of difficult-to-transport cases was associated with poorer neurological outcomes and longer total transportation times in patients with OHCA.
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Affiliation(s)
- Azusa Taguchi
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Shotaro Aso
- Department of Health Services Research, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroshi Yamagami
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
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Nuñez-Argote L, Corns A, Moser R. Blood banking services in critical access hospitals in Kansas: A laboratory perspective. Am J Clin Pathol 2024:aqae169. [PMID: 39703156 DOI: 10.1093/ajcp/aqae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/02/2024] [Indexed: 12/21/2024] Open
Abstract
OBJECTIVES To investigate the resource capacity for blood banking in critical access hospitals (CAHs) in Kansas and the experiences of medical laboratory personnel working in them. METHODS An electronic survey was implemented to record data from all 82 CAHs in Kansas between May and July 2023. The distance between hospitals with no blood bank services and commercial blood banks was calculated. RESULTS Only 63.4% of Kansas CAHs located in nonmetropolitan counties reported access to 24/7 blood bank services. In 12.2% of laboratories with 5 or fewer workers, there were no staff proficient in blood bank testing. While 72% of laboratories could perform type and screen and crossmatching, many lacked antibody identification capacity. Only 2 hospitals had the capacity to transfuse packed red blood cells, plasma, and platelets simultaneously if needed, with 20.6% of nonmetropolitan hospitals holding no blood products in inventory. CONCLUSIONS The blood banking capacity of CAHs in Kansas is influenced by the lack of workforce availability and training, reduced availability of blood products, and distance from facilities where blood is processed. Solutions tailored to the unique rural environment are needed to ensure adequate access to blood for patients.
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Affiliation(s)
- Letycia Nuñez-Argote
- John R. and Kathy R. Hariston College of Health and Human Sciences, North Carolina Agricultural and Technical State University, Greensboro, NC, US
| | | | - Robert Moser
- The Kansas Center for Rural Health, The University of Kansas Medical Center, Salina, KS, US
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Krishna E. Socioeconomic factors influencing rural-urban ambulance response time disparities in Connecticut. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:19. [PMID: 39627457 PMCID: PMC11615172 DOI: 10.1007/s43999-024-00055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 11/07/2024] [Indexed: 12/06/2024]
Abstract
Across the U.S, it is a documented fact that rural areas have longer ambulance response times and tend to have lower median income. The objective of this study was to test if the rural-urban emergency medical service (EMS) response time disparity was related to wealth disparity in the state of Connecticut. All mean EMS response times were sourced from the 2016 Office of Emergency Medical Services Data Report. Rural definitions were sourced from the Connecticut Office of Rural Health. Median income data was drawn from the Connecticut Office of Policy and Management. A Mann-Whitney U test determined if the average rural EMS response time was greater than the non-rural EMS response time. Pearson coefficients quantified the relationship between median income and EMS response time. A t-test ascertained if the average median income differed between the two datasets. The mean EMS response time was 12.98 min (SD = 3.36) rural and 8.26 min (SD = 2.12) non-rural. Rural mean response time and median income were not significantly correlated (r = -.148, p=.247); non-rural mean response time and median income were also not significantly related. No significant disparity was detected (t=0.478, p=.633) between the mean rural household income ($98,258) and mean non-rural household income ($95,706). Significant disparities in EMS response times can exist between rural and non-rural towns separate from median income trends, as is the case in Connecticut. These findings may have limited generalizability because of Connecticut's relatively high median income as compared to other states yet may be relevant to states with similar economic metrics.
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Hernandez N, Zagales R, Awan MU, Kumar S, Cruz F, Evans K, Heller K, Zito T, Elkbuli A. Factors contributing to disparities in trauma care between urban vs rural trauma centers: Towards improving trauma care access and quality of care delivery. Injury 2024; 55:112017. [PMID: 39531788 DOI: 10.1016/j.injury.2024.112017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/02/2024] [Accepted: 11/03/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND We aim to explore and target factors contributing to disparities in trauma-care outcomes between urban vs rural trauma centers including EMS protocols, trauma centers' (TC) distribution, infrastructure, and hospital resources. METHODS A comprehensive literature review was conducted from January 1988 through April 1st, 2024, using Google Scholar, Embase, Cochrane, ProQuest, and PubMed. Included studies evaluated prehospital and in-hospital factors impacting trauma outcomes in urban and rural care settings. Key outcomes of interest were EMS transport times, TC access, inter-hospital transfers, trauma system utilization, and workforce infrastructure. RESULTS A review of 29 studies demonstrated prolonged EMS on-scene and transport times, higher undertriage rates, and lower geospatial access to TCs in rural compared to urban settings. Transferring from rural to urban TCs was associated with increased mortality and designating rural TCs as Level III TCs reduced mortality (32 % decrease, p < 0.0001). The unregulated expansion of TCs did not improve patient access or outcomes. Rural hospitals lacked specialized providers, had more hospitalizations (x̄ rural = 685.4 vs x̄ urban = 566.3; p = 0.005), ICU admissions (20.2% vs 11.6 %, p = 0.042), and ventilation requirements (37.8% vs 20.7 %, p = 0.001) among trauma patients. CONCLUSIONS Rural trauma patients often experience worse outcomes than their urban counterparts, possibly due to longer prehospital times, reduced TC access, and less specialized care. The designation of targeted Level III TCs in rural areas has been associated with improved outcomes. In contrast, unregulated TC expansion has not necessarily enhanced access or outcomes for rural patients.
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Affiliation(s)
- Nickolas Hernandez
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Ruth Zagales
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad Usman Awan
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Sarthak Kumar
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Francis Cruz
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Kelsey Evans
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Kathleen Heller
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Tracy Zito
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA.
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Lazzarin T, Ballarin RS, Zornoff L, Tanni SE, Paiva SARD, Azevedo PS, Minicucci MF. Sepsis management in pre-hospital care - the earlier, the better? BMC Emerg Med 2024; 24:220. [PMID: 39563231 PMCID: PMC11575029 DOI: 10.1186/s12873-024-01137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 11/14/2024] [Indexed: 11/21/2024] Open
Abstract
Emergency medical services often serve as the initial point of contact for septic patients, offering crucial pre-hospital intervention opportunities. However, the efficacy of pre-hospital interventions remains uncertain. From this perspective, we'll talk about the available evidence of pre-hospital sepsis and septic shock treatment and the barriers to its implementation.
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Affiliation(s)
- Taline Lazzarin
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
| | - Raquel Simões Ballarin
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Leonardo Zornoff
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Suzana Erico Tanni
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Sergio Alberto Rupp de Paiva
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Paula Schmidt Azevedo
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Marcos Ferreira Minicucci
- Internal Medicine Department - Botucatu Medical School, São Paulo State University (Unesp), Medical School, Rubião Junior s/n, Botucatu, SP, CEP: 18618-970, Brazil
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10
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Thompson JA, Mudaranthakam DP, Chollet-Hinton L. The rural mortality penalty in U.S. hospital patients with COVID-19. Popul Health Metr 2024; 22:20. [PMID: 39143603 PMCID: PMC11323646 DOI: 10.1186/s12963-024-00340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/28/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic brought greater focus to the rural mortality penalty in the U.S., which describes the greater mortality rate in rural compared to urban areas. Although it is widely thought that issues such as access to care, age structure of the population, and differences in behavior are likely drivers of the rural mortality penalty, few studies have attempted to tie delayed access to care in rural populations to healthcare outcomes quantitatively. Therefore, it is critical to try and understand these factors to enable more effective public health policy. METHODS We performed a cross-sectional analysis of a population of patients with COVID-19 who were admitted to hospitals in the United States between 3/1/2020 and 2/26/2023 to better understand factors leading to outcome disparities amongst groups that all had some level of access to hospital care. Nevertheless, it is widely thought that rural populations often experience delayed access to care, due to transportation and other constraints. Therefore, we hypothesized that deteriorated patient condition at admission likely explained some of the observed difference in mortality between rural and urban populations. RESULTS Our results supported our hypothesis, showing that the rural mortality penalty persists in this population and that by multiple measures, rural patients were likely to be admitted in worse condition, had worse overall health, and were older. CONCLUSIONS Although the pandemic threw the rural mortality penalty into sharp relief, it is important to remember that it existed prior to the pandemic and will continue to exist until effective interventions are implemented. This study demonstrates the critical need to address the underlying factors that resulted in rural-dwelling patients being admitted to the hospital in worse condition than their urban-dwelling counterparts during the COVID-19 pandemic, which likely affected other healthcare outcomes as well.
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Affiliation(s)
- Jeffrey A Thompson
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, 5032A Robinson Hall, Kanas City, KS, 66160, USA.
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, 5032A Robinson Hall, Kanas City, KS, 66160, USA
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, 5032A Robinson Hall, Kanas City, KS, 66160, USA
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11
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Grubic N, Hill B, Allan KS, Maximova K, Banack HR, Del Rios M, Johri AM. Mediators of the Association Between Socioeconomic Status and Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review. Can J Cardiol 2024; 40:1088-1101. [PMID: 38211888 DOI: 10.1016/j.cjca.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024] Open
Abstract
Low socioeconomic status (SES) is associated with poor outcomes after out-of-hospital cardiac arrest (OHCA). Patient characteristics, care processes, and other contextual factors may mediate the association between SES and survival after OHCA. Interventions that target these mediating factors may reduce disparities in OHCA outcomes across the socioeconomic spectrum. This systematic review identified and quantified mediators of the SES-survival after OHCA association. Electronic databases (MEDLINE, Embase, PubMed, Web of Science) and grey literature sources were searched from inception to July or August 2023. Observational studies of OHCA patients that conducted mediation analyses to evaluate potential mediators of the association between SES (defined by income, education, occupation, or a composite index) and survival outcomes were included. A total of 10 studies were included in this review. Income (n = 9), education (n = 4), occupation (n = 1), and composite indices (n = 1) were used to define SES. The proportion of OHCA cases that had bystander involvement, presented with an initial shockable rhythm, and survived to hospital discharge or 30 days increased with higher SES. Common mediators of the SES-survival association that were evaluated included initial rhythm (n = 6), emergency medical services response time (n = 5), and bystander cardiopulmonary resuscitation (n = 4). Initial rhythm was the most important mediator of this association, with a median percent excess risk explained of 37.4% (range 28.6%-40.0%; n = 5; 1 study reported no mediation) and mediation proportion of 41.8% (n = 1). To mitigate socioeconomic disparities in outcomes after OHCA, interventions should target potentially modifiable mediators, such as initial rhythm, which may involve improving bystander awareness of OHCA and the need for prompt resuscitation.
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Affiliation(s)
- Nicholas Grubic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine S Allan
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Katerina Maximova
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hailey R Banack
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marina Del Rios
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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12
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Li C, Meng X. Effective analysis of job satisfaction among medical staff in Chinese public hospitals: a random forest model. Front Public Health 2024; 12:1357709. [PMID: 38699429 PMCID: PMC11063264 DOI: 10.3389/fpubh.2024.1357709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Objective This study explored the factors and influence degree of job satisfaction among medical staff in Chinese public hospitals by constructing the optimal discriminant model. Methods The participant sample is based on the service volume of 12,405 officially appointed medical staff from different departments of 16 public hospitals for three consecutive years from 2017 to 2019. All medical staff (doctors, nurses, administrative personnel) invited to participate in the survey for the current year will no longer repeat their participation. The importance of all associated factors and the optimal evaluation model has been calculated. Results The overall job satisfaction of medical staff is 25.62%. The most important factors affecting medical staff satisfaction are: Value staff opinions (Q10), Get recognition for your work (Q11), Democracy (Q9), and Performance Evaluation Satisfaction (Q5). The random forest model is the best evaluation model for medical staff satisfaction, and its prediction accuracy is higher than other similar models. Conclusion The improvement of medical staff job satisfaction is significantly related to the improvement of democracy, recognition of work, and increased employee performance. It has shown that improving these five key variables can maximize the job satisfaction and motivation of medical staff. The random forest model can maximize the accuracy and effectiveness of similar research.
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Affiliation(s)
| | - Xuehui Meng
- Department of Health Service Management, Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, China
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13
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Schneider K, Williams M, Mohr NM, Ahmed A. Rural Emergency Medical Services Clinicians' Perceptions and Preferences in Receiving Clinical Feedback From Hospitals: A Qualitative Needs Assessment. PREHOSP EMERG CARE 2024; 28:735-744. [PMID: 38416871 DOI: 10.1080/10903127.2024.2324970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/18/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Emergency medical services (EMS) clinicians experience dissatisfaction with the quality and quantity of clinical feedback from hospitals. Satisfaction is further diminished by the lack of a standardized systems approach. The purpose of this study was to identify rural clinicians' perceptions and preferences regarding clinical feedback received from hospitals, the delivery mechanisms, and its impact on their relationships with health care organizations. METHODS This was a qualitative study focused on EMS clinicians involved in rural prehospital care at a single Midwestern academic medical center. Using a phenomenological framework, semi-structured interviews were conducted with medical directors, service directors, fire captains, air medical personnel, emergency medical responders, emergency medical technicians, advanced emergency medical technicians, and paramedics, all of whom were selected through purposive sampling. Interviews were recorded, transcribed, and independently coded by two trained reviewers. RESULTS Twenty participants (11 frontline clinicians and 9 administrative staff members) with a wide range of clinical experience from 14 air and ground EMS agencies were interviewed. Emerging themes included: (1) the value or usefulness of feedback; (2) desired feedback system characteristics; (3) barriers to receiving feedback; (4) utilization and application of feedback; and (5) the feedback's impact on the relationship with health care organizations. Participants felt that clinical feedback from hospitals was especially important as a method of improving quality of care, though was rarely provided. Professional development was seen as a major benefit of receiving clinical feedback from hospitals. CONCLUSION Our results suggest that consistent clinical feedback provided by hospitals was valued. Establishing a culture of providing organized feedback to practicing rural EMS clinicians is important for professional development and can strengthen the relationships between EMS clinicians and hospitals. These study findings can assist in the development and implementation of a standardized feedback instrument to benefit rural EMS clinicians, patients, and the health care system as a whole.
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Affiliation(s)
- Katherine Schneider
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Mimi Williams
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- Divison of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Management and Entrepreneurship, University of Iowa Tippie College of Business, Iowa City, Iowa
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14
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Cooper-Ohm S, Habecker P, Humeniuk R, Bevins RA. Factors Associated with Gaps in Naloxone Knowledge: Evidence from a 2022 Great Plains Survey. RESEARCH SQUARE 2023:rs.3.rs-3536993. [PMID: 37961638 PMCID: PMC10635394 DOI: 10.21203/rs.3.rs-3536993/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background The rising prevalence of fast-acting opioids in the United States suggests the increased need for non-first responder administration of naloxone. Effective administration of naloxone during an overdose requires that bystanders are familiar with, have access to, and know how to use naloxone. Methods Drawing on the 2022 Nebraska Annual Social Indicators survey, we analyzed naloxone familiarity, access, and competency to administer among a statewide, address-based sample of Nebraskan adults. Results There were significant gaps in naloxone knowledge in Nebraska. Although 75.6% of respondents were familiar with naloxone, only 18.6% knew how to access naloxone and 17.6% knew how to use naloxone. We find that more frequent religious service attendance is associated with lower odds of naloxone familiarity. Among those familiar with naloxone, a higher perception of community stigma towards opioids generally is associated with lower odds of naloxone access and competency. Higher perception of community stigma towards heroin, methamphetamines, and cocaine, however, is associated with higher odds of naloxone access. Finally, past overdose experience, lifetime illicit opioid use, being close to a person who uses opioids, and having access to illicit opioids was not significantly associated with naloxone familiarity, access, or competency among respondents in Nebraska's two largest cities, Omaha and Lincoln. Outside of these cities, past overdose experience and access to illicit opioids was associated with higher odds of naloxone access and competency, but lifetime opioid use and being close to a person who uses opioids had no effect. Conclusions Our findings highlight the continued need for education on naloxone with a specific focus on access and competency to further reduce opioid-related overdose deaths. Education campaigns targeted at places of worship or individuals close to people who use opioids may further serve those with a lower likelihood of naloxone familiarity and promote knowledge of naloxone among those with higher odds of encountering an overdose. Further work is needed to understand differences in the relationship between substance-specific perceived stigma and its association with naloxone access.
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Riney L, Palmer S, Finlay E, Bertrand A, Burcham S, Hendry P, Shah M, Kothari K, Ashby D, Ostermayer D, Semenova O, Abo BN, Abes B, Shimko N, Myers E, Frank M, Turner T, Kemp M, Landry K, Roland G, Fishe J. EMS Administration of Systemic Corticosteroids to Pediatric Asthma Patients: An Analysis by Severity and Transport Interval. PREHOSP EMERG CARE 2023; 27:900-907. [PMID: 37428954 PMCID: PMC10592383 DOI: 10.1080/10903127.2023.2234996] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Pediatric asthma exacerbations are a common cause of emergency medical services (EMS) encounters. Bronchodilators and systemic corticosteroids are mainstays of asthma exacerbation therapy, yet data on the efficacy of EMS administration of systemic corticosteroids are mixed. This study's objective was to assess the association between EMS administration of systemic corticosteroids to pediatric asthma patients on hospital admission rates based on asthma exacerbation severity and EMS transport intervals. METHODS This is a sub-analysis of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI AS ODT). EASI AS ODT is a non-randomized, stepped wedge, observational study examining outcomes one year before and one year after seven EMS agencies incorporated an oral systemic corticosteroid option into their protocols for the treatment of pediatric asthma exacerbations. We included EMS encounters for patients ages 2-18 years confirmed by manual chart review to have asthma exacerbations. We compared hospital admission rates across asthma exacerbation severities and EMS transport intervals using univariate analyses. We geocoded patients and created maps to visualize the general trends of patient characteristics. RESULTS A total of 841 pediatric asthma patients met inclusion criteria. While most patients were administered inhaled bronchodilators by EMS (82.3%), only 21% received systemic corticosteroids, and only 19% received both inhaled bronchodilators and systemic corticosteroids. Overall, there was no significant difference in hospitalization rates between patients who did and did not receive systemic corticosteroids from EMS (33% vs. 32%, p = 0.78). However, although not statistically significant, for patients who received systemic corticosteroids from EMS, there was an 11% decrease in hospitalizations for mild exacerbation patients and a 16% decrease in hospitalizations for patients with EMS transport intervals greater than 40 min. CONCLUSION In this study, systemic corticosteroids were not associated with a decrease in hospitalizations of pediatric patients with asthma overall. However, while limited by small sample size and lack of statistical significance, our results suggest there may be a benefit in certain subgroups, particularly patients with mild exacerbations and those with transport intervals longer than 40 min. Given the heterogeneity of EMS agencies, EMS agencies should consider local operational and pediatric patient characteristics when developing standard operating protocols for pediatric asthma.
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Affiliation(s)
- Lauren Riney
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
| | | | | | | | | | - Phyllis Hendry
- University of Florida College of Medicine – Jacksonville
| | - Manish Shah
- Baylor College of Medicine, Texas Children’s Hospital
| | | | - David Ashby
- Baylor College of Medicine, Texas Children’s Hospital
| | | | - Olga Semenova
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
| | - Benjamin N. Abo
- Lee County Emergency Medical Services, Florida
- Florida State University College of Medicine
- Sarasota County Fire Department, Florida
| | | | | | | | - Marshall Frank
- Florida State University College of Medicine
- Sarasota County Fire Department, Florida
| | | | | | | | - Greg Roland
- Nassau County Fire Rescue Department, Florida
| | - Jennifer Fishe
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
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