Evaluating the Impact of a Novel Mobile Care Team on the Prevalence of Ambulatory Care Sensitive Conditions Presenting to Emergency Medical Services in Nova Scotia.

INTRODUCTION: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency Medical Services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS Mobile Care Team (MCT) was implemented in an under-serviced community. The MCT responds in a non-transport unit to referrals from EMS, emergency and primary care, and to low-acuity 911 calls in a defined geographic region. Our objective was to compare the prevalence of ACSC in ground ambulance (GA) responses before and after the introduction of the MCT.

METHODS: A cross-sectional analysis of GA and MCT patients with ACSC (determined by chief complaint, clinical impression, treatment protocol, and medical history) from one year pre-MCT implementation to one year post-MCT implementation was conducted for the period of October 1, 2012, to September 30, 2014. Demographics were described. ACSC prevalence was compared using the chi-squared test.

RESULTS: There were 975 calls pre-MCT and 1208 GA/95 MCT calls post-MCT. ACSC in GA patients pre- and post-MCT was similar: n=122, 12.5% vs. n=185, 15.3%; p=0.06. ACSC in patients seen by EMS (GA plus MCT) increased in the post-MCT period: 122 (12.5%) vs. 204 (15.7%) p=0.04. Pre-MCT implementation vs post-implementation, GA ACSC calls differed significantly by sex with higher female utilization (n=50 vs. n=105; p=0.007), but not age (65.38, ± 15.12 vs. 62.51 ± 20.48; p=0.16) . Post-MCT, the prevalence of specific ACSC increased for GA: hypertension (p<0.001) and congestive heart failure (p=0.04). MCT patients with ACSC were less likely to have a primary care provider compared to GA (90.2% and 87.6% vs. 63.2%; p=0.003, p=0.004).

CONCLUSION: The prevalence of ACSC did not decrease for GA with the introduction of the MCT, but ACSC in the overall patient population served by EMS increased. It is possible more patients with ACSC call, or are referred to EMS, for the new MCT service. Given that MCT patients were less likely to have a primary care provider, this may represent an increase in access to care or a shift away from other emergency/episodic care. These associations must be further studied to inform the ideal utility of adding such services to EMS and healthcare systems.