This study retrospectively compared alternatives for navigating low-acuity patients in two emergency medical services systems. System A involved a response to every 9-1-1 request with an "evaluate, treat, and refer" process, in which paramedics decided whether patients could be treated on-scene and referred to a primary care provider or urgent care center. System B used a "telephone triage and referral" process, in which callers of low severity were diverted from 9-1-1 to call centers where nurses provided advice and/or a referral to a primary care provider/urgent care center. We hypothesized that systems A and B would differ in terms of the percentage of patients following referral instructions and the percentage of patients who were satisfied with their care.
Independent variables were age, sex, and ZIP code. The two outcome measures were whether the patient followed the instructions given and patient satisfaction. χ(2) tests and multivariate logistic regression were used.
Controlling for age, sex, income, and race, patients in system A had a lower likelihood of following instructions (odds ratio 0.31; 95% confidence interval 0.14-0.69). Satisfaction rates were high (>93%) but equivalent.
The odds were lower that callers in system A would follow instructions. Satisfaction rates suggest that people are willing to accept alternatives to transport to the emergency department and high percentages of patients follow the instructions given.