Is Rurality Associated with Higher Probability of Conveyance to Hospital Following Diabetes-Related Ambulance Callouts? A Retrospective Observational Study

Objectives: Understanding the factors that influence avoidable and unavoidable hospital conveyance, including rurality and distance from hospital for diabetes-related metabolic problems is important and will help to inform guidelines and develop policy for emergency services including paramedic and ambulance staff. This study compared the impact of degree of rurality, and other factors on conveyance rates across rural and urban areas in Scotland. Methods: Using a national retrospective five-year dataset from the Scottish Ambulance Service we conducted a univariate, bivariate and multivariable analysis of factors influencing conveyance to hospital for people with diabetes-related metabolic complications. The analysis focused on rurality using a national standardised classification, initial blood glucose level, type and complexity of treatment at the scene, day of the week or time of day, paramedic attendance, time spent at the scene and the distance to the nearest hospital as potentially significant factors. Results: Conveyance rates were highest for those experiencing hyperglycaemia (82%), for those under 20yr (69%) or over 80yr (64%), and for females (58%). Rates were lower for longer time spent at the scene and the longer the distance to hospital from the scene. Probability of conveyance was more likely with increasing age, with glucose levels in the normal or higher range and less likely for males, and if there was a paramedic in attendance. There was no association of degree of rurality with probability of conveyance. Conclusions: Conveyance to hospital following ambulance callouts for diabetes metabolic complications is related to predictable factors. The presence of a paramedic is associated with lower probability of conveyance. Rurality does not appear to be associated with increased probability of higher conveyance rates.