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Wilkinson-Stokes M, Yap C, Crellin D, Bange R, Braitberg G, Gerdtz M. How should non-emergency EMS presentations be managed? A thematic analysis of politicians', policymakers', clinicians' and consumers' viewpoints. BMJ Open 2024; 14:e083866. [PMID: 39059805 DOI: 10.1136/bmjopen-2024-083866] [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] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE In 2023, Australian government emergency medical services (EMS) responded to over 4 million consumers, of which over 56% were not classified as an 'emergency', at the cost of AU$5.5 billion. We explored the viewpoints of politicians, policymakers, clinicians and consumers on how these non-emergency requests should be managed. DESIGN A realist framework was adopted; a multidisciplinary team (including paramedicine, medicine and nursing) was formed; data were collected via semistructured focus groups or interviews, and thematic analysis was performed. SETTING AND PARTICIPANTS 56 participants were selected purposefully and via open advertisement: national and state parliamentarians (n=3); government heads of healthcare disciplines (n=3); government policymakers (n=5); industry policymakers in emergency medicine, general practice and paramedicine (n=6); EMS chief executive officers, medical directors and managers (n=7); academics (n=8), frontline clinicians in medicine, nursing and paramedicine (n=8); and consumers (n=16). RESULTS Three themes emerged: first, the reality of the EMS workload (theme titled 'facing reality'); second, perceptions of what direction policy should take to manage this ('no silver bullet') and finally, what the future role of EMS in society should be ('finding the right space'). Participants provided 16 policy suggestions, of which 10 were widely supported: increasing public health literacy, removing the Medical Priority Dispatch System, supporting multidisciplinary teams, increasing 24-hour virtual emergency departments, revising undergraduate paramedic university education to reflect the reality of the contemporary role, increasing use of management plans for frequent consumers, better paramedic integration with the healthcare system, empowering callers by providing estimated wait times, reducing ineffective media campaigns to 'save EMS for emergencies' and EMS moving away from hospital referrals and towards community care. CONCLUSIONS There is a need to establish consensus on the role of EMS within society and, particularly, on whether the scope should continue expanding beyond emergency care. This research reports 16 possible ideas, each of which may warrant consideration, and maps them onto the standard patient journey.
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Affiliation(s)
- Matt Wilkinson-Stokes
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Celene Yap
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Di Crellin
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ray Bange
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - George Braitberg
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Marie Gerdtz
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Wilkinson-Stokes M, Tew M, Yap CYL, Crellin D, Gerdtz M. The Economic Impact of Community Paramedics Within Emergency Medical Services: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00902-3. [PMID: 39017994 DOI: 10.1007/s40258-024-00902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective. METHODS A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line ('000', '111', '999', '911' or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings. RESULTS Eleven studies (n = 7136 intervention group) met the criteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14-78% (higher quality studies reduced emergency department transportation by 50-54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338-1227 per attendance in four studies (n = 2962). One study performed an economic evaluation (n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold. CONCLUSIONS Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local policies) and stochastic (such as the patient's medical condition) factors. As models unanimously reduced ED transportation-a major contributor to costs-they in turn lead to net healthcare system savings, provided there is sufficient demand to outweigh model costs and generate net savings. However, all models shift costs from EDs to EMSs, and therefore appropriate redistribution of benefits may be necessary to incentivise EMS investment. Policymakers for EMSs could consider negotiating with their health department, local ED or insurers to introduce a rebate for successful community paramedic non-ED-transportations. Following this, geographical areas with suitable non-emergency demand could be identified, and community paramedic models introduced and tested with a prospective economic evaluation or, where this is not feasible, with sufficient data collection to enable a post hoc analysis.
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Affiliation(s)
- Matt Wilkinson-Stokes
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Michelle Tew
- Melbourne Health Economics, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Celene Y L Yap
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Di Crellin
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Marie Gerdtz
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
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Zaphir JS, Murphy KA, MacQuarrie AJ, Stainer MJ. Understanding The Role of Cognitive Load In Paramedical Contexts: A Systematic Review. PREHOSP EMERG CARE 2024:1-23. [PMID: 38922409 DOI: 10.1080/10903127.2024.2370491] [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: 12/29/2023] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
Objectives: Cognitive load refers to the working memory resources required during a task. When the load is too high or too low this has implications for an individual's task performance. In the context of paramedicine and emergency medical services (EMS) broadly, high cognitive load could potentially put patient and personnel safety at risk. This systematic review aimed to determine the current understanding of the role of cognitive load in paramedical contexts.Methods: To do this, five databases were searched (Elsevier Embase, ProQuest Psychology, CINAHL, Ovid Medline, and Ovid PsychINFO) using synonyms of cognitive load and paramedical contexts. Included articles were full text, peer reviewed empirical research, with a focus on cognitive load and EMS work. Two reviewers screened titles, abstracts, and full text using a traffic light system against the inclusion and exclusion criteria. The quality of evidence was assessed using the GRADE framework. This study was registered on PROSPERO (CRD42022384246). No funding was received for this research.Results: The searches identified 73 unique articles and after title/abstract and full text screening, 25 articles were included in the final review. Synthesis of the research revealed 10 categories of findings in the area. These are clinical performance, cognitive processes, emotional responses, physical expenditure, physiological responses, equipment and ergonomics, expertise and experience, multiple loads, cognitive load measures, and task complexity.Conclusions: From these findings it was determined that there is agreement in terms of what factors influence cognitive load in paramedical contexts, such as cognitive processes, task complexity, physical expenditure, level of experience, multiple types of loads, and the use of equipment. Cognitive load influences clinical task performance and has a bi-directional relationship with emotion. However, the literature is mixed regarding physiological responses to cognitive load, and how they are best measured. These findings highlight potential intervention points where cognitive load can be managed or reduced to improve working conditions for EMS clinicians and safety for their patients.
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Affiliation(s)
- Jasmine S Zaphir
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
| | - Karen A Murphy
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
| | | | - Matthew J Stainer
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
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Sadri P, Keenan A, Angeles R, Marzanek F, Pirrie M, Agarwal G. Physician perspectives of the community paramedicine at clinic (CP@clinic) and my care plan app (myCP app) for older adults. BMC PRIMARY CARE 2024; 25:187. [PMID: 38796442 PMCID: PMC11127385 DOI: 10.1186/s12875-024-02436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Community Paramedicine (CP) is an emerging model of care addressing health problems through non-emergency services. Little evidence exists examining the integration of an app for improved patient, CP, and family physician (FP) communication. This study investigated FP perspectives on the impact of the Community Paramedicine at Clinic (CP@clinic) program on providing patient care and the feasibility and value of a novel "My Care Plan App" (myCP app). METHODS This retrospective mixed-methods study included an online survey and phone interviews to elucidate FPs ' perspectives on the CP@clinic program and the myCP app, respectively, between January 2021 and May 2021. FPs with patients in the CP@clinic program were recruited to participate. Survey responses were summarized using descriptive statistics, and audio recordings from the interviews thematically analyzed. RESULTS Thirty-eight FPs completed the survey and 10 FPs completed the phone interviews. 60.5% and 52.6% of FPs reported that the CP@clinic program improved their ability to further screen and diagnose patients for hypertension, respectively (in addition to their regular screening practices). The themes that emerged in the phone interviews were grouped into three topics: app benefits, drawbacks, and integration within practice. Overall, FPs described the myCP app as user-friendly and useful to improve interprofessional communication with CPs. CONCLUSIONS CP@clinic helped family physicians to screen and monitor chronic disease. The myCP app can impact health service delivery by closing the gap between primary, community, and emergency care through an eHealth information-sharing platform.
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Affiliation(s)
- Pauneez Sadri
- 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, Hamilton, ON, L8S 4L8, Canada
| | - Amelia Keenan
- 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, Hamilton, ON, L8S 4L8, 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
| | - Melissa Pirrie
- 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, Hamilton, ON, L8S 4L8, Canada.
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Daniels B, McGinnis C, Topaz LS, Greenwald P, Turchioe MR, Creber RMM, Sharma R. Bridging the digital health divide-patient experiences with mobile integrated health and facilitated telehealth by community-level indicators of health disparity. J Am Med Inform Assoc 2024; 31:875-883. [PMID: 38269583 PMCID: PMC10990509 DOI: 10.1093/jamia/ocae007] [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: 10/09/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Evaluate the impact of community tele-paramedicine (CTP) on patient experience and satisfaction relative to community-level indicators of health disparity. MATERIALS AND METHODS This mixed-methods study evaluates patient-reported satisfaction and experience with CTP, a facilitated telehealth program combining in-home paramedic visits with video visits by emergency physicians. Anonymous post-CTP visit survey responses and themes derived from directed content analysis of in-depth interviews from participants of a randomized clinical trial of mobile integrated health and telehealth were stratified into high, moderate, and low health disparity Community Health Districts (CHD) according to the 2018 New York City (NYC) Community Health Survey. RESULTS Among 232 CTP patients, 55% resided in high or moderate disparity CHDs but accounted for 66% of visits between April 2019 and October 2021. CHDs with the highest proportion of CTP visits were more adversely impacted by social determinants of health relative to the NYC average. Satisfaction surveys were completed in 37% of 2078 CTP visits between February 2021 and March 2023 demonstrating high patient satisfaction that did not vary by community-level health disparity. Qualitative interviews conducted with 19 patients identified differing perspectives on the value of CTP: patients in high-disparity CHDs expressed themes aligned with improved health literacy, self-efficacy, and a more engaged health system, whereas those from low-disparity CHDs focused on convenience and uniquely identified redundancies in at-home services. CONCLUSIONS This mixed-methods analysis suggests CTP bridges the digital health divide by facilitating telehealth in communities negatively impacted by health disparities.
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Affiliation(s)
- Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Christina McGinnis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Peter Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | | | | | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
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Sass J, Hampton D, Edward J, Cardarelli R. Evaluation of the Impact of Discharge Clinic Follow-Up Interventions on 30-Day Readmission Rates. Popul Health Manag 2024; 27:137-142. [PMID: 38484314 DOI: 10.1089/pop.2023.0273] [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] [Indexed: 04/06/2024] Open
Abstract
Care transition programs can result in cost avoidance and decreased resource utilization. This project aimed to determine whether implementation of a discharge clinic, referral to a community paramedicine program, or a second postdischarge call affected 30-day readmission rates. This single-center retrospective exploratory design study included 727 discharged patients without access to a primary care provider who were scheduled for a discharge clinic transitions appointment. Readmission rates were 17.7% for those who completed a discharge appointment and 24.7% for those who did not; 4% for those completing a second postdischarge call and 26% for those who did not; and 11.1% for those referred to a community paramedicine program and 24.9% for those not referred. A completed discharge clinic appointment resulted in 36% lower odds of readmission. A completed discharge clinic appointment was effective in reducing 30-day readmission rates as was a follow-up call.
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Affiliation(s)
- Jessica Sass
- Family & Community Medicine, UK Healthcare, Lexington, Kentucky, USA
| | - Debra Hampton
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Jean Edward
- UK College of Nursing, Lexington, Kentucky, USA
- Markey Cancer Center, UK Healthcare, Lexington, Kentucky, USA
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Paramalingam A, Ziesmann A, Pirrie M, Marzanek F, Angeles R, Agarwal G. Paramedic attitudes and experiences working as a community paramedic: a qualitative survey. BMC Emerg Med 2024; 24:50. [PMID: 38561672 PMCID: PMC10983637 DOI: 10.1186/s12873-024-00972-5] [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: 02/15/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Community paramedicine (CP) is an extension of the traditional paramedic role, where paramedics provide non-acute care to patients in non-emergent conditions. Due to its success in reducing burden on hospital systems and improving patient outcomes, this type of paramedic role is being increasingly implemented within communities and health systems across Ontario. Previous literature has focused on the patient experience with CP programs, but there is lack of research on the paramedic perspective in this role. This paper aims to understand the perspectives and experiences, both positive and negative, of paramedics working in a CP program towards the community paramedic role. METHODS An online survey was distributed through multiple communication channels (e.g. professional organizations, paramedic services, social media) and convenience sampling was used. Five open-ended questions asked paramedics about their perceptions and experiences with the CP role; the survey also collected demographic data. While the full survey was open to all paramedics, only those who had experience in a CP role were included in the current study. The data was qualitatively analyzed using a comparative thematic analysis. RESULTS Data was collected from 79 respondents who had worked in a CP program. Three overarching themes, with multiple sub-themes, were identified. The first theme was that CP programs fill important gaps in the healthcare system. The second was that they provide paramedics with an opportunity for lateral career movement in a role where they can have deeper patient connections. The third was that CP has created a paradigm shift within paramedicine, extending the traditional scope of the practice. While paramedics largely reported positive experiences, there were some negative perceptions regarding the slower pace of work and the "soft skills" required in the role that vary from the traditional paramedic identity. CONCLUSIONS CP programs utilize paramedic skills to fill a gap in the healthcare system, can improve paramedic mental health, and also provide a new pathway for paramedic careers. As a new role, there are some challenges that CP program planners should take into consideration, such as additional training needs and the varying perceptions of CP.
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Affiliation(s)
- Aarani Paramalingam
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Andrea Ziesmann
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Melissa Pirrie
- 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
| | - Ricardo Angeles
- 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 Street West, Hamilton, Ontario, L8S 4L8, Canada.
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Kasting ML, Laily A, Burney HN, Head KJ, Daggy JK, Zimet GD, Schwab-Reese LM. County-Level Factors Associated With Influenza and COVID-19 Vaccination in Indiana, 2020‒2022. Am J Public Health 2024; 114:415-423. [PMID: 38386970 PMCID: PMC10937598 DOI: 10.2105/ajph.2023.307553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Abstract
Objectives. To assess COVID-19 and influenza vaccination rates across Indiana's 92 counties and identify county-level factors associated with vaccination. Methods. We analyzed county-level data on adult COVID-19 vaccination from the Indiana vaccine registry and 2021 adult influenza vaccination from the Centers for Disease Control and Prevention. We used multiple linear regression (MLR) to determine county-level predictors of vaccinations. Results. COVID-19 vaccination ranged from 31.2% to 87.6% (mean = 58.0%); influenza vaccination ranged from 33.7% to 53.1% (mean = 42.9%). In MLR, COVID-19 vaccination was significantly associated with primary care providers per capita (b = 0.04; 95% confidence interval [CI] = 0.02, 0.05), median household income (b = 0.23; 95% CI = 0.12, 0.34), percentage Medicare enrollees with a mammogram (b = 0.29; 95% CI = 0.08, 0.51), percentage uninsured (b = -1.22; 95% CI = -1.57, -0.87), percentage African American (b = 0.31; 95% CI = 0.19, 0.42), percentage female (b = -0.97; 95% CI = -1.79, ‒0.15), and percentage who smoke (b = -0.75; 95% CI = -1.26, -0.23). Influenza vaccination was significantly associated with percentage uninsured (b = 0.71; 95% CI = 0.22, 1.21), percentage African American (b = -0.07; 95% CI = -0.13, -0.01), percentage Hispanic (b = -0.28; 95% CI = -0.40, -0.17), percentage who smoke (b = -0.85; 95% CI = -1.06, -0.64), and percentage who completed high school (b = 0.54; 95% CI = 0.21, 0.87). The MLR models explained 86.7% (COVID-19) and 70.2% (influenza) of the variance. Conclusions. Factors associated with COVID-19 and influenza vaccinations varied. Variables reflecting access to care (e.g., insurance) and higher risk of severe disease (e.g., smoking) are notable. Programs to improve access and target high-risk populations may improve vaccination rates. (Am J Public Health. 2024;114(4):415-423. https://doi.org/10.2105/AJPH.2023.307553).
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Affiliation(s)
- Monica L Kasting
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Alfu Laily
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Heather N Burney
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Katharine J Head
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Joanne K Daggy
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Gregory D Zimet
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Laura M Schwab-Reese
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [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: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Spelten E, Thomas B, van Vuuren J, Hardman R, Burns D, O'Meara P, Reynolds L. Implementing community paramedicine: A known player in a new role. A narrative review. Australas Emerg Care 2024; 27:21-25. [PMID: 37567857 DOI: 10.1016/j.auec.2023.07.003] [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: 05/24/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Community Paramedicine is a model of care which is effective and accepted by health professionals and the community. Community paramedicine delivers low acuity primary care to disadvantaged communities and addresses service gaps. We aimed to identify successful implementation of community paramedicine models and signalled opportunities and challenges. METHODS A narrative review was conducted. We identified 14 literature reviews from four databases EMBASE, CINAHL, PubMed, Cochrane. The results from the thematic analysis were structured along the quadruple aim for healthcare redesign framework. RESULTS The reviews supported acceptability of the model. Patients are satisfied and there is evidence of cost reduction. Long term evidence of the positive effects of community paramedicine on patient, community health and the health system are lacking. Equally, there is unfamiliarity about the role and how it is part of an integrated health model. CONCLUSIONS Community paramedicine could alleviate current stresses in the healthcare system and uses an available workforce of registered paramedics. To facilitate integration, we need more evidence on long-term effects for patients and the system. In addition, the unfamiliarity with the model needs to be addressed to enhance the uptake of the model.
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Affiliation(s)
- Evelien Spelten
- Violet Vines Marshman Centre for Rural Health Research, Rural Health School, La Trobe University, Victoria, Australia.
| | - Brodie Thomas
- Violet Vines Marshman Centre for Rural Health Research, Rural Health School, La Trobe University, Victoria, Australia
| | - Julia van Vuuren
- Violet Vines Marshman Centre for Rural Health Research, Rural Health School, La Trobe University, Victoria, Australia
| | - Ruth Hardman
- Violet Vines Marshman Centre for Rural Health Research, Rural Health School, La Trobe University, Victoria, Australia; Sunraysia Community Health Services, Mildura, Victoria, Australia
| | - David Burns
- La Trobe University, Rural Health School, Department of Rural Allied Health - Paramedicine, Australia
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Victoria, Australia
| | - Louise Reynolds
- College of Sport, Health and Engineering, Victoria University, Victoria, Australia
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Quatman CE, Wiseman JM, Dickinson C, Leach MC, Hislop M, Kegelmeyer DA, Kloos AD, Quatman-Yates CC. The role of community paramedicine in fall prevention: A SWOT analysis. J Am Geriatr Soc 2024; 72:512-519. [PMID: 37974544 PMCID: PMC10922653 DOI: 10.1111/jgs.18687] [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: 07/24/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Millions of older US adults fall annually, leading to catastrophic injuries, over 32,000 deaths and healthcare costs of over $55 billion. This study evaluated perceived benefits and limitations of using community paramedicine for fall prevention strategies from the lens of older adults, caregivers, and healthcare providers. METHODS Semi-structured focus groups were held with individuals from three stakeholder groups: (1) community-dwelling older adults (age ≥60), (2) caregivers, and (3) healthcare providers. The Strengths-Weaknesses-Opportunities-Threats (SWOT) framework was used to quantitatively analyze stakeholder perceptions of using community paramedicine for fall prevention strategies. RESULTS A total of 10 focus groups were held with 56 participants representing older adults (n = 15), caregivers (n = 16), and healthcare providers (n = 25). Community paramedicine was supported as a model of fall prevention by older adults, caregivers, and healthcare providers. Participants identified strengths such as visibility to the home environment, ability to implement home modifications, implicit trust in emergency medical services (EMS), and capacity to redirect resources toward prevention. Additionally, participants acknowledged opportunities such as providing continuity of care across the healthcare spectrum, improving quality and safety of care and potentially reducing unnecessary emergency department use. Participants endorsed weaknesses and threats such as funding, concerns of patients about stigma, and struggles with medical data integration. CONCLUSIONS The results of this study illuminate the opportunity to leverage community paramedicine to address a variety of perceived barriers in order to design and implement better solutions for fall prevention efforts.
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Affiliation(s)
- Carmen E. Quatman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jessica M. Wiseman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Chandler Dickinson
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Monica C. Leach
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michelle Hislop
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Deb A. Kegelmeyer
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne D. Kloos
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine C. Quatman-Yates
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
- The Ohio State University Sports Medicine Research Institute, Columbus, OH, USA
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12
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Taplin JG, Bill L, Blanchard IE, Barnabe CM, Holroyd BR, Healy B, McLane P. Exploring paramedic care for First Nations in Alberta: a qualitative study. CMAJ Open 2023; 11:E1135-E1147. [PMID: 38086557 PMCID: PMC10721334 DOI: 10.9778/cmajo.20230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prior work has shown that a greater proportion of First Nations patients than non-First Nations patients arrive by ambulance to emergency departments in Alberta. The objective of this study was to understand First Nations perspectives on transitions in care involving paramedics, and paramedic perspectives on serving First Nations communities. METHODS Participants for this participatory qualitative study were selected by means of purposive sampling through author networks, established relationships and knowledge of the Alberta paramedicine system. First Nations research team members engaged First Nations community organizations to identify and invite First Nations participants. Four sharing circles were held virtually in July 2021 via Zoom by the Alberta First Nations Information Governance Centre. We analyzed the data from the sharing circles using a Western thematic approach. The data were reviewed by Indigenous researchers. RESULTS Forty-four participants attended the 4 sharing circles (8-14 participants per circle), which ranged from 68 to 88 minutes long. We identified 3 major themes: racism, system barriers and solutions. First Nations participants described being stereotyped as misusing paramedic systems and substance using, which led to racial discrimination by paramedics and emergency department staff. Discrimination and lack of options to return home after care sometimes led First Nations patients to avoid paramedic care, and lack of alternative care options drove patients to access paramedic care. First Nations providers described facing racism from colleagues and completing additional work to act as cultural mentors to non-First Nations providers. Paramedics expressed moral distress when called on to handle issues outside their scope of practice and when they observed discrimination that interfered with patient care. Proposed solutions included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models. INTERPRETATION First Nations people face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities, and First Nations should lead in the design of and priority setting for paramedic services in their communities.
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Affiliation(s)
- John G Taplin
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Lea Bill
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Ian E Blanchard
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Cheryl M Barnabe
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Brian R Holroyd
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Patrick McLane
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta.
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Leduc S, Wells G, Thiruganasambandamoorthy V, Cantor Z, Kelly P, Rietschlin M, Vaillancourt C. The hospital care and outcomes of long-term care patients treated by paramedics during an emergency call: exploring the potential impact of 'treat-and-refer' pathways and community paramedicine. CAN J EMERG MED 2023; 25:873-883. [PMID: 37715067 DOI: 10.1007/s43678-023-00590-3] [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: 04/07/2022] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Adults living in long-term care (LTC) are at increased risk of harm when transferred to the emergency department (ED), and programs targeting treatment on-site are increasing. We examined characteristics, clinical course, and disposition of LTC patients transported to the ED to examine the potential impact of alternative models of paramedic care for LTC patients. METHODS We conducted a health records review of paramedic and ED records between April 1, 2016, and March 31, 2017. We included emergency calls originating from LTC centers and patients transported to either ED campus of The Ottawa Hospital. We excluded scheduled or deferrable transfers, and patients with Canadian Triage and Acuity Scale of 1. We categorized patients into groups based on care they received in the ED. We calculated standardized differences to examine differences between groups. RESULTS We identified four groups: (1) patients requiring no treatment or diagnostics in the ED (7.9%); (2) patients receiving ED treatment within current paramedic directives and no diagnostics (3.2%); (3) patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and (4) patients requiring admission (34.1%). CONCLUSION This study found 7.9% of LTC patients transported to the ED did not receive diagnostics, medications, or treatment, and overall 11.1% of patients could have been treated by paramedics within current medical directives using 'treat-and-refer' pathways. This group could potentially expand utilizing community paramedics with expanded scopes of practice.
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Affiliation(s)
- Shannon Leduc
- Ottawa Paramedic Service, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - George Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Venkatesh Thiruganasambandamoorthy
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Zach Cantor
- Ottawa Paramedic Service, Ottawa, ON, Canada
| | - Peter Kelly
- Ottawa Paramedic Service, Ottawa, ON, Canada
| | | | - Christian Vaillancourt
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Okoh CM, Moczygemba LR, Thurman W, Brown C, Hanson C, Baffoe JO. An examination of the emerging field of community paramedicine: a national cross-sectional survey of community paramedics. BMC Health Serv Res 2023; 23:516. [PMID: 37221608 DOI: 10.1186/s12913-023-09537-x] [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: 05/29/2022] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Community Paramedicine is an evolving community-based model that expands paramedic roles from emergency and transport care to a focus on non-emergent and preventive health services tailored to local community needs. Though community paramedicine is a growing field and acceptance is gradually increasing, there is limited information on community paramedics (CPs) perceptions of their expanded roles. The study's aim is to assess CPs' perceptions about their training, roles, role clarity, role readiness, role satisfaction, professional identity, interprofessional collaboration, and the future of the community paramedicine care model. METHODS Using the National Association of Emergency Medical Technicians-mobile integrated health (NAEMT-MIH) listserv, a cross-sectional survey was conducted in July/August 2020 using a 43-item web-based questionnaire. Thirty-nine questions evaluated CPs' training, roles, role clarity, role readiness, role satisfaction, professional identity, interprofessional collaboration, and program/work characteristics. Four open-ended questions examined perceptions of the future of community paramedicine care models and challenges/opportunities encountered during the COVID-19 pandemic. Data was analyzed using Spearman's correlation, Wilcoxon Mann-Whitney U, and Kruskal-Wallis tests. Open-ended questions were analyzed using qualitative content analyses. RESULTS Responses from fifty-seven CPs were analyzed. Most (80%) completed didactic and/or clinical training. Nearly all respondents (96.5%) performed health assessments; only 38.6% administered vaccines. Overall, participants were neutral about their role readiness with a mean score of 3.3/5.0. The mean role clarity was 15.5 (range 4-29; higher scores = higher clarity), professional identity was 46.8 (range 30-55; higher scores = higher identity), role satisfaction was 4.4/5 with 5 = very satisfied, and interprofessional collaboration was 9.5/10 (10 = very important). Role clarity training (rho = 0.4, p = 0.0013) and higher interprofessional collaboration (rho = 0.4, p = 0.0015) were found to be significantly associated with the enhancement of professional identity. Respondents who completed training showed higher role satisfaction compared to those who did not (p = 0.0114). COVID-19 challenges included keeping up with emerging policies/procedures, CPs' well-being, and inadequate funding to meet service needs; opportunities identified included service delivery expansion and CPs meeting community needs in a flexible manner. Respondents reported that sustainable payment models, expanding services, and geographic reach were important to the future of community paramedicine. CONCLUSIONS Interprofessional collaboration is important to fulfill CPs roles. Role clarity and readiness could be improved, which aligns with the emerging nature of community paramedicine. The future of the community paramedicine care model is dependent on funding and expanding reach of services.
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Affiliation(s)
- Chinyere Mma Okoh
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA.
| | - Leticia R Moczygemba
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA
| | - Whitney Thurman
- The University of Texas at Austin School of Nursing, 1710 Red River St, Austin, TX, 78712, USA
| | - Carolyn Brown
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA
| | - Christopher Hanson
- TMF Health Quality Institute, 3107 Oak Creek Dr Ste. 200, Austin, TX, 78727, USA
| | - James O Baffoe
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA
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Ulintz AJ, Gage CB, Powell JR, Wang HE, Panchal AR. Mobile Integrated Health Care Roles of US EMS Clinicians: A Descriptive Cross-Sectional Study. PREHOSP EMERG CARE 2023; 28:179-185. [PMID: 37141533 DOI: 10.1080/10903127.2023.2210219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Mobile integrated health care (MIH) leverages emergency medical services (EMS) clinicians to perform local health care functions. Little is known about the individual EMS clinicians working in this role. We sought to describe the prevalence, demographics, and training of EMS clinicians providing MIH in the United States (US). METHODS This is a cross-sectional study of US-based, nationally certified civilian EMS clinicians who completed the National Registry of Emergency Medical Technicians (NREMT) recertification application during the 2021-2022 cycle and completed the voluntary workforce survey. Workforce survey respondents self-identified their job roles within EMS, including MIH. If an MIH role was selected, additional questions clarified the primary role in EMS, type of MIH provided, and hours of MIH training received. We merged the workforce survey responses with the individual's NREMT recertification demographic profile. The prevalence of EMS clinicians with MIH roles and data on demographics, clinical care provided, and MIH training were calculated using descriptive statistics, including proportions with associated binomial 95% confidence intervals (CI). RESULTS Of 38,960 survey responses, 33,335 met inclusion criteria and 490 (1.5%; 95%CI 1.3-1.6%) EMS clinicians indicated MIH roles. Of these, 62.0% (95%CI 57.7-66.3%) provided MIH as their primary EMS role. EMS clinicians with MIH roles were present in all 50 states and certification levels included emergency medical technician (EMT) (42.8%; 95%CI 38.5-47.2%), advanced emergency medical technician (AEMT) (3.5%; 95%CI 1.9-5.1%), and paramedic (53.7%; 95%CI 49.3-58.1%). Over one-third (38.6%; 95%CI 34.3-42.9%) of EMS clinicians with MIH roles received bachelor's degrees or above, and 48.4% (95%CI 43.9%-52.8%) had been in their MIH roles for less than 3 years. Nearly half (45.6%; 95%CI 39.8-51.6%) of all EMS clinicians with primary MIH roles received less than 50 hours (h) of MIH training; only one-third (30.0%; 95%CI 24.7-35.6%) received more than 100 h of training. CONCLUSION Few nationally certified US EMS clinicians perform MIH roles. Only half of MIH roles were performed by paramedics; EMT and AEMT clinicians performed a substantial proportion of MIH roles. The observed variability in certification and training suggest heterogeneity in preparation and performance of MIH roles among US EMS clinicians.
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Affiliation(s)
- Alexander J Ulintz
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Christopher B Gage
- National Registry of Emergency Medical Technicians, Columbus, USA
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Jonathan R Powell
- National Registry of Emergency Medical Technicians, Columbus, USA
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
- National Registry of Emergency Medical Technicians, Columbus, USA
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
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Lurie T, Adibhatla S, Betz G, Palmer J, Raffman A, Andhavarapu S, Harris A, Tran QK, Gingold DB. Mobile integrated health-community paramedicine programs' effect on emergency department visits: An exploratory meta-analysis. Am J Emerg Med 2023; 66:1-10. [PMID: 36640693 DOI: 10.1016/j.ajem.2022.12.041] [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: 08/03/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes. METHODS We searched Pubmed, Embase, CINAHL, and Scopus databases for peer-reviewed MIH-CP literature from January 1, 2000, to July 24, 2021. We included all full-text English studies whose program met the National Associations of Emergency Medical Technicians definition, reported ED visits, and had an MIH-CP related intervention and outcome. We established risk ratios for each included study through interpreting the reported data. We performed a random-effects and cumulative meta-analysis of ED visit data, tests of heterogeneity, and a moderator analysis to assess for factors influencing the magnitude of observed effect. RESULTS We identified 16 studies that reported ED visit data and included 12 in our meta-analysis. All studies were observational; 3 used matched controls, 6 pre-post controls, and 3 without controls. 7 studies' intervention were diversion/triage while 5 studies intervened with health education/home primary care services. Pooled risk ratio for our data set was 0.56 (95% confidence interval 0.42-0.74). Cumulative meta-analysis revealed that as of 2018 MIH-CP programs began to show consistent reductions in ED visits. Significant heterogeneity was seen among studies, with I-squared >90%. Moderator analysis showed reduced heterogeneity for matched-control studies. CONCLUSION Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity.
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Affiliation(s)
- Tucker Lurie
- Wellspan York Hospital, Department of Emergency Medicine, 1001 South George Street, York, PA 17403, USA.
| | - Srikar Adibhatla
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Gail Betz
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Jamie Palmer
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Alison Raffman
- Hennepin County Medical Center, Department of Emergency Medicine, 730 S 8th St, Minneapolis, MN 55415, United States of America.
| | - Sanketh Andhavarapu
- University of Maryland at College Park, College Park, MD 20742, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA.
| | - Andrea Harris
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Quincy K Tran
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street; 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, Baltimore, MD 21201, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA.
| | - Daniel B Gingold
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street; 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Louras N, Reading Turchioe M, Shafran Topaz L, Demetres MR, Ellison M, Abudu-Solo J, Blutinger E, Munjal KG, Daniels B, Masterson Creber RM. Mobile Integrated Health Interventions for Older Adults: A Systematic Review. Innov Aging 2023; 7:igad017. [PMID: 37090165 PMCID: PMC10114527 DOI: 10.1093/geroni/igad017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 03/04/2023] Open
Abstract
Background and Objectives Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). Discussion and Implications There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.
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Affiliation(s)
- Nathan Louras
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Michelle R Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, USA
| | - Melani Ellison
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jamie Abudu-Solo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Erik Blutinger
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Kevin G Munjal
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Rahim F, Jain B, Patel T, Jain U, Jain P, Palakodeti S. Community Paramedicine: An Innovative Model for Value-Based Care Delivery. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E65-E68. [PMID: 36580427 DOI: 10.1097/phh.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Faraan Rahim
- Duke University, Durham, North Carolina (Mr Rahim); Massachusetts Institute of Technology, Cambridge, Massachusetts (Mr B. Jain); University of Pennsylvania, Philadelphia, Pennsylvania (Mr Patel); University of Pittsburgh, Pittsburgh, Pennsylvania (Mr U. Jain); Highmark Health, Pittsburgh, Pennsylvania (Dr P. Jain); Indiana University of Pennsylvania, Indiana, Pennsylvania (Dr P. Jain); and Case Western Reserve University, Cleveland, Ohio (Dr Palakodeti)
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Cavanagh N, Blanchard IE, Weiss D, Tavares W. Looking back to inform the future: a review of published paramedicine research. BMC Health Serv Res 2023; 23:108. [PMID: 36732779 PMCID: PMC9893690 DOI: 10.1186/s12913-022-08893-4] [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] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. METHODS We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. RESULTS The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. CONCLUSIONS Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.
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Affiliation(s)
- N. Cavanagh
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - I. E. Blanchard
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - D. Weiss
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada
| | - W. Tavares
- grid.512795.dThe Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Health and Society, University of Toronto, Toronto, Ontario Canada ,York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario Canada
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Johnson D, Druschel J, Wattai B, Mann J. Factors Associated With Successful Enrollment in a Community Paramedicine Program for Heart Failure. Cureus 2023; 15:e34811. [PMID: 36915830 PMCID: PMC10008085 DOI: 10.7759/cureus.34811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Participation in community paramedicine (CP) programs, sometimes referred to as Mobile Integrated Healthcare (MIH), may improve patient-centered outcomes and reduce hospital readmissions. The objective of this study was to correlate patient and system-specific factors with successful enrollment in a CP program for heart failure. Methods We conducted a retrospective review of patients enrolled in a CP program after hospitalization for a heart failure-related diagnosis. All patients greater than 18 years of age referred to the CP program with a heart-failure-related diagnosis were included. Factors including age, sex, hospital length of stay, enrollment method, concurrent use of transitional care services, care team, and service line referral were collected. The primary outcome was successful enrollment which led to an initial home visit. Chi-square and t-tests were performed to determine if the outcome differed between cohorts. Results A total of 908 patients met the inclusion criteria, and 677 (74.7%) received home visits. Increased participation was noted in patients enrolled in person (81.1% vs. 66%, p<0.01) and those also receiving transitional care services (78.9% vs. 62.5%, p<0.01). Conclusion We conclude that efforts should be made to contact patients in person, prior to hospital discharge, who are eligible for CP services.
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Affiliation(s)
- Daniel Johnson
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Jason Druschel
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Brandon Wattai
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Jessica Mann
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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von Rüden C, Ewers A, Brand A, Hungerer S, Erichsen CJ, Dahlmann P, Werner D. The Influence of Human Factors Training in Air Rescue Service on Patient Safety in Hospitals: Results of an Online Survey. MEDICINES (BASEL, SWITZERLAND) 2022; 10:medicines10010002. [PMID: 36662486 PMCID: PMC9861563 DOI: 10.3390/medicines10010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background: Air rescue crew members work equally in aviation and medicine, and thus occupy an important interface between the two work environments of aviation and medicine. The aim of this study was to obtain responses from participants to a validated online-based questionnaire regarding whether hospitals may benefit from the commitment of a medical hospital staff which is also professionally involved in the aviation system as emergency physicians and Helicopter Emergency Medical Services Technical Crew Members (HEMS TC). Furthermore, it focused on the question of whether the skills acquired through Crew Resource Management (CRM) training in the air rescue service might also be used in the ground-based rescue service and, if so, whether they may have a positive effect. Methods: Medical air rescue staff of 37 German air rescue stations was included. Between 27 November 2020 and 03 March 2021, 253 out of 621 employees (response rate: 40.7%) participated voluntarily in a validated anonymized online survey. A quantitative test procedure was performed using the modified questionnaire on teamwork and patient safety (German version). Results: The examination and interpretation of the internal consistency (Cronbach's alpha) resulted in the following reliabilities: Factor I (Cooperation): α = 0.707 (good); Factor II (Human factors): α = 0.853 (very good); Factor III (Communication): α = 0.657 (acceptable); and Factor IV (Safety): α = 0.620 (acceptable). Factor analysis explained 53.1% of the variance. Conclusions: The medical clinicians participating in this online survey believed that the skills they learned in human factors training such as CRM are helpful in their daily routine work in hospitals or other medical facilities, as well as in their ground-based rescue service activities. These findings may result in the recommendation to make CRM available on a regular to the medical staff in all medical facilities and also to ground-based rescue service staff aiming to increase patient safety and employee satisfaction.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +49-8841-480; Fax: +49-8841-3026
| | - Andre Ewers
- Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Andreas Brand
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sven Hungerer
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Philipp Dahlmann
- Center for Academic Further Education, Deggendorf Institute of Technology, 94469 Deggendorf, Germany
| | - Daniel Werner
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, 80539 Munich, Germany
- Department of Medicine, ADAC Air Rescue Service, 80686 Munich, Germany
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22
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Quatman CE, Wiseman JM, Sheridan E, Caterino JM, Weade M, Wisner D, Leyshon C, Quatman-Yates C. Automated referral to community paramedicine during 9-1-1 fall calls for resource activation. J Am Geriatr Soc 2022; 70:3578-3584. [PMID: 36039856 PMCID: PMC9771950 DOI: 10.1111/jgs.18011] [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: 10/08/2021] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We sought to improve the referral process to a community paramedicine (CP) program following a 9-1-1 encounter. METHODS An electronic health record (EHR) for CP records with the ability to link to emergency EHR was identified and implemented with a single-click referral to the CP program. Referrals were tracked for 15 months before and after implementation. RESULTS Referral capacity increased from an average of 14.2 referrals per month to 44.9 referrals per month. CONCLUSION The results of this study suggest an EHR is a useful investment for CP programs and may be integral to efficient program operations.
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Affiliation(s)
- Carmen E Quatman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jessica M Wiseman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth Sheridan
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Weade
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - David Wisner
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - Christine Leyshon
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - Catherine Quatman-Yates
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA, Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA, Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA, The Ohio State University Sports Medicine Research Institute, Columbus, OH, USA
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Shannon B, Eaton G, Lanos C, Leyenaar M, Nolan M, Bowles K, Williams B, O'Meara P, Wingrove G, Heffern JD, Batt A. The development of community paramedicine; a restricted review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3547-e3561. [PMID: 36065522 PMCID: PMC10087318 DOI: 10.1111/hsc.13985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 08/13/2022] [Indexed: 05/22/2023]
Abstract
Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality.
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Affiliation(s)
- Brendan Shannon
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Georgette Eaton
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Matthew Leyenaar
- Department of Health and Wellness, Emergency Health ServicesGovernment of Prince Edward IslandPrince Edward IslandCanada
| | - Mike Nolan
- County of Renfrew Paramedic ServicePembrokeCanada
| | - Kelly‐Ann Bowles
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Brett Williams
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Peter O'Meara
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Gary Wingrove
- International Roundtable on Community ParamedicineDuluthMNUSA
| | - JD Heffern
- Indigenous Services Canada, Government of CanadaOttawaOntarioCanada
| | - Alan Batt
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
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Barry T, Batt A, Agarwal G, Booker M, Casey M, McCombe G. Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives. HRB Open Res 2022; 5:40. [PMID: 36072818 PMCID: PMC9418754 DOI: 10.12688/hrbopenres.13545.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Irish health policy emphasises the role of Primary Care and General Practice however, there is a growing shortage of General Practitioners (GPs) in Ireland. Paramedics have traditionally focused on emergency care in the community. More recently Paramedics have taken on roles in General Practice in international jurisdictions, but not yet in Ireland. This study aimed to explore key stakeholder perceptions of ‘the potential for Paramedic roles in Irish General Practice’. Methods: We conducted an exploratory, qualitative stakeholder consultation study incorporating in-depth semi structured telephone interviews followed by thematic analysis. Interviews were conducted with a total of eighteen participants that included six senior Paramedics (Advanced Paramedics), seven General Practitioners (GPs), three Practice Nurses and two Practice Managers. Results: Participants in this study expressed polarised views on the potential for Paramedic roles in Irish General Practice. Paramedics were enthusiastic, highlighting opportunity for professional development and favourable working conditions. GPs, Practice Nurses and Managers were more circumspect and had concerns that Paramedic scope and skillset was not currently aligned to General Practice care. GPs, Practice Nurses and Managers emphasised a greater role for expanded General Practice Nursing. There were varied perceptions on what the potential role of a Paramedic in General Practice might entail, but consensus that Government support would be required to facilitate any potential developments. Conclusions: The findings of this research can inform future development of novel roles in Irish General Practice and suggests that there is appetite from within the Paramedic profession to pursue such roles. A pilot demonstration project, grounded in an action research framework could address data gaps and potential concerns. Any future developments should occur in tandem with and with due consideration for the expansion of General Practice Nursing in Ireland.
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Affiliation(s)
- Tomás Barry
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Alan Batt
- Paramedic Programs, Fanshawe College, London, Ontario, Canada
| | - Gina Agarwal
- Departments of Family Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Booker
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mary Casey
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
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Grudzen CR, Barker PC, Bischof JJ, Cuthel AM, Isaacs ED, Southerland LT, Yamarik RL. Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician. EMERGENCY CANCER CARE 2022; 1:10. [PMID: 35966217 PMCID: PMC9362452 DOI: 10.1186/s44201-022-00010-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
Eighty-one percent of persons living with cancer have an emergency department (ED) visit within the last 6 months of life. Many cancer patients in the ED are at an advanced stage with high symptom burden and complex needs, and over half is admitted to an inpatient setting. Innovative models of care have been developed to provide high quality, ambulatory, and home-based care to persons living with serious, life-limiting illness, such as advanced cancer. New care models can be divided into a number of categories based on either prognosis (e.g., greater than or less than 6 months), or level of care (e.g., lower versus higher intensity needs, such as intravenous pain/nausea medication or frequent monitoring), and goals of care (e.g., cancer-directed treatment versus symptom-focused care only). We performed a narrative review to (1) compare models of care for seriously ill cancer patients in the ED and (2) examine factors that may hasten or impede wider dissemination of these models.
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Costa Jacobsohn G, Maru AP, Green RK, Gifford AN, Lukasik MD, Bandara T, Caprio TV, Cochran AL, Cushman JT, Jones CMC, Kind AJH, Lohmeier M, Shah MN. Multimethod Process Evaluation of a Community Paramedic Delivered Care Transitions Intervention for Older Emergency Department Patients. PREHOSP EMERG CARE 2022; 27:841-850. [PMID: 35748597 PMCID: PMC9839887 DOI: 10.1080/10903127.2022.2094514] [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: 04/19/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits. METHODS The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on the acceptability of the adapted CTI. Using a multimethod approach, the CTI implementation was assessed quantitatively for site- and coach-level differences. Qualitatively, barriers to implementation and participant satisfaction with the CTI were thematically analyzed. RESULTS Of the 863 patient participants, 726 (84.1%) completed their home visits. Cancellations were usually patient-generated (94.9%). Most planned follow-up visits were successfully completed (94.6%). Content on the planning for red flags and post-discharge goal setting was discussed with high rates of fidelity overall (95% and greater), while content on outpatient follow-up was lower overall (75%). Differences in service delivery between the two sites existed for the in-person visit and the first phone follow-up, but the differences narrowed as the study progressed. Participants showed a 24.6% increase in patient activation (i.e., behavioral adoption) over the 30-day study period (p < 0.001).Overall, participants reported that the program was beneficial for managing their health, the quality of coaching was high, and that the program should continue. Not all participants felt that they needed the program. Community paramedic coaches reported barriers to CTI delivery due to patient medical problems and difficulties with phone visit coordination. Coaches also noted refusal to communicate or engage with the intervention as an implementation barrier. CONCLUSIONS Community paramedic coaches delivered the adapted CTI with high fidelity across geographically distant sites and successfully facilitated participant engagement, highlighting community paramedics as an effective resource for implementing such patient-centered interventions.
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Affiliation(s)
- Gwen Costa Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Apoorva P Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Rebecca K Green
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Angela N Gifford
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew D Lukasik
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tikiri Bandara
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics, University of Rochester Medical Center, Rochester, New York
| | - Amy L Cochran
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Mathematics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Amy J H Kind
- Department of Medicine (Geriatrics and Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Medicine (Geriatrics and Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Elden OE, Uleberg O, Lysne M, Haugdahl HS. Community paramedicine: cost-benefit analysis and safety evaluation in paramedical emergency services in rural areas - a scoping review. BMJ Open 2022; 12:e057752. [PMID: 35680256 PMCID: PMC9185415 DOI: 10.1136/bmjopen-2021-057752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the current knowledge and possibly identify gaps in the knowledge base for cost-benefit analysis and safety concerning community paramedicine in rural areas. DESIGN Scoping review. DATA SOURCES MEDLINE via PubMed, CINAHL, Cochrane and Embase up to December 2020. STUDY SELECTION All English studies involving community paramedicine in rural areas, which include cost-benefit analysis or safety evaluation. DATA EXTRACTION This scoping review follows the methodology developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We systematically searched for all types of studies in the databases and the reference lists of key studies to identify studies for inclusion. The selection process was in two steps. First, two reviewers independently screened 2309 identified articles for title and abstracts and second performed a full-text review of 24 eligible studies for inclusion. RESULTS Three articles met the inclusion criteria concerning cost-benefit analysis, two from Canada and one from USA. No articles met the inclusion criteria for safety evaluation. CONCLUSION There are knowledge gaps concerning safety evaluation of community paramedicine in rural areas. Three articles were included in this scoping review concerning cost-benefit analysis, two of them showing positive cost-effectiveness with community paramedicine in rural areas.
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Affiliation(s)
- Odd Eirik Elden
- Department of Pre-Hospital Services, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Marianne Lysne
- Department of Research, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hege Selnes Haugdahl
- Department of Research, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Boland LL, Jin D, Hedger KP, Lick CJ, Duren JL, Stevens AC. Evaluation of an EMS-based community paramedic pilot program to reduce frequency of 9-1-1 calls among high utilizers. PREHOSP EMERG CARE 2022:1-8. [PMID: 35666265 DOI: 10.1080/10903127.2022.2086653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background - Many community paramedic interventions aim to reduce unnecessary emergency department visits among high utilizers of acute care, but fewer focus specifically on reducing summons for emergency medical services (EMS). We implemented an EMS-based pilot program that identified high utilizers of 9-1-1 and facilitated community paramedic outreach encounters to understand and address potentially unnecessary 9-1-1 calls. This study compares the pre- and post-intervention incidence rate of 9-1-1 calls among program participants.Methods - This retrospective evaluation was conducted using pilot data from a single U.S. EMS agency that responds to approximately 100,000 9-1-1 calls annually. High utilizers, defined as individuals with ≥3 9-1-1 calls in 90 days, were identified for recruitment between February 1, 2019 and December 31, 2019. community paramedics recruited participants via phone and then conducted home visits to assist them with navigation away from unnecessary 9-1-1 use. Dispatch data from September 1, 2018 to December 31, 2019 were used to compute the incidence rate of 9-1-1 calls per 30 person-days of observation before and after the initial home visits.Results - Data from 108 program participants were analyzed. The majority were over the age of 50 (79%), and 33% completed more than one visit. Median person-days of observation before and after the initial home visit were 354 days and 132 days, respectively. Participants called 9-1-1 an average of 0.68 times per 30 person-days prior to the community paramedic intervention, and 0.51 times per 30 person-days after the intervention, which represents an overall mean decrease in 9-1-1 utilization of 25% (p < 0.001). Although a decrease in 9-1-1 utilization was observed in the majority of participants, the 9-1-1 call rate increased in 29% of participants. No statistically significant changes in 9-1-1 use were observed in participants who received more than one home visit or who were in the highest quartile of 9-1-1 use prior to the intervention.Conclusion - This pilot work demonstrates the feasibility of an EMS-based, community paramedic-only intervention to reduce unnecessary 9-1-1 calls and suggests that some modest reductions in EMS use may be achievable by dispatching community paramedics to conduct home visits with frequent users of 9-1-1.
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Affiliation(s)
- Lori L Boland
- Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, Minnesota, USA.,Care Delivery Research, Allina Health, 800 East 28th Street, Minneapolis, MN, USA
| | - Diana Jin
- Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, Minnesota, USA
| | - Kimberly P Hedger
- Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, Minnesota, USA
| | - Charles J Lick
- Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, Minnesota, USA
| | - Joey L Duren
- Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, Minnesota, USA
| | - Andrew C Stevens
- Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, Minnesota, USA
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Overheu D, Gleitsmann S, Scherbeitz H, Klingler H, Warnecke T, Jacobsen N. [State-certified Health Professionals Supported by Telemedicine in the On-call Service of Community Doctors]. ZFA. ZEITSCHRIFT FUR ALLGEMEINMEDIZIN 2022; 98:207-214. [PMID: 37275305 PMCID: PMC10224645 DOI: 10.53180/zfa.2022.0207-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/28/2022] [Indexed: 06/07/2023]
Abstract
Background Regional Associations of Statutory Health Insurance Physicians in Germany are obliged to provide around-the-clock non-emergency care. This includes out-of-hours care, weekends, and public holidays. Due to a growing shortage of specialised doctors in private practice - especially in more rural area - this well-established system might be about to collapse. A possible solution could lie in training medical personnel to work under telemedical supervision. Methods The Association of Statutory Health Insurance Physicians of Lower Saxony, Klinikum Oldenburg AöR, and Johanniter-Unfall-Hilfe (JUH) Germany developed a pilot scheme in which specially-trained paramedics provided out-of-hours non-emergency medical services. Supervision was ensured by telemedical backup. Descriptive statistics were used to analyse the data. Results The majority of cases occurred in urban areas in the afternoon or at night. Most problems could be resolved by providing patient counselling. The majority of patients presented with unspecific symptoms. Telemedical support by a medical doctor was only required in 2.1 % of cases. In Germany, treatment by paramedics is widely accepted. In 63.5 % of cases patients could remain in an ambulatory setting. Conclusions Our study showed that non-emergency out-of-hours service can be competently delivered by paramedics under telemedical supervision. However, the expansion of high-speed wireless internet access is crucial for ensuring nationwide telemedical support. More research is needed to find out whether the described pilot scheme can be rolled out or even expanded in more rural areas of Germany.
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Affiliation(s)
- Daniel Overheu
- Klinikum Oldenburg AöR, Deutschland
- Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Oldenburg AöR, Universitätsklinik für Anästhesiologie, Rahel-Straus-Straße 10, 26133 Oldenburg, Deutschland
| | | | - Helmut Scherbeitz
- Kassenärztliche Vereinigung Niedersachsen, Bezirksstelle Oldenburg, Deutschland
| | | | | | - Nils Jacobsen
- Klinikum Oldenburg AöR, Deutschland
- Institut für Rettungs- und Notfallmedizin, Ab 01.06.2022: Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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Barry T, Batt A, Agarwal G, Booker M, Casey M, McCombe G. Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives. HRB Open Res 2022; 5:40. [DOI: 10.12688/hrbopenres.13545.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Irish health policy emphasises the role of Primary Care and General Practice however, there is a growing shortage of General Practitioners (GPs) in Ireland. Paramedics have traditionally focused on emergency care in the community. More recently Paramedics have taken on roles in General Practice in international jurisdictions, but not yet in Ireland. This study aimed to explore key stakeholder perceptions of ‘the potential for Paramedic roles in Irish General Practice’. Methods: We conducted an exploratory, qualitative stakeholder consultation study incorporating in-depth semi structured telephone interviews followed by thematic analysis. Interviews were conducted with a total of eighteen participants that included six senior Paramedics (Advanced Paramedics), seven General Practitioners (GPs), three Practice Nurses and two Practice Managers. Results: Participants in this study expressed polarised views on the potential for Paramedic roles in Irish General Practice. Paramedics were enthusiastic, highlighting opportunity for professional development and favourable working conditions. GP’s, Practice Nurses and Managers were more circumspect and had concerns that Paramedic scope and skillset was not currently aligned to General Practice care. GP’s, Practice Nurses and Managers emphasised a greater role for expanded General Practice Nursing. There were varied perceptions on what the potential role of a Paramedic in General Practice might entail, but consensus that Government support would be required to facilitate any potential developments. Conclusions: The findings of this research can inform future development of novel roles in Irish General Practice and suggests that there is appetite from within the Paramedic profession to pursue such roles. A pilot demonstration project, grounded in an action research framework could address data gaps and potential concerns. Any future developments should occur in tandem with and with due consideration for the expansion of General Practice Nursing in Ireland.
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Allana A, Tavares W, Pinto AD, Kuluski K. Designing and Governing Responsive Local Care Systems - Insights from a Scoping Review of Paramedics in Integrated Models of Care. Int J Integr Care 2022; 22:5. [PMID: 35509960 PMCID: PMC9009364 DOI: 10.5334/ijic.6418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods A study was conducted following Arksey and O'Malley's method for scoping reviews, using Valentijn's Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.
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Affiliation(s)
- Amir Allana
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
| | - Walter Tavares
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- The Wilson Centre and Temerty Faculty of Medicine, University of Toronto|University Health Network, CA
- York Region Paramedic Services, Community and Health Services Department, The Regional Municipality of York, CA
| | - Andrew D. Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, CA
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Institute for Better Health, Trillium Health Partners, CA
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Agarwal G, Keenan A, Pirrie M, Marzanek-Lefebvre F. Integrating community paramedicine with primary health care: a qualitative study of community paramedic views. CMAJ Open 2022; 10:E331-E337. [PMID: 35440482 PMCID: PMC9022935 DOI: 10.9778/cmajo.20210179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Community paramedicine (CP) is an emerging model of care that addresses local health needs through programs led by community paramedics; however, CP remains poorly defined and appears to lack systematic integration with the broader health system, specifically primary care, within which it is seated. The purpose of the study was to elucidate the views of community paramedics and their stakeholders in Ontario, Canada, on the topic of integrating CP with the broader health system. METHODS This was a retrospective qualitative analysis of a public recording of a CP provincial forum held in Ontario, Canada, in 2017. Forum attendees (paramedics and stakeholders) were invited by email if they had attended a similar provincial forum in the past (no exclusion criteria for attendance). In small- and large-group discussions, attendees discussed their views on how CP could fit into primary care and what medical oversight and acceptance for the profession could involve. A recording of the large-group discussion, which is publicly available, was transcribed and thematically analyzed. RESULTS The 89 participants varied in professional affiliation (66% from a paramedic service, n = 59). Among those from paramedic services, 33% were community paramedics (n = 14). Five major themes emerged: defining the role of community paramedics, how CP may integrate with other services, how to garner support for CP, where standardization is needed and possible oversight structures. INTERPRETATION Community paramedics and their stakeholders have insights into barriers and facilitators for integration with the health system. These study findings could help inform the integration of health and social services in Ontario with a consideration for the unique position and potential of community paramedics.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine (Agarwal, Keenan, Pirrie, Marzanek-Lefebvre), and Health Research Methods, Evidence, and Impact (Agarwal, Keenan), McMaster University, Hamilton, Ont.
| | - Amelia Keenan
- Department of Family Medicine (Agarwal, Keenan, Pirrie, Marzanek-Lefebvre), and Health Research Methods, Evidence, and Impact (Agarwal, Keenan), McMaster University, Hamilton, Ont
| | - Melissa Pirrie
- Department of Family Medicine (Agarwal, Keenan, Pirrie, Marzanek-Lefebvre), and Health Research Methods, Evidence, and Impact (Agarwal, Keenan), McMaster University, Hamilton, Ont
| | - Francine Marzanek-Lefebvre
- Department of Family Medicine (Agarwal, Keenan, Pirrie, Marzanek-Lefebvre), and Health Research Methods, Evidence, and Impact (Agarwal, Keenan), McMaster University, Hamilton, Ont
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Patton A, O'Donnell C, Keane O, Henry K, Crowley D, Collins A, Redmond E, Glynn N, Dunne M, Deasy C. The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine. BMC Emerg Med 2021; 21:138. [PMID: 34794391 PMCID: PMC8601091 DOI: 10.1186/s12873-021-00536-x] [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: 06/28/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Internationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls. In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service. Methods The APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service. A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database. Results Two thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations. Conclusion Increased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00536-x.
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Affiliation(s)
- Andrew Patton
- Emergency Department, Cork University Hospital, Wilton, Cork, Ireland.
| | - Cathal O'Donnell
- Medical Directorate, National Ambulance Service, Health Service Executive, Limerick, Ireland
| | - Owen Keane
- Emergency Department, Cork University Hospital, Wilton, Cork, Ireland
| | - Kieran Henry
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Donal Crowley
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Adrian Collins
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Eoghan Redmond
- School of Medicine, University College Cork, Cork, Ireland
| | - Nicky Glynn
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Martin Dunne
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Conor Deasy
- Emergency Department, Cork University Hospital, Wilton, Cork, Ireland
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Leyenaar MS, Allana A, Sinha SK, Nolan M, Agarwal G, Tavares W, Costa AP. Relevance of assessment items in community paramedicine home visit programmes: results of a modified Delphi study. BMJ Open 2021; 11:e048504. [PMID: 34764166 PMCID: PMC8587454 DOI: 10.1136/bmjopen-2020-048504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Guidelines for a structured assessment in community paramedicine home visit programmes have not been established and evidence to inform their creation is lacking. We sought to investigate the relevance of assessment items to the practice of community paramedics according to a pre-established clarity-utility matrix. DESIGN We designed a modified-Delphi study consisting of predetermined thresholds for achieving consensus, number of rounds of for scoring items, a defined meeting and discussion process, and a sample of participants that was purposefully representative. SETTING AND PARTICIPANTS We established a panel of 26 community paramedics representing 20 municipal paramedic services in Ontario, Canada. The sample represented a majority of paramedic services within the province that were operating a community paramedicine home visit programme. MEASURES Drawing from a bank of standardised assessment items grouped according to domains aligned with the International Classification on Functioning, Disability, and Health taxonomy, 64 previously pilot-tested assessment items were scored according to their clarity (being free from ambiguity and easy to understand) and utility (being valued in care planning or case management activities). Assessment items covered a broad range of health, social and environmental domains. To conclude scoring rounds, assessment items that did not achieve consensus for relevance to assessment practices were discussed among participants with opportunities to modify assessment items for subsequent rounds of scoring. RESULTS Resulting from the first round of scoring, 54 assessment items were identified as being relevant to assessment practices and 3 assessment items were removed from subsequent rounds. The remaining 7 assessment items were modified, with some parts removed from the final items that achieved consensus in the final rounds of scoring. CONCLUSION A broadly representative panel of community paramedics identified consensus for 61 assessment items that could be included in a structured, multidomain, assessment instrument for guiding practice in community paramedicine home visit programmes. TRAIL REGISTRATION NUMBER ISRCTN58273216.
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Affiliation(s)
- Matthew S Leyenaar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Emergency Health Services, Prince Edward Island Department of Health and Wellness, Charlottetown, Prince Edward Island, Canada
| | - Amir Allana
- Institute of Health Policy Management & Evaluation, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Samir K Sinha
- Geriatric Medicine, Sinai Health System, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nolan
- Paramedic Service, County of Renfrew, Pembroke, Ontario, Canada
| | - Gina Agarwal
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Walter Tavares
- Institute of Health Policy Management & Evaluation, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- The Wilson Centre and Post MD Education, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Schwab-Reese LM, Renner LM, King H, Miller RP, Forman D, Krumenacker JS, DeMaria AL. "They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program. BMC Health Serv Res 2021; 21:1167. [PMID: 34706727 PMCID: PMC8550812 DOI: 10.1186/s12913-021-07192-8] [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: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.
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Affiliation(s)
- Laura M Schwab-Reese
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Lynette M Renner
- School of Social Work, College of Education and Human Development, University of Minnesota, St. Paul, MN, USA
| | - Hannah King
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - R Paul Miller
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | - Darren Forman
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | | | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Rasku T, Helminen M, Kaunonen M, Thyer E, Paavilainen E, Joronen K. A Retrospective Review of Patient Records and Factors Associated with Decisions Made by Community Nurse-Paramedics' in Finland. NURSING REPORTS 2021; 11:690-701. [PMID: 34968343 PMCID: PMC8608054 DOI: 10.3390/nursrep11030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs' decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients' homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs' decisions. These patients' most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs' decisions of the patient's care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities.
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Affiliation(s)
- Tuija Rasku
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
- Tays Research Services, Tampere University Hospital, 33520 Tampere, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
- General Administration, Pirkanmaa Hospital District, Tampere University, 33014 Tampere, Finland
| | - Elizabeth Thyer
- Dean’s Unit School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2750, Australia;
| | - Eija Paavilainen
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
- General Administration, The Hospital District of South Ostrobothnia, 60220 Seinäjoki, Finland
| | - Katja Joronen
- Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland;
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Leyenaar MS, McLeod B, Jones A, Brousseau AA, Mercier E, Strum RP, Nolan M, Sinha SK, Agarwal G, Tavares W, Costa AP. Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study. CAN J EMERG MED 2021; 23:828-836. [PMID: 34403118 PMCID: PMC8575756 DOI: 10.1007/s43678-021-00153-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
Objectives The aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations. Methods Our study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests. Results Data were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example). Conclusion When using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers. Protocol registration ISRCTN 58273216. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-021-00153-4.
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Affiliation(s)
- Matthew S Leyenaar
- Prince Edward Island Department of Health and Wellness, Charlottetown, PEI, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Brent McLeod
- Hamilton Niagara Haldimand Brant Local Health Integration Network, Grimsby, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Eric Mercier
- Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine de l'Université Laval, Quebec, QC, Canada
| | - Ryan P Strum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Nolan
- County of Renfrew Paramedic Service, Pembroke, ON, Canada
| | | | - Gina Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Walter Tavares
- Faculty of Medicine, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Heath, University of Toronto, Toronto, ON, Canada.,York Region Paramedic Services, Regional Municipality of York, Sharon, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Quatman-Yates CC, Wisner D, Weade M, Gabriel M, Wiseman JM, Sheridan E, Garvin JH, Bridges JFP, Santry HP, Panchal AR, Fernandez S, Quatman CE. Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative. PREHOSP EMERG CARE 2021; 26:410-421. [PMID: 33909512 PMCID: PMC8626520 DOI: 10.1080/10903127.2021.1922556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Getting effective fall prevention into the homes of medically and physically vulnerable individuals is a critical public health challenge. Community paramedicine is emerging globally as a new model of care that allows emergency medical service units to evaluate and treat patients in non-emergency contexts for prevention efforts and chronic care management. The promise of community paramedicine as a delivery system for fall prevention that scales to community-level improvements in outcomes is compelling but untested.Objective: To study the impact of a community paramedic program's optimization of a fall prevention system entailing a clinical pathway and learning health system (called Community-FIT) on community-level fall-related emergency medical service utilization rates.Methods: We used an implementation science framework and quality improvement methods to design and optimize a fall prevention model of care that can be embedded within community paramedic operations. The model was implemented and optimized in an emergency medical service agency servicing a Midwestern city in the United States (∼35,000 residents). Primary outcome measures included relative risk reduction in the number of community-level fall-related 9-1-1 calls and fall-related hospital transports. Interrupted time series analysis was used to evaluate relative risk reduction from a 12-month baseline period (September 2016 - August 2017) to a 12-month post-implementation period (September 2018-August 2019).Results: Community paramedic home visits increased from 25 in 2017, to 236 in 2018, to 517 in 2019, indicating a large increase in the number of households that benefited from the efforts. A relative risk reduction of 0.66 (95% [CI] 0.53, 0.76) in the number of fall calls and 0.63 (95% [CI] 0.46, 0.75) in the number of fall-related calls resulting in transports to the hospital were observed.Conclusions: Community-FIT may offer a powerful mechanism for community paramedics to reduce fall-related 9-1-1 calls and transports to hospitals that can be implemented in emergency medical agencies across the country.
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Affiliation(s)
- Catherine C Quatman-Yates
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - David Wisner
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Mark Weade
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Mindy Gabriel
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Jessica M Wiseman
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Elizabeth Sheridan
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Jennifer H Garvin
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - John F P Bridges
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Heena P Santry
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Ashish R Panchal
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Soledad Fernandez
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
| | - Carmen E Quatman
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio (CCQ-Y); Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio (CCQ-Y); Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio (CCQ-Y); Upper Arlington Fire Division, Upper Arlington, Ohio (DW, MW); Westerville Division of Fire, Westerville, Ohio (MG); Department of Orthopaedics, The Ohio State University, Columbus, Ohio (JMW, ES, CEQ); Health Information Management and Systems, The Ohio State University, Columbus, Ohio (JHG); Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio (JHG, JFPB, SF); Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University Wexner Medical Center, Columbus, Ohio (JFPB, HPS, CEQ); Department of Surgery, The Ohio State University, Columbus, Ohio (HPS); Department of Emergency Surgery, The Ohio State University, Columbus, Ohio (ARP); Center for EMS, The Ohio State University, Columbus, Ohio (ARP)
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Rosa A, Dissanayake M, Carter D, Sibbald S. Community paramedicine to support palliative care. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1912690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Rosa
- Faculty of Health Sciences, Western University, London, Canada
| | - M. Dissanayake
- Faculty of Health Sciences, Western University, London, Canada
| | - D. Carter
- Middlesex-London Paramedic Service, London, Canada
| | - S. Sibbald
- Faculty of Health Sciences, Western University, London, Canada
- Department of Family Medicine Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine and The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Xi D, McCombe G, Agarwal G, Booker M, Cullen W, Bury G, Barry T. Paramedics working in general practice: a scoping review. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13250.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The term ‘paramedic’ has traditionally related to a healthcare professional trained to provide pre-hospital emergency care; however, paramedics are increasingly taking on novel additional non-emergency roles. General practice is facing unprecedented demand for its services related to rising expectations, an aging society and increased prevalence of chronic disease. Paramedics may be recruited to work in general practice to meet some of these demands. We undertook a scoping review to map the current literature considering paramedics working in general practice and inform follow-on research. Methods: We employed the six-stage scoping review framework developed by Arksey and O’Malley. Our research question was ‘to identify the scope of practice, nature of training/qualifications, challenges faced, and impacts of paramedics working in general practice’. Results: After searching PUBMED (Medline, n = 487), EMBASE (n = 536) and the Cochrane Library (n = 0) in June 2020, we identified eleven full-text articles that met our inclusion criteria. The literature suggests that paramedics have diverse skills that enable roles within general practice, some of which are context specific. Additional training is considered necessary to facilitate the transition from emergency care to general practice. We found no research that quantitatively assessed the impact of paramedics working in general practice on healthcare expenditure or patient health outcomes. Conclusions: There is a paucity of empiric scientific literature considering paramedic working in general practice. Further research is needed to inform training pathways, the structure of clinical practice and to measure outcomes.
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Allana A, Pinto AD. Paramedics Have Untapped Potential to Address Social Determinants of Health in Canada. ACTA ACUST UNITED AC 2021; 16:67-75. [PMID: 33720825 PMCID: PMC7957353 DOI: 10.12927/hcpol.2021.26432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The role of paramedics, including select paramedics providing primary and preventive care in homes and community settings, is evolving in health systems around the world. These developments are associated with improvements in health outcomes, improved access to services and reduced emergency department use. Building on these existing trends in paramedicine, and because social conditions contribute to illness and are strong predictors of future health service use, addressing patients' social needs should be integrated into core paramedic practice in Canada. We discuss how paramedic education, culture and governance could better enable paramedics to address the social determinants of health.
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Affiliation(s)
- Amir Allana
- MSc Candidate, Health Services Research, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Fellow, McNally Project for Paramedicine Research; Graduate Student, Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON
| | - Andrew D Pinto
- Associate Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Scientist and Director, Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Clinician Scientist, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Staff Physician, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON
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Whate A, Elliott J, Carter D, Stolee P. Performance of the interRAI ED Screener for Risk-Screening in Older Adults Accessing Paramedic Services. Can Geriatr J 2021; 24:8-13. [PMID: 33680258 PMCID: PMC7904328 DOI: 10.5770/cgj.24.451] [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] [Indexed: 11/22/2022] Open
Abstract
Background Paramedics respond to a significant number of non-emergency calls generated by older adults each year. Paramedics routinely assess and screen older adults to determine risk level and need for additional follow-up. This project implemented the interRAI ED Screener into routine care to determine whether the screener and resulting Assessment Urgency Algorithm (AUA) score is useful in predicting adverse outcomes. Methods We conducted a population-based retrospective study using administrative health data for patients aged 65+ assessed by paramedics from July 2016 to February 2017. Patients were assigned an AUA score and classified into three risk categories. Outcome data including hospitalizations, Emergency Department (ED) visits, home care status, and survival were collected and compared across AUA risk categories using descriptive and analytical statistics. Results Of the 2,801 patients screened, 31.9% were classified as high risk, 23.6% as moderate risk, and 44.6% as low risk. Patients who scored in the highest risk category were found to have longer hospital stays, and were more likely to require home care (p<.0001). The AUA risk category also predicted survival (p<.001). Conclusions The AUA predicted multiple adverse outcomes in this population. Use of the AUA by paramedics may aid in earlier identification of those in need of additional intervention and services.
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Affiliation(s)
- Alexandra Whate
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Dustin Carter
- Community Paramedicine, Middlesex-London Paramedic Service, London, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Agarwal G, Pirrie M, Angeles R, Marzanek F, Thabane L, O'Reilly D. Cost-effectiveness analysis of a community paramedicine programme for low-income seniors living in subsidised housing: the community paramedicine at clinic programme (CP@clinic). BMJ Open 2020; 10:e037386. [PMID: 33109643 PMCID: PMC7592288 DOI: 10.1136/bmjopen-2020-037386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of the Community Paramedicine at Clinic (CP@clinic) programme compared with usual care in seniors residing in subsidised housing. DESIGN A cost-utility analysis was conducted within a large pragmatic cluster randomised controlled trial (RCT). Subsidised housing buildings were matched by sociodemographics and location (rural/urban), and allocated to intervention (CP@clinic for 1 year) or control (usual care) via computer-assisted paired randomisation. SETTING Thirty-two subsidised seniors' housing buildings in Ontario. PARTICIPANTS Building residents 55 years and older. INTERVENTION CP@clinic is a weekly community paramedic-led, chronic disease prevention and health promotion programme in the building common areas. CP@clinic is free to residents and includes risk assessments, referrals to resources, and reports back to family physicians. OUTCOME MEASURES Quality-adjusted life years (QALYs) gained, measured with EQ-5D-3L. QALYs were estimated using area-under-the curve over the 1-year intervention, controlling for preintervention utility scores and building pairings. Programme cost data were collected before and during implementation. Costs associated with emergency medical services (EMS) use were estimated. An incremental cost effectiveness ratio (ICER) based on incremental costs and health outcomes between groups was calculated. Probabilistic sensitivity analysis using bootstrapping was performed. RESULTS The RCT included 1461 residents; 146 and 125 seniors completed the EQ-5D-3L in intervention and control buildings, respectively. There was a significant adjusted mean QALY gain of 0.03 (95% CI 0.01 to 0.05) for the intervention group. Total programme cost for implementing in five communities was $C128 462 and the reduction in EMS calls avoided an estimated $C256 583. The ICER was $C2933/QALY (bootstrapped mean ICER with Fieller's 95% CI was $4850 ($2246 to $12 396)) but could be even more cost effective after accounting for the EMS call reduction. CONCLUSION The CP@clinic ICER was well below the commonly used Canadian cost-utility threshold of $C50 000. CP@clinic scale-up across subsidised housing is feasible and could result in better health-related quality-of-life and reduced EMS use in low-income seniors. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, NCT02152891.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph's Healthcare Research Institute, Hamilton, Ontario, Canada
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Pharmacy Consulting, Health Benefits and Payment Solutions, TELUS Health, Toronto, Ontario, Canada
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Langabeer JR, Persse D, Yatsco A, O'Neal MM, Champagne-Langabeer T. A Framework for EMS Outreach for Drug Overdose Survivors: A Case Report of the Houston Emergency Opioid Engagement System. PREHOSP EMERG CARE 2020; 25:441-448. [PMID: 32286893 DOI: 10.1080/10903127.2020.1755755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Fatalities from drug-induced overdoses in the United States have taken greater than 292,000 lives in the last five years, and nearly two-thirds of these are opioid-related. The burden on prehospital emergency medical services (EMS) to respond to these incidents is growing. The standard of care typically involves overdose reversal and rapid transport, although a few agencies have begun to use community paramedicine to more proactively follow-up, initiate treatment, and refer patients to addiction medicine providers. Methods: In this manuscript we share the details of an outreach case study to serve as a blueprint for other agencies and municipalities to adopt and refine. The University of Texas Health Science Center, in partnership with the Houston Fire Department and other local first responder agencies, developed a program in Houston, Texas based on rapid response to post-overdose survivors using available incident data from the primary municipal agencies. Results: The Houston Emergency Opioid Engagement System (HEROES) was created to more comprehensively address the opioid epidemic. By utilizing data extracted from the patient care record system, a team comprised of a peer recovery coach and a paramedic is dispatched to the home location of a recent overdose (OD) incident to provide outreach. Conclusions: Outreach dialog and motivational interviewing techniques are used to provide awareness of treatment options and to engage individuals into a treatment program. A case report of this program and recommendations for broader adoption are presented.
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