1
|
Adibhatla S, Lurie T, Betz G, Palmer J, Raffman A, Andhavarapu S, Harris A, Tran QK, Gingold DB. A Systematic Review of Methodologies and Outcome Measures of Mobile Integrated Health-Community Paramedicine Programs. PREHOSP EMERG CARE 2022; 28:168-178. [PMID: 36260780 DOI: 10.1080/10903127.2022.2138654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/10/2022] [Accepted: 10/16/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mobile integrated health-community paramedicine (MIH-CP) uses patient-centered, mobile resources in the out-of-hospital environment to increase access to care and reduce unnecessary emergency department (ED) usage. The objective of this systematic review is to characterize the outcomes and methodologies used by MIH-CP programs around the world and assess the validity of the ways programs evaluate their effectiveness. METHODS The PubMed, Embase, CINAHL, and Scopus databases were searched for peer-reviewed literature related to MIH-CP programs. We included all full-length studies whose programs met the National Association of Emergency Medical Technicians definition, had MIH-CP-related interventions, and measured outcomes. We excluded all non-English papers, abstract-only, and incomplete studies. RESULTS Our initial literature review identified 6434 titles. We screened 178 full-text studies to assess for eligibility and identified 33 studies to include in this review. These 33 include four randomized controlled trials, 17 cohort studies, eight 8 case series, and four 4 cross-sectional studies. Of the 29 non-randomized trials, five used matched controls, 13 used pre-post, and 11 used no controls. Outcomes measured were hospital usage (24 studies), ED visits (15), EMS usage (23), patient satisfaction (8), health-related outcomes (8), and cost (9). Studies that evaluated hospital usage reported one of several outcome measures: hospital admissions (11), ED length of stay (3), and hospital readmission rate (2). EMS usage was measured by ambulance transports (12) and EMS calls (10). Cost outcomes observed were ambulance transport savings (7), ED visit savings (4), hospital admission savings (3), and cost per quality-adjusted life year (2). CONCLUSION Most studies assessing MIH-CP programs reported success of their interventions. However, significant heterogeneity of outcome measures and varying quality of study methodologies exist among studies. Future studies designed with adequately matched controls and applying uniform core metrics for cost savings and health care usage are needed to better evaluate the effectiveness of MIH-CP programs.
Collapse
Affiliation(s)
| | - Tucker Lurie
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
| | - Gail Betz
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Jamie Palmer
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Alison Raffman
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Sanketh Andhavarapu
- University of Maryland at College Park, College Park, Maryland
- The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea Harris
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Quincy K Tran
- University of Maryland School of Medicine, Baltimore, Maryland
- University of Maryland at College Park, College Park, Maryland
- The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, Maryland
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel B Gingold
- University of Maryland School of Medicine, Baltimore, Maryland
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
2
|
Dzerounian J, Pirrie M, AlShenaiber L, Angeles R, Marzanek F, Agarwal G. Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing. BMC Geriatr 2022; 22:473. [PMID: 35650537 PMCID: PMC9158350 DOI: 10.1186/s12877-022-03116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults living in social housing are a vulnerable population facing unique challenges with health literacy and chronic disease self-management. We investigated this population's knowledge of cardiovascular disease and diabetes mellitus, and self-efficacy to make health behaviour changes (for example, physical activity). This study characterized the relationship between knowledge of health risk factors and self-efficacy to improve health behaviours, in order to determine the potential for future interventions to improve these traits. METHODS A cross-sectional study (health behaviour survey) with adults ages 55+ (n = 599) from 16 social housing buildings across five Ontario communities. Descriptive analyses conducted for demographics, cardiovascular disease and diabetes knowledge, and self-efficacy. Subgroup analyses for high-risk groups were performed. Multivariate logistic regressions models were used to evaluate associations of self-efficacy outcomes with multiple factors. RESULTS Majority were female (75.6%), white (89.4%), and completed high school or less (68.7%). Some chronic disease subgroups had higher knowledge for those conditions. Significant (p < 0.05) associations were observed between self-efficacy to increase physical activity and knowledge, intent to change, and being currently active; self-efficacy to increase fruit/vegetable intake and younger age, knowledge, and intent to change; self-efficacy to reduce alcohol and older age; self-efficacy to reduce smoking and intent to change, ability to handle crises, lower average number of cigarettes smoked daily, and less frequent problems with usual activities; self-efficacy to reduce stress and ability to handle crises. CONCLUSIONS Those with chronic diseases had greater knowledge about chronic disease. Those with greater ability to handle personal crises and intention to make change had greater self-efficacy to change health behaviours. Development of stress management skills may improve self-efficacy, and proactive health education may foster knowledge before chronic disease develops.
Collapse
Affiliation(s)
- Jasmine Dzerounian
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Ontario, L8S 4K1, Hamilton, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Leena AlShenaiber
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Ontario, L8S 4K1, Hamilton, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Ontario, L8S 4K1, Hamilton, Canada.
| |
Collapse
|